Healthtech solutions
DELIVERING BUSINESS CONFIGURABLE SOLUTIONS
Our team of seasoned consultants is dedicated to guiding national and regional health plans through complex challenges, facilitating the implementation of straightforward and effective solutions.
Our consultants prioritize collaboration and innovative thinking, working alongside you as a cohesive team. We bridge the gap between business and IT with proven industry expertise, delivering scalable, business-driven technology and process solutions. Our approach harnesses emerging technologies to optimize operations, enhance patient outcomes, and improve overall experiences.
Payer services we offer
Utilization management
Ensuring the appropriate and efficient use of medically necessary healthcare resources, services, and treatments while optimizing administrative processes and costs.
Our comprehensive approach with custom healthcare payer solutions enables health plans to enhance operations and have fiscal oversight of their members’ services.
Automation of benefit discovery
Automation of benefit discovery
Automate and auto-populate the database of members to efficiently retrieve relevant information and details across various systems, eliminating manual data retrieval and streamlining the process for customer advocates and their teams.
Clinical decision support systems
Clinical decision support systems
A decision engine that analyzes and determines the auto-approval or need for further review of service requests, expediting the decision-making process and addressing potential data gaps upfront to optimize efficiency and minimize the involvement of high-cost resources.
Role-based visualization
Role-based visualization
Within our healthcare payer solutions, our solution aggregates data and access control, allowing users to access specific data sets that pertain to their role, thereby increasing the accuracy of decision-making.
AI in auth process
AI in auth process
Artificial intelligence presents a natural fit where outdated human decisions can be automated through ML models trained on established criteria. This scalable and agile approach reduces administrative costs and optimizes workflow to improve member satisfaction.
Care management
Delivering patient-centered quality care by leveraging data insights to ensure that patients/members receive appropriate and timely care to prevent their healthcare costs from escalating.
Our comprehensive solution manages and determines the most suitable next steps, personalizing care delivery, cost containment, and enhancing patient outcomes throughout the healthcare journey.
Characterization
Characterization
Utilizing valuable insights from large amounts of data to assist healthcare professionals in timely intervention and personalized care, improving efficiency, and enhancing communication to prevent further complications.
Case management solutions
Case management solutions
Our case management solutions prioritize health conditions and streamline patient routing, eliminating the need to outsource specialized services. We coordinate efforts, guide decision-making, and integrate seamlessly with payer enrollment for a more efficient healthcare management process.
AI in predictive risk stratification
AI in predictive risk stratification
Leveraging the power of AI to generate risk scores and recommend timely intervention and prioritize resources to improve patient engagement, reduce unnecessary utilization, and improve outcomes.
Delivering innovative & future-ready healthcare experiences.
Claims matching
Enabling claims matching by integrating authorization and claims data to ensure accurate payments. This guarantees healthcare organizations are accurately paying for the services they authorized.
Our comprehensive healthcare payer solutions perform checks and balances to validate claims, bridging the gap between utilization management and claims systems.
Simplification process
Simplification process
Automating claims processing by streamlining workflows and creating configurable exception handling based on the organization’s unique needs. This increases the efficiency of adjudicating claims by only showing relevant information.
Personalize dashboards
Personalize dashboards
Provide custom screens for financial services unit to identify and address pending claims, enhancing decision-making efficiency.
Data manipulation/data processing
Data manipulation/data processing
Validating claim data against utilization management systems/authorization systems for accuracy and consistency, eliminating manual effort and human error.
Clinical decision support
Automating clinical decision-making processes to provide agile capabilities to clinicians in specialty chronic condition management, like Oncology, Diabetes, etc. Eliminating the complexity and challenges associated with rules engine configuration by creating a single and reliable source of truth for medical necessity.
The clinical decision support system as a consolidated source ensures data consistency and accuracy across any healthcare organization, streamlining and simplifying the authorization process at scale.
Authorization and regimen management
Authorization and regimen management
Facilitating authorization processes to manage multiple regimens and approval criteria across diverse health plans, ensuring accuracy and variation evaluation prior to making a decision.
Lifecycle tool
Lifecycle tool
Enabling initial shell authorization with collected data and running it against member benefit eligibility and other decision factors.
Decision engine tool
Decision engine tool
Streamlining the workflow process for regimens approval by cross-checking them against pre-approved criteria of each health plan, considering traditional treatment plans, drug approvals, and alternatives prior to automating a decision.
Auditable/review component tool
Auditable/review component tool
Oversight of workflow to validate regimen variations during the authorization process. The tool provided a mechanism for auditing changes and their impact across the organization.
Payer case studies
Healthcare
Improving Platform Reliability with Real-Time Monitoring
Real-time monitoring improved ServiceNow platform reliability with better device tracking, centralized support, and stronger operational visibility.
Healthcare
Modernizing Service Operations with ServiceNow CSM
A customized ServiceNow CSM solution streamlined healthcare case management, improved agent productivity, and created a more scalable service model.
Artificial Intelligence
Accelerating Clinical Knowledge Delivery with AI
An AI-powered knowledge delivery solution helped clinical teams access the right information faster, improving speed, accuracy, and decision support.
AWS
Improving Speed & Security Across Health Systems
Health system modernization improved speed, strengthened security, and created a more dependable digital experience across critical operations.
Healthcare
Accelerating Care Delivery with Intelligent Automation
Disjointed healthcare workflows were unified with intelligent automation, improving patient journeys, communication, and operational efficiency.
AWS
Transforming Diabetes Care with Cloud AI
Cloud AI transformed diabetes care with a scalable event-driven platform that cut infrastructure costs, reduced incidents, and improved response times.
Artificial Intelligence
Enhancing Claims Intelligence with AI Analytics
AI-powered claims intelligence improved visibility, sped decisions, and helped teams uncover patterns faster for smarter, more accurate claims operations.
Artificial Intelligence
Improving Patients Engagement With Conversational AI
10Pearls helped healthcare providers improve patient engagement with conversational AI that automated follow-ups, reduced clinician workload, and sped up care responses.
.Net
Medical Device Tracking
10Pearls modernized medical device tracking with real-time asset visibility, smarter inventory management, and faster field service decisions.
Healthcare
MSK Telemedicine Platform
A personalized MSK telemedicine platform improved plan adherence by 55%, reduced surgical referrals by 89%, and transformed patient care.
Awards & recognitions
Payer insights
Healthtech
Boost efficiency and outcomes with practical AI healthcare solutions
While bold ideas tend to dominate the conversation, real-world adoption remains relatively slow. This disconnect stems from an industry-wide focus on AI projects that promise to reinvent healthcare entirely while overlooking the immediate, practical applications...
Healthtech
Integrating innovative technologies to transform key prior authorization services
Discover how automated decision support is transforming the prior authorization process, and see how 10Pearls Health emerges as a strategic partner in healthtech, revolutionizing prior authorization services for improved efficiency and patient outcomes.
Healthtech
Using AI to solve challenges in healthcare payer operations
Generative AI has revolutionized financial management, bringing about a new standard for efficiency and precision. Processes like financial analysis and forecasting, which demanded meticulous data collection, in-depth trend analysis, and careful evaluation of financial data,...
Healthtech
Revolutionizing payer engagement, enhancing member satisfaction, and improving health outcomes
Revolutionizing Payer Engagement, Enhancing Member Satisfaction, and Improving Health Outcomes.
Healthtech
Full clinical snapshot – unifying data for population health
In today's dynamic healthcare landscape, seamless access to comprehensive patient data stands as a cornerstone for informed decision-making and optimal patient care.
Healthtech
Caregiver support services in US healthcare: Gaps and opportunities
Anyone caring for an older loved one with complex chronic conditions, disabilities, cognitive decline, or age-related frailties knows the practical, emotional, and financial challenges of being a family caregiver.
Healthtech
Enhance digital healthcare for all: The importance of intuitive design
It’s no secret that the patient healthcare journey is a daunting one- full of uncertainty, isolation, and anxiety.
Healthtech
How IoMT (the Internet of Medical Things) is disrupting healthcare
In this post, we’ll discuss how IoMT (Internet of Medical Things) is disrupting the health industry and what applications we might see in the future.
Healthtech
Our top takeaways from Voice of Healthcare
A delegation from 10Pearls attended the Voice of Healthcare Summit, where they got to learn about the advancements in the healthcare industry.
Healthtech
How Blockchain is Revolutionizing Healthcare
In this post, we'll discuss what revolutionary changes the blockchain technology can bring in the healthcare industry.