Solutions

Connect to Payers

Products and providers use Redox to maximize payer partnerships.

Extend the reach and impact of your product by connecting to payers

Whether you are looking to sell your product to new payers or streamline workflows with your existing payer partners, Redox can help.

Leverage a single connection with Redox to exchange data with payers in any format (FHIR, X12, HL7v2, JSON, etc.). Data are normalized on both ends to ensure they can be harmonized with existing data sources, systems, and workflows. Simplified integration and the ability to rapidly scale will give your product a competitive advantage. We can connect your product to enable and of a variety of use cases with speed.

Payer integration use cases

Streamline payer-provider workflows

Connect to payers and/or clearinghouses to digitize revenue cycle workflows including eligibility, prior authorization, claim, and payment.

Coordinate & monitor member care

Receive payer orders/referrals, exchange remote patient monitoring data, send lab and genomic test results, and more.

Engage payer members

Exchange member information to help payers improve member communications, and build outstanding experiences.

 

Provide care to payer members

Check eligibility, enroll members in your services, schedule appointments, receive patient demographic information, and transmit information about the care you provide back to the payer (e.g. CCD).

Close member care gaps

Harmonize payer and provider data to return insights that can be acted on to enhance population health initiatives, advance value-based care programs, and improve HEDIS/STARS performance.

Check eligibility & request payment

Confirm customer benefit eligibility, and send and receive claims and payments with payer partners and/or clearinghouses.

Move past your X12 woes

Whatever your use case, don’t let an aversion to X12 be a barrier to creating optimized workflows that truly wow your customers. Redox can convert many common X12 transactions to FHIR, making the data more approachable and more useful for your development teams. The Redox API supports the exchange of all claims (835/837, 276/277), eligibility (270/271), benefit (834), and prior authorization (278) data in an FHIR format. Watch the replay of our Tech Talk or check out our X12 to FHIR product page to learn more about how Redox can light X12 on FHIR.

Products that trust Redox to connect them to payers

Looking to improve your product pitches to payers?

Get tips from health plan innovation leaders on what matters when pitching your product, and how to build long-lasting relationships after the sale.

Security First

Keeping member health information secure is our highest priority and we are committed to continually enhancing our security as technology changes and our infrastructure evolves.  We are HIPAA compliant and certified by HITRUST and SOCII. Learn more about Redox’s security-first culture.

Why Redox?

Once you connect with Redox you can be confident that you have an expert integration partner who is committed to accelerating your integrations, reducing overhead, and navigating complexity. We have an A rating from KLAS Research and will support you through each step of the connection process.

Prepare

  • Project Planning
  • Scoping & Implementation
  • Proactive Monitoring & Alerts
  • Tier 1 Support

Execute

  • Interface Mappings
  • Issue Resolution
  • EHR Upgrades
  • Workflow Optimization

Maintain

  • VPN Heartbeat Monitoring
  • Certification Management
  • Automated Message Retriggers
  • 24/7 On-call Engineers

Contact us to see if Redox is a good fit for your payer integreation needs.