Payer and Government

We understand the unique challenges faced by regional health plans, provider-owned health plans and large national payers, as well as federal, state and local government agencies. Under the demands of new care and payment models, these organizations require robust technology solutions in order to effectively and efficiently deliver quality services to their customers, members and clients.

From advisory services to implementation and optimization, we help our clients adapt their business processes and implement technology solutions to thrive in the changing healthcare landscape. We have extensive technical and operational experience with mainstream core claims, benefits administration, population health and care management systems. We help clients select and implement new systems, and we also facilitate training for end users. Following go-live, we offer maintenance, ongoing support and IT staff augmentation services. We also offer comprehensive optimization services focused on the areas of BI/Analytics, population health, care management, assessments and performance improvement to help you maximize the value of your IT investment.

Our Services

We want to help payers make the right IT decisions for their business by providing third party counsel andicon-payer-advisory expertise. We offer advisory services focused on system selection and implementation, as well as contract negotiation and M&A strategy.

  • IT Strategy
  • System Selection
  • System Procurement
  • M&A Strategy
  • IT & Operations Assessments
  • Contract Negotiation
Cumberland consultants understand the technical intricacies of leading claims and benefits administration systems,icon-payer-implementation including HealthEdge, Facets and QNXT, and excel at both implementation planning and project management.

  • Planning
  • Project Leadership
  • Project Staffing
  • IT & Operations Assessments
We recognize that IT success goes beyond system go-live. Through our optimization services you can maximize the icon-payer-optimizationlong-term value of your technology solutions.

  • Assessments
  • Performance Improvement
  • Care Management
  • Population Health
  • Analytics
icon-payer-governmentservicesWe help federal, state and local government agencies develop requests for proposals (RFPs), facilitate registration programs, manage health information exchanges (HIEs), and more.

  • RFP Development
  • HIE Support
  • Registration Programs
  • Project Management
  • Project Staffing

Payer and Government

We understand the unique challenges faced by regional health plans, provider-owned health plans and large national payers, as well as federal, state and local government agencies. From advisory services to implementation and optimization, we help our clients adapt their business processes and implement technology solutions to thrive in the changing healthcare landscape. We have extensive technical and operational experience with mainstream core claims, benefits administration, population health and care management systems.
Our Services

  • Connector.

    Advisory

  • Connector.

    Implementation

  • Connector.

    Optimization

  • Connector.

    Government Services


Featured Services

HealthEdge

A HealthEdge partner since 2008, we have successfully led HealthRules implementations, integrations and various projects for health plans, government agencies and payers nationwide.

QNXT

Our consultants are certified on the QCSI QMACS product and have worked on implementations, upgrades and other projects throughout QNXT product history.

Facets

On average, our consultants have more than 10 years of Facets experience and have been working on Facets projects since the system was introduced in 2001.

System Expertise


  • Connector.

    TriZetto (QNXT, Facets, etc.)

  • Connector.

    HealthEdge (HealthRules)

  • Connector.

    DST (AMISYS, PowerMHC, PowerMHS)

  • Connector.

    Monument/HealthTrio

  • Connector.

    HP/EDS (MetaVance)

  • Connector.

    ikaSystems (ikaClaims, etc.)

  • Connector.

    McKesson (ClaimCheck, ClaimsXten)

  • Connector.

    Perot/Dell (Diamond, Excellus)

  • Connector.

    Plexis (ClaimsManager, Quantum Choice)

  • Connector.

    RAM Technologies (eHEALTHsuite)

  • Connector.

    Others