HMS

Lorica Health offers advanced claims analytics solutions and services tailored for the healthcare sector. Established in 2011 as CMC Insurance Solutions, the company originated from research conducted at the Capital Markets Cooperative Research Centre, which has a history of developing innovative technology. Lorica Health specializes in providing data analytics services that support the health insurance industry, including consulting practices, payment integrity, and clinical coding and billing audits. By leveraging its analytical capabilities, Lorica Health aims to enhance operational efficiency and improve the accuracy of healthcare claims processing.

MedAdvisor International is an Australian company that specializes in developing software for personal medication management. Founded in 2010 and headquartered in Camberwell, Australia, the company offers the MedAdvisor platform, which connects health professionals with patients through mobile and web technologies. This platform features an interactive app that facilitates medication adherence by providing personalized tips, reminders, and prompts. Users can manage their prescriptions by signing up with their preferred pharmacies, accessing a Smart Medication List that updates automatically, and utilizing features such as Fill-My-Scripts and Take-My-Meds. The app also includes a Carer mode, allowing users to manage the medications of dependents. MedAdvisor operates across multiple regions, including Australia, the United States, and the United Kingdom, with a significant portion of its revenue generated from U.S. operations. The company's focus is on enhancing health outcomes through innovative medication management solutions.

VitreosHealth, Inc. specializes in predictive analytics and risk stratification for population health management. The company offers a wide range of tools, including population state-of-health analyzers and performance optimization modules, aimed at improving care quality and managing costs across various healthcare settings. Its services help healthcare providers identify high-risk patients, predict hospitalization probabilities, and tailor interventions, enhancing overall patient outcomes. VitreosHealth operates under an Insights-as-a-Service model, leveraging diverse data sources such as electronic health records, claims data, and socio-economic factors to deliver actionable health insights. The company serves a global clientele, including Fortune 500 businesses in countries like the United States, the United Kingdom, and India. Founded in 2009 and headquartered in Plano, Texas, VitreosHealth also collaborates with major partners to advance its analytics capabilities in the healthcare sector. As of September 2019, it functions as a subsidiary of HMS Holdings Corp.

Eliza Corporation blends technology, communication expertise, and data analytics to drive healthy behavior change. The company's intelligent, tailored interactions-including automated calls-make health and healthcare information more accessible, more actionable, and more engaging. Each program is powered by Eliza's patented speech recognition technology, rich web and multi-modal delivery platform, population profile analysis, and Continuity of Care Record (CCR) capabilities. These programs consistently yield the best outcomes in the industry in terms of improved engagement, health and wellness measures, and financial savings. Eliza's customers include the nations leading health plans, disease management firms, pharmaceutical companies, pharmacy benefit managers and employers. The results of Eliza's programs have been recognized by organizations including the Centers for Prevention and Disease Control, the BlueCross BlueShield Association, URAC, Entrepreneur magazine, The Consumer Directed Health Care Congress and Harvard Medical School.

Essette provides a web-based care management platform designed to assist healthcare organizations in managing population health and enhancing patient engagement. The software offers a user-friendly interface that facilitates coordination among care teams while integrating with various data repositories and external electronic medical records. Essette focuses on delivering real-time monitoring and reporting, along with analytics capabilities, to support high-value collaborative care. The company is dedicated to offering integrated solutions that blend technology with innovative approaches, ensuring that clients receive effective tools to streamline their operations and improve patient outcomes.

MedRecovery Management specializes in workers' compensation recovery services, focusing on identifying and recovering improperly paid funds within the business sector. The company employs data mining techniques to analyze claims and uncover financial discrepancies, ensuring that clients can reclaim lost resources. By streamlining the recovery process, MedRecovery Management aids organizations in optimizing their financial performance and enhancing their operational efficiency.

HealthDataInsights, Inc. is a technology-enabled healthcare services company that focuses on identifying and recouping fraud, abuse, and overpayments for government payors, health plans, and employers. The company specializes in detecting claim overpayments to various providers, including hospitals, physicians, and durable medical equipment suppliers. HealthDataInsights offers several key resources, including MyHealthCompass, a web-based tool that delivers quality and financial information about healthcare providers; Financial Compass Plus, a database and software solution for financial and operational metrics; and Clinical Compass Plus, a desktop solution designed for healthcare decision-makers to analyze clinical data and improve quality while reducing costs. Additionally, the company operates as a recovery audit contractor. Headquartered in Las Vegas, Nevada, HealthDataInsights also has operations in Newport Beach, California, and Orlando, Florida.

Chapman Kelly provides dependent eligibility audits to large, self-insured employers, as well as plan and claims audits to both employers and managed care organizations.

Allied Management Group Special Investigation Unit, Inc. provides fraud, waste, and abuse prevention solutions for healthcare companies, health plans, and government agencies in the United States. The company provides services in the areas of fraud, waste, and abuse compliance creation and management; Automated Claims Evaluator (ACE), a forensic editing solution for medical claims; and Automated Investigation Management System, a fraud, waste, and abuse investigative tracking system.

Verify Solutions, LLC provides professional audit services for employers. The company’s services include dependent eligibility reviews and human resources data reviews. It also audits and updates an employer's human resource database, as well as assist in gathering the data to meet EEOC reporting requirements.

IntegriGuard, LLC provides medical record reviews, financial reviews, and education activities for benefit programs and payment systems in the United States. The company offers audit, investigation, medical review, data aggregation and analysis, enrollment and eligibility verification, training, and compliance services. It serves Centers for Medicare & Medicaid Services, the U.S.

Prudent Rx, Inc. specializes in providing a range of audit and consulting services to the pharmaceutical industry, focusing on pharmacy auditing. The company offers comprehensive pharmacy audit programs, including facility site reviews and evaluations of pharmacy benefit managers (PBMs) and rebate structures. Its consulting services encompass prior authorization program development, policy and procedure formulation, and custom proposal evaluations. Additionally, Prudent Rx engages in plan design analysis and formulary review, helping clients assess the performance and results of their programs. Through these services, the company aims to enhance operational efficiency and ensure compliance within the pharmaceutical sector.

Permedion is an independent healthcare quality review and improvement organization based in Westerville, Ohio. The company specializes in providing independent utilization and external medical reviews for state government and private clients throughout the United States. Permedion's services focus on utilization management, which includes prior authorization, concurrent reviews, and retrospective reviews. These offerings help ensure that both inpatient and outpatient services are medically necessary, billed correctly, and adhere to high-quality standards.