Our Services
Better outcomes through smarter technology
We combine data analytics, process optimization, technology integration, and AI-powered automation to help healthcare organizations achieve higher acceptance rates, recovered revenue, and reduced operational risk. We stay current with emerging tools so you get the right solution — not just the familiar one.
Fractional CIO / CTO Leadership
Executive-level technology leadership on a fractional basis for payers, provider groups, and investor-backed organizations. We advise on IT roadmaps, oversee technology strategy, and lead cross-functional teams of developers, coders, and analysts to deliver enterprise outcomes.
- IT strategy & roadmap development
- Technology budget planning & oversight
- Vendor evaluation & partnership management
- Cross-functional team leadership
- Board and executive advisory
Risk Adjustment & RAF Analytics
Deep expertise in HCC/Risk Adjustment data warehousing, RAF score optimization, and encounter submission processes for Medicare Advantage, Medicaid, and commercial plans. We help ensure timely, accurate revenue forecasting and proper CMS payment.
- HCC coding & risk adjustment optimization
- RAF score improvement (proven 20%+ gains)
- RAPS & encounter submission processes
- Revenue forecasting & financial modeling
- CMS encounter acceptance optimization (65% to 99%)
Data Integration & ETL Pipelines
End-to-end data pipeline architecture spanning EMR, claims, labs, and pharmacy systems. We build scalable, audit-ready data operations that modernize legacy platforms and provide a single source of truth across your organization.
- ETL pipeline design & implementation
- EMR, claims, labs & pharmacy integration
- Legacy platform modernization
- Data warehouse architecture
- Real-time data operations
EDI & Transaction Processing
Comprehensive EDI/X12 expertise including 837/835 enhancement tools, ACH/EFT payment modules, and trading partner relationship management. We reduce claims workload and ensure compliance with evolving HIPAA transaction standards.
- 837/835/X12 transaction processing
- ACH/EFT module development
- Trading partner onboarding & management
- Claims workload reduction
- HIPAA compliance & remediation
Medicare Advantage Systems
Full-lifecycle Medicare Advantage platform design including enrollment systems, provider network adequacy tools, claims adjudication engines, and 508-compliant member-facing applications. We have implemented health plans end-to-end for major payers.
- Enrollment & eligibility systems
- Provider network adequacy tools
- Claims adjudication engines
- 508-compliant platform design
- CMS data exchange & reporting
PDE & Part D Operations
Automated PDE intake, quality control, and response processing systems that cut manual effort, minimize audit risk, and drive CMS acceptance rates to 99%. We create real enterprise value from Part D data operations.
- PDE intake & QC automation
- Response file processing
- Audit readiness & compliance
- CMS submission optimization
- Part D reporting & analytics
Healthcare Web Applications
Custom web application development for healthcare organizations — from medical practices to health plans. We create, maintain, analyze, and enhance web-based platforms that support clinical and operational workflows.
- Custom healthcare portals
- Provider & member-facing applications
- Clinical workflow tools
- Reporting & analytics dashboards
- AI-assisted workflow automation
HIPAA & Compliance
We help your organization comply with HIPAA requirements through new trading partner relationships, secure transaction processing, and comprehensive audit preparation for claims, eligibility, authorizations, and more.
- HIPAA compliance assessment
- Secure data exchange implementation
- Trading partner compliance
- Audit preparation & support
- Security policy development
How We Work
Evidence-based tool selection, outcome-driven delivery
We don't prescribe a single technology stack. Every engagement starts with understanding your outcomes, then selecting the right combination of tools and approaches to get you there.
Discover & Diagnose
We map your current systems, data flows, and pain points to identify where the highest-impact improvements exist.
Select the Right Tools
Whether the answer is AI and automation, a custom ETL pipeline, or a process redesign, we choose based on evidence and fit — not trend.
Build & Integrate
We architect and implement solutions that work within your existing ecosystem — minimizing disruption while maximizing value.
Measure & Optimize
Every engagement is tied to measurable outcomes. We track KPIs, iterate on what works, and continuously evaluate emerging tools for further gains.
Our toolkit is always evolving. We continuously evaluate emerging technologies — including AI/ML, intelligent automation, and advanced analytics — to ensure our clients benefit from the best available approaches, not just yesterday's solutions.
Need a tailored solution?
Every organization is different. Let us understand your unique challenges and design a strategy that delivers results.