Redox | November 03, 2021
Redox announces their payer-specific interoperability solution. This expansion of Redox's platform allows payers to meet current and future CMS regulatory requirements while also enabling connections with providers, partners and vendors. As a result, payers can access the data necessary to unlock administrative efficiencies, understand the breadth of member journeys, and improve care.
The CMS Interoperability and Patient Access final rule mandates that payers enable patients to access payer-hosted clinical and claims data upon a patient's request via third-party applications. Payers must also make provider directories publicly available for third-party applications. In 2022, those mandates will expand such that payers must exchange data with other payers at a patient's request. Further proposed are additional interoperability mandates focused on providing electronic access to prior authorization requests.
Redox connects payers to the data and applications needed to keep pace with a rapidly shifting healthcare and technology landscape.
Redox solves data interoperability for:
Electronic prior authorization Connect providers and payers to streamline the $30 billion existing prior authorization process to reduce administrative waste.
Closing Care Gaps Receive clinical information for your member population and send insights back to providers to ensure best practice guidelines are met and that all care team members are in sync.
Integrating digital health solutions Power data exchange between the growing ecosystem of third-party applications used in managing patient populations and individual patient health.
Direct Scheduling Build superior member experiences by enabling real-time scheduling with any provider in your network.
"Large payers already know that Redox has the most extensive network in the healthcare data interoperability space, and they are using Redox's platform as a strategic advantage, Although the mandates aren't yet urgent, payers are moving quickly to adopt them because those payers are already benefiting from its efficiencies."
- Garrett Rhodes, Product Manager for Payers at Redox.
Redox accelerates the development and distribution of healthcare software solutions with a full-service integration platform to securely and efficiently exchange healthcare data. With just one connection, data can be transmitted across a growing network of 1,700+ healthcare delivery organizations and 300 independent software vendors. Members of the Redox Network exchange more than 20 million patient records per day, leveraging a single data standard compatible with more than 85 electronic health record systems. Redox exists to make healthcare data useful and every patient's experience a little bit better.
Sun Life | January 06, 2022
Sun Life U.S. has partnered with Teledentistry.com to bring members 24/7 virtual access to dental providers, whenever, and wherever they are. The service is automatically incorporated into members' dental coverage, and provides a safety net for those who need dental care in emergencies, while traveling, or at night or on weekends.
"Oral health is part of overall health, and we are committed to helping our members get the right care when they need it, whether for regular preventive care visits or emergencies, We are thrilled to partner with Teledentistry.com to make dental benefits and urgent dental care more accessible, and meet our members where they are."
-Joi Tillman, vice president of Voluntary, Dental and Vision at Sun Life U.S.
With easy-to-navigate virtual access, members who need a dental consultation can get one quickly from a Teledentistry.com dentist, and get referred for definitive care if necessary. Consultation results are communicated to the member's dental provider for follow-up care. By accessing a Teledentistry.com dental professional any time virtually, members can get the care they need at the right time and may reduce their costs, especially in cases of emergency when the only alternative may be an ER visit.
"Teledentistry.com is dedicated to improving access to dental care, Our team of dentists is ready to help with a virtual consultation, prescribe medications as appropriate and refer patients to a local in-network dentist for regular care. We are proud to partner with Sun Life to help support their members with a virtual dentist anytime they need one."
-Dr. Vilas Sastry, CEO of Teledentistry.com.
About Sun Life
Sun Life is a leading international financial services organization providing insurance, wealth and asset management solutions to individual and corporate Clients. Sun Life has operations in a number of markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda. As of September 30, 2021, Sun Life had total assets under management of C$1.39 trillion.
Cardinality.ai | December 08, 2021
Cardinality.ai, a data technology group helping government agencies achieve better outcomes through artificial intelligence (AI) solutions has acquired ClearCycle, based in Redmond WA, a proven Claims and Disbursement Management technology provider since 1983, for the Healthcare and Insurance industries, to expand its suite of SaaS solutions.
"The acquisition of ClearCycle will accelerate our mission of enabling government workers to deliver citizen services effectively. ClearCycle's depth of knowledge in claims, payments, disbursements, and compliance reporting with their track record of serving its clients in regulated industries will expedite the deployment of our ready-built solutions. In addition, we welcome the ClearCycle team, who will improve our ability to serve US Government agency clients and increase the scale of our US-based client success team."
- Thiag Loganathan, CEO of Cardinality.ai.
"Joining hands with the Cardinality team, we are excited about the possibilities of coupling our 20+ years of knowledge and subject matter expertise with Cardinality's modern software, built with configurable modules, cloud-based tech, a powerful AI assistant, and an intuitive interface, powered by a low-code platform"
- Ravi Nithyanandham, Chief Technology Officer of ClearCycle.
With decades of experience in complex healthcare claims, payments, disbursements, translation to different currencies with international funding requirements, and regulatory reporting, the ClearCycle acquisition improves Cardinality features, such as compliance tracking, Medicare and Medicaid reporting while ensuring payments are disbursed quickly, appropriately, and traced easily.
ClearCycle will continue to operate under that name and is now a wholly owned subsidiary of Cardinality.ai.
Cardinality helps government agencies achieve better social and economic outcomes through intuitive, AI cloud-based solutions. Founded in 2017 by four serial entrepreneurs and a team of data specialists, the company has one goal: impact a billion lives. And it's already on its way—Cardinality solutions are being used by multiple agencies in the states of Indiana and Maryland. Their suite of solutions is built specifically for workforce, health, and human services leveraging it's modern AI Case Management, CRM, ERP, RedBird AI and Low-Code platform, so that agencies can modernize existing systems up to 50% faster than other low-code platforms and 200% faster than custom or unproven solutions.