HMS

Lorica Health provides advanced claims analytics solutions and services to the healthcare sector. Lorica Health was first established in 2011 as CMC Insurance Solutions, a commercial spin off of research conducted the Capital Markets Cooperative Research Centre (CMCRC), a $100 million funded research and development centre founded in 2001. CMCRC played a central role in the development and commercialisation of SMARTS, a world-leading surveillance solution used by financial markets regulators, exchanges and brokers across 40 countries and acquired by NASDAQ in 2010

VitreosHealth enables disruptive change in population health management. Vitreos Insights-as-a-Service delivers population risk models, and predictive and prescriptive health insights so everyone throughout the healthcare continuum can achieve a patient-centric focus and contribute to financial performance. With VitreosHealth’s closed-loop performance management process, you can transform the business of population health management into a center of excellence to enhance clinical efforts and drive better health outcomes. Insights start with predictive clinical risk scores, non-clinical markers, gaps-in-care, and prescriptive care recommendations. We show your care managers, clinicians, administrators and C-suite, which patients and members are going to become high risk, predict their probability of hospitalization or escalation of chronic disease, and help determine the interventions they need right now to delay or avoid high-cost healthcare episodes. Healthcare providers and payers choose the insights delivery method that’s right for their organization – mobile 3-click insights apps, embedded into the EHR or workflow system, or via other electronic format. VitreosHealth Population Health Management powers all predictive and prescriptive analytics, leverages a comprehensive portfolio of disease-specific predictive risk models, and applies every source of data at your disposal: EHR, claims or billing, household, consumer, socio-economic and behavioral. VitreosHealth – everything you need to power population health management. As a pioneer of Advanced Population Health analytics for Big Data, we leverage the broadest set of data sources including EHR, claims, HRAs, socioeconomic and well-being data for predictive risk and prescriptive care management. We offer this through the first healthcare Insights-as-a-Service (IaaS) delivery model for population risk models, and predictive and prescriptive health insights for a complete view into the healthcare continuum. Each “insights-view” achieves a patient-centric focus from every stakeholder perspective within the healthcare organization that will contribute to quality health outcomes and improved financial performance.

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® web-based care management software offers a robust alternative to ‘shrink wrapped’ applications. Incredibly powerful and user-friendly, Essette software—built upon a refreshingly efficient platform—is rapidly becoming the preferred choice for healthcare organizations seeking a simple means of delivering high-value, collaborative care. Whether the need is for real-time monitoring and reporting of data, interface ability with “core systems,” analytics, exchanges and external EMRs, or the added expertise of Clinical Consultants, Essette is committed to providing its clients with integrated solutions that combine technology with creative thought and integrity.

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., a technology-enabled healthcare services company, provides fraud, abuse, and overpayment identification and recoupment solutions for government payors, health plans, and employers. It specializes in the identification and recoupment of claim overpayments to providers, such as hospitals, physicians, DMEs, and other specialty providers. The company offers MyHealthCompass, a Web-based resource that provides quality and financial information on providers to healthcare consumers; Financial Compass Plus, a database and software solution, which supplies financial, operational, and productivity measures; and Clinical Compass Plus, a desktop solution that allows healthcare decision-makers to access, analyze, and present clinical information to identify opportunities, reduce costs, and improve quality. It also operates as a recovery audit contractor. HealthDataInsights, Inc. was formerly known as HealthMarketInsights, Inc. The company is headquartered in Las Vegas, Nevada with additional 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.