Coperor One Member
Meet the Challenge of Managing Health Plan Member Data

 

Coperor One Member consolidates and maintains health plan member data across the internal systems. Improve analytics, claims processing and member outreach by creating a high-quality member master file.

Across Systems. Across Companies. One Platform.

Third Party Administrators: How much is manual claim intervention costing you?

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Member Data Quality Challenges for Healthcare Payers

Create a 360-degree view of member information from multiple internal systems and reconcile this with claims and encounter data from your provider network.

Systems are Moving to a Cloud Ecosystem

With the growth of cloud-based application systems, it is necessary for payers to meet the unique security, encryption and integration challenges created by a hybrid or cloud-native application architecture.

Evolving Data Privacy and Consent Regulations

CCPA, GDPR, and other regulations are evolving how data must be treated, even in areas outside of California and the EU.

Consumers at the Center of Healthcare

The challenges of today’s consumer-centric healthcare have exceeded the capabilities of traditional MDM vendors. Coperor E-MDM is ideally suited to the challenges of incorporating data from wearables, digital health devices and telehealth systems.

Enter Coperor One Member

Coperor One Member helps payer organizations continually improve member-related data and use it to improve operational efficiency and customer satisfaction in real-time.

Benefits to Health Plans

Integrate and Track Care Across All Systems

Health plans have invested in multiple systems to manage all aspects of their members’ medical needs. Coperor One Member enables a health plan to see a complete picture of each member irrespective of the underlying systems in use.

Lower Overall Cost-of-Care

Simple, inexpensive interventions can yield dramatic savings to a health plan and improve member outcomes. However, this is only possible if the payer can accurately identify candidates for these programs – that’s where the Coperor One Member solution comes in.

Meet Compliance and Wellness Goals

Multiple quality programs exist intending to reward effective care. Health plans with the Coperor One Member solution enjoy an advantage over their competitors with richer member profiles for more targeted care.

Benefits to Members

Personalized Care for Optimal Outcomes

By understanding more about each member, their unique needs, social circumstances, and claims history, a health plan can better design personalized care for improved outcomes. Both the collection and compilation of member-related information from any system are simplified.

Maximized Care Coordination

Coordinated care programs require that all authorized participants can easily exchange information about the member. Tie together different medical record systems with medical management programs for optimum results.

Improved Access to Healthcare

Managed care providers have proven the immense benefits of proactive interventions to avoid medical procedures. Care programs are only as effective as they are accessible. Build a comprehensive understanding of each member’s unique needs and circumstances to support the design of care.

TPA Challenges

A key performance indicator for third-party administrators is the number of claims that can be correctly processed automatically without human intervention. Coperor maximizes auto-adjudication rates for TPA’s by aligning Provider and Member data in claims to their master data profiles.

Enter Coperor One Provider and One Member

Reduce Claims Processing Costs

By eliminating manual review of claims that do not match on provider or member details, TPA’s are able to improve auto adjudication rates by 20% – 40%.

Improve Analytics

Claims data often contains alternate representations of provider and member identifiers that must be linked to master profiles to ensure that analytics are not skewed by avoidable duplication.

Collaborate With Risk-Bearing Groups

Claims data may contain information about members and their dependents. Coperor enables collaborative tools that ensure that insights into member data can be reconciled with provider group carrying shared risk.