Healthtech · Health Data & Interoperability · 200–1000 · North America #b029_17

Context

We provide an interoperability operating platform for health insurers and state programs, covering data acquisition, compliance, quality and payment integrity.

Industry

Healthtech · Health Data & Interoperability

Size

200–1000 employees

Region

North America

Tools budget

$5K–20K per month

Needs

Claims & prior authorization. Upcoming federal deadlines for electronic prior authorization mean our insurer clients need automation delivered quickly.

Today: health plan claims and clinical feeds acquired through a proprietary data bridge and repository · Urgency: this year

Regulatory reporting. Insurers must publish interoperability API metrics, and we compile those reports across many clients.

Today: payer mandate readiness delivered by a dedicated compliance module and expert services team · Urgency: this year

Data pipelines & integration. We acquire data once and reuse it across workflows, which demands reliable, observable pipelines.

Today: three layer platform acquires, normalizes and validates data before analytics applications use it · Urgency: this year

Who decides

cto · security review

Expects from suppliers

Deep knowledge of insurer regulatory rules; Pipelines with clear monitoring; Experience with state program clients

Not a fit

Provider only tools; Vendors new to government programs

Stack

cloud: Azure-class hyperscaler, data warehouse: cloud, compliance tooling in place

Buying triggers

regulatory change, scaling transaction volume