Healthcare Payer Solutions

Supporting 400+ Payers nationwide to drive efficiency, member satisfaction, and compliance

Optimize network management, credentialing, clinical decision-making, compliance, and
more with symplr solutions for payers.

Reimagine payer success with symplr

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Reduce data redundancy

Streamline data management, eliminate redundancies and ensuring a single source of truth. 

Deliver outstanding member experiences

Enhance member satisfaction best-in-class solutions and accurate data.

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Increase efficiency across your organization

Automate repetitive tasks to enhance efficiency and free up resources for more critical functions. 

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Remain at the forefront of innovation
Stay ahead with cutting-edge capabilities that evolve with the healthcare landscape.
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Standardize implementation and support

Achieve consistency and reliability with standardized implementation processes and robust support. 

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Make evidence-based decisions

Leverage comprehensive data analytics to make informed, evidence-based decisions that drive better outcomes. 

Proven industry solutions supporting 9 of 10 largest Health Plans nationwide

Innovative solutions that efficiently replace outdated systems, enable seamless integration, and free your organization from the limitations of siloed data.

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Reduce backlogs and delays with automation

Expedite credentialing and protect your health plan members with software created for payer organizations.

Overcome challenges with siloed data, disparate systems, and poor data integrity. 

Benefit from our highly configurable, end-to-end provider data management solution that leading payer organizations rely on for their single source of truth. 

Gain peace of mind your data is protected with the highest level of security – HITRUST CSF certification. symplr Payer is the only provider data management SaaS solution to achieve this level of security. 

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Deliver a modern, value-based experience

In today’s healthcare realm, providing a modern value-based experience is a requirement for member satisfaction and internal efficiencies alike.  

With the push to value-based care contracts and other regulatory drivers demanding accurate/timely data updates, payers must successfully manage provider data at scale and assign providers to correct networks and specialties based on locations.  

With symplr Directory, you can access, understand, and manage provider network data from a holistic view. Integrated directly with symplr Payer, leverage this data to efficiently steer members to top quality providers and facilities.  

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Spend 75% less time on primary source verification

Our NCQA-accredited and certified Credentials Verification Organization (CVO) team is the industry leader in credentialing and backed by hundreds of credentialing experts.  

We serve as an extension of your team to perform all Primary Source Verification (PSV) services, fill gaps, and resolve backlogs for short or long-term projects.  

Our experienced CVO specialists help take the stress out of credentialing by performing verifications, expirable management, and ongoing monitoring services, so you can focus on managing provider data and better healthcare outcomes.

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Meet the 7 hallmarks of an effective compliance program

Using partial solutions with manual processes leaves you vulnerable to risk and operational inefficiencies. symplr Compliance provides a holistic solution to meet payer-specific needs.  

Safeguard revenue and reputation by ensuring compliance with federal and state regulations. Mitigate financial risk, reputational damage, and unwanted oversight associated with compliance issues or incidents.  

Increase visibility with healthcare-specific tools to aid in avoiding penalties, litigation, and government oversight. 

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Make coverage policy, utilization management, and appeals decisions with confidence

Health plans face an overwhelming amount of clinical evidence and an acute shortage of relevant, timely, useful, and appropriate information. Researching clinical evidence for new and changing policies can be challenging. The time, expense, and staff expertise can be alleviated with a resource built by experts in the field.   

The well-organized and easy-to-navigate Hayes Knowledge Center makes clinical evidence accessible to medical directors, policy analysts, researchers, and clinical staff alike. Medical Code Briefs, articles, and research scorecards, including links to primary sources, make determining policy more efficient and thorough.  

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Stay on top of your network's provider quality metrics

Quality metrics enable health plans to set accurate benchmarks and reimbursement rates. Track any potential quality care issues/incidents, grievances, or complaints from inception to outcome, including formal peer review when needed. 

Configurable to include your own policies, procedures, and bylaws—and mapped to a list of severity levels—this web-based HIPAA and SSL-secure solution meets organizational goals and complies with NCQA  audits and URAC standards.  

Your crucial quality data identifies when an employee or provider has crossed a threshold, costing revenue loss or jeopardizing quality and patient safety—or helps you recognize an  individual’s positive, lasting contribution to your  member population, supporting value-based care outcomes. 

See how symplr is achieving outcomes for customers today

This type of framework is critical to consistent decision making. Regulatory bodies look for a consistent non-biased approach to decision making when we undergo audits.

Medical Director and Hayes Customer

Thanks to symplr Payer, we can credential 60% more providers (5,000 up from 3,000) 30% more quickly with the same staff because symplr Payer automates the primary source verification. It pulls, uploads, and stores the supporting verification for us. Everything we need is right there!

Hennepin Health


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