Who We Serve

Payers

Clinical Data Accelerator for Payers

Maximize the usability of your clinical data with our Clinical Data Accelerator. This solution is built to drive fast, scalable high quality clinical data you can leverage for HEDIS and quality measure reporting, risk adjustment, and compliance. Our solution gives you full visibility into your data with a traceable history that supports compliance and audit readiness.

Evaluate and screen message data quality using PIQI scoring model. Objectively measure if patient messages meet your minimum acceptable data quality standards. Reject those that don’t, continue to process those that do.

Transform accepted messages. Data in C-CDA, HL7 v2.x, X12, FHIR, and other message formats are transformed through a single engine, automatically transformed into FHIR to meet CMS interoperability requirements.

Uplift data usability by normalizing clinical data. Clinical and administrative data are mapped to standard terminologies creating trustworthy data and improved interoperability.

Analyze clinical data. Use rules-based clinical logic and value sets to validate data for risk adjustment, HEDIS, and quality measure performance.

Screen uplifted messages to higher standard. Ingest the high-quality data and quarantine messages with critical failures to keep them from contaminating your data store.

Uplift data usability by normalizing clinical data. Clinical and administrative data are mapped to standard terminologies creating trustworthy data and improved interoperability.

Analyze clinical data. Use rules-based clinical logic and value sets to validate data for risk adjustment, HEDIS, and quality measure performance.

Screen uplifted messages to higher standard. Ingest the high-quality data and quarantine messages with critical failures to keep them from contaminating your data store.

The Clinical Data Accelerator provides trustworthy, secure high-quality clinical data for efficient downstream use.

Don’t just take our word for it. Read the Clinical Data Solutions for Payers case study. This top health plan client was able to streamline over 40 million clinical data records within 90 days quickly clearing a backlog of clinical data for better risk adjustment.

Solving Clinical Data Challenges for Payer Organizations

One consistent theme we hear from health plan leaders is that clinical data is harder to use than it should be. That’s why we created the Clinical Data Accelerator solution to help with common challenges that payer organizations face. It integrates easily into your workflow to optimize and organize clinical data for better downstream use. Here are a few ways:

Advance Digital-First HEDIS and eCQM Readiness

For years, health plans have relied on manual chart reviews and paper records to validate care and close quality gaps. As NCQA moves toward digital-first HEDIS and electronic clinical quality measures (eCQMs), success will depend on the ability to access, standardize, and trust digital clinical data. Clinical Architecture’s Clinical Data Accelerator streamlines that transition by mapping and transforming clinical data into FHIR-ready, high-quality information that’s immediately usable for HEDIS and Stars reporting. It automates the integration of standard terminologies such as ICD-10, LOINC, and RxNorm to reduce manual review efforts and accelerate data readiness. The result is complete, accurate, and trusted data that improves measure acceptance rates, increases numerator capture, and positions your plan to lead in the digital-first era of quality measurement.

Improve Risk Adjustment and HCC Capture

Accurate HCC coding drives fair reimbursement and strengthens financial stability for health plans, and it depends on complete, reliable data. Our Clinical Data Accelerator offers clinically curated value sets that extend beyond the raw CMS mappings to incorporate diagnoses, labs, medications, and procedures that provide supporting evidence for each HCC. This helps your organization identify missed or under-reported conditions, validate submitted codes with confidence, and close documentation gaps before they become audit findings. By leveraging these value sets, health plans can capture the full risk profile of their members, safeguard against penalties, and maximize revenue through more accurate risk adjustment.

Enable FHIR Transformation and Interoperability Compliance

Ingest and transform multiple healthcare data formats through a single solution. The Clinical Data Accelerator converts HL7 v2.x, C-CDA, X12, and other formats into FHIR for use in API-based exchange without the need for custom development or manual processing. This supports CMS requirements for member access and payer-to-payer exchange while streamlining compliance, improving scalability, and preparing your infrastructure for future interoperability demands.

Better Data Enhances the Usability of Patient Data for Payers and Providers

At HLTH 2025, during the Payer & Provider Insights panel moderated by Colin Hung (Healthcare IT Today), our CEO, Charlie Harp, joined Lauren Riplinger (AHIMA) and Viet Nguyen, MD (HL7) to discuss the real-world impact of poor-quality data—and how meaningful improvements can be achieved through standards, the emerging PIQI (Patient Information Quality Improvement) framework, and intentional data governance.

Look inside the HLTH 2025 Payer and Provider Insights Report for key takeaways and more.

Read the Report

Driving Clinical Data Quality at Scale for Health Plans

Clinical Architecture’s industry leading data quality solutions serve clients across healthcare. Our clients include top Medicare health plan providers, four of the five top integrated delivery networks (IDNs), the Centers for Disease Control, Department of Veterans Affairs, and others.

Contact us to discuss your data quality challenges and see how our solutions prepare your organization with the clean, connected, and AI-ready data needed for effective decision-making.