Payer Solutions

Modern Tools for Smarter Payer Operations

Office Ally® strengthens payer operations with solutions that streamline workflows, help ensure compliance and reduce costs.  Whether you're looking to simplify EDI transactions, close care gaps or enhance claim workflows, Office Ally's infrastructure and insights support your quality initiatives and keep operations running smoothly.

Enhance Core EDI Workflows

Reduce administrative overhead with scalable infrastructure that supports your preferred workflows. Gain control over key transactions without disrupting your internal systems.

  • Consolidate claims, eligibility and remits through a coordinated clearinghouse model
  • Simplify operations by reducing vendor complexity and transaction silos
  • Choose between real-time or batch transactions based on your workflow
  • Add hosted solutions without needing to rework internal systems

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Ensure Compliance and Accuracy

Reduce claim errors with validation rules aligned to your plan’s requirements. Stay compliant even when internal infrastructure is limited.

  • Apply custom edit logic to catch and fix errors early
  • Maintain HIPAA, CMS and state-level compliance
  • Support real-time eligibility and claim status transactions with X12-compliant transactions to improve response accuracy and reduce provider follow-up
  • Improve adjudication rates by reducing manual corrections

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Uncover and Close Care Gaps

Use longitudinal claims data to identify and address gaps in care. Strengthen your quality performance and improve patient outcomes.

  • Leverage longitudinal claims data to gain visibility across patient history
  • Boost quality scores by identifying missed care opportunities
  • Equip provider partners with actionable reports that support targeted outreach
  • Track plan-wide progress in preventive and chronic condition care

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Foster Better Provider Partnerships

Reduce friction with cleaner data and targeted reports. Align with providers around shared care goals and build stronger relationships.

  • Respond to provider inquiries with accurate, real-time claims and eligibility data
  • Strengthen shared goals with transparent data exchange and quality reporting
  • Deliver HEDIS-aligned insights that guide provider performance
  • Reduce escalations and onboarding delays through streamlined coordination

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Talk to Our Experts to Learn More

Have questions about our products? Want a demo? Let us schedule a call to help you choose the best solution for your needs.

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