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Associated Press
a day ago
- Business
- Associated Press
Cohere Health Tops Black Book Research Ratings for Clinical and Payer Data Interoperability at AHIP 25
LAS VEGAS, NV / ACCESS Newswire / June 16, 2025 / Black Book Research, an independent healthcare technology research firm, announced today at AHIP 25 that Cohere Health has received the highest ratings in Clinical and Payer Data Interoperability based on comprehensive feedback from 628 managed care and health plan IT, clinical, and finance leaders surveyed in Q1-Q2 2025. The qualitative key performance indicators developed specifically for payer interoperability and data exchange are considered by Black Book Research to be the most reliable measures of true health plan performance satisfaction. Respondents identified Cohere Health's strengths in Clinical Data Interoperability, specifically highlighting exceptional accuracy and completeness of clinical data exchange and real-time integration capabilities. Additionally, participants emphasized the intuitive, user-friendly nature of Cohere's provider portal, reporting significant improvements in quality and risk care gap closure, as well as high provider satisfaction ratings. Survey feedback also emphasized Cohere Health's real-time clinical data updates, ensuring timeliness and precision in clinical information exchange. In Payer Data Interoperability, survey participants recognized Cohere Health for exceeding interoperability mandates through a highly scalable and secure hub-and-spoke model. Respondents underscored the substantial administrative efficiencies achieved, noting remarkable reductions in complexity, accelerated data transitions between health plans, and robust security and privacy measures that met or exceeded industry expectations. 'The survey results clearly demonstrate that Cohere Health has consistently delivered on key interoperability requirements valued by payers and health plans,' said Doug Brown, Founder of Black Book Research. 'These findings are particularly relevant for organizations navigating complex regulatory environments and seeking operational efficiency.' Industry stakeholders can access complimentary managed care-focused research reports at the Black Book homepage. Detailed competitive intelligence reports on the twenty vendors covered are also available by contacting [email protected]. About Black Book Research Black Book Research is an independent, vendor-agnostic market research firm dedicated to healthcare technology and services. Black Book Research is not affiliated with AHIP or its association management, nor is it sponsored by or financially linked to Cohere Health. Contact InformationPress Office 8008637590 SOURCE: Black Book Research press release
Associated Press
10-06-2025
- Business
- Associated Press
Black Book Research Demonstrates Two-Decade Commitment to Excellence in Managed Care Industry Insights
In-Depth, Transparent Industry Studies Highlight Leading IT Solutions, Managed Services, Outsourcing, and Advisory Firms Serving Health Plans Since 2004; AHIP Conference to Showcase Top Vendor Recognitions LAS VEGAS, NV / ACCESS Newswire / June 10, 2025 / Ahead of next week's AHIP Annual Conference in Las Vegas, Black Book Research highlights its long-standing commitment to providing comprehensive, unbiased, and actionable insights within the Managed Care sector. Since 2004, Black Book has conducted rigorous surveys and studies focused on IT solutions, managed services, outsourcing partners, and consulting and advisory firms dedicated to supporting health plan operations. Renowned for its detailed methodology and transparency for commercial insurance tech, Black Book surveys delve deeply into the operational efficiencies, technological advancements, and strategic complexities faced by health plan organizations. Its extensive surveys evaluate more than 50 specific categories of software and services within managed care, capturing the unfiltered voice of end-users and stakeholders. Black Book's unbiased results offer unmatched clarity, empowering managed care organizations to make informed decisions based on real-world experiences. At the upcoming AHIP conference, June 16 - 18, 2025, in Las Vegas, Black Book Research will spotlight the top-performing IT vendors serving the managed care industry, recognizing outstanding performance in user satisfaction, innovation, and operational excellence in dozens of software and managed services categories. Curently Featured Q2 2025 Reports and Deep-Dive Analyses (Each of these detailed studies is available for full and complimentary access to all managed care stakeholders through Black Book Research's website, facilitating transparent knowledge sharing and industry growth. All four press releases are also available in the Black Book Newswire media room at providing direct access for industry stakeholders.) Ensuring Real-Time Compliance and Operational Excellence: Technology Strategies Used by 5-Star Medicare Advantage Plans (Released May 2025) This report explores strategic technological deployments in Medicare Advantage (MA) organizations that consistently achieve top-tier star ratings. It emphasizes how leading MA plans employ IT for real-time compliance, provider integration, and efficient operational management under intensified CMS audit pressures. Optimizing Member Experience: Technology Strategies Behind Elite Medicare Advantage Plans' Success (Released May 2025) Detailing digital strategies that underpin superior member engagement and satisfaction, this study underscores best practices and IT innovations adopted by elite MA plans to improve CAHPS and NPS performance scores. Technology Driving Performance: How Elite MA Plans Leverage Data, Care Coordination, and Advanced Analytics (Released May 2025) This comprehensive analysis outlines the impactful use of data analytics, AI-driven insights, and sophisticated care coordination technologies by high-performing MA plans, demonstrating their strategies to achieve operational excellence and regulatory compliance. The Elite 50 Technology Vendors Driving Medicare Advantage 5-Star Ratings Amid Heightened CMS Audit Standards: An Industry Resource (Released May 2025) A pivotal report identifying and ranking the top 50 IT vendors whose solutions directly contribute to achieving and sustaining high Medicare Advantage star ratings. The detailed vendor evaluations reveal critical technology capabilities that ensure CMS compliance and performance success. Each of these detailed studies is available for full and complimentary access to all managed care stakeholders through Black Book Research's website, facilitating transparent knowledge sharing and industry growth. See The Rapid Expansion of Healthcare Outsourcing (Released April 2025) Also includes vendor evaluations and insights into the managed services and outsourced/offshored niches of the managed care industry. It is available for download at AHIP Conference Recognition and Ongoing Commitment Black Book Research will publicly acknowledge the distinguished IT vendors who have consistently demonstrated superior client satisfaction, measurable outcomes, and innovation at the AHIP 2025 Conference. Additionally, Black Book experts will be on-site to engage with attendees, offer strategic insights, and further deepen the conversation about industry trends shaping the future of managed care. 'We have maintained an unwavering commitment to provide the managed care industry with actionable insights derived directly from healthcare leaders and technology users,' said Doug Brown, Founder of Black Book Research. 'Our detailed approach ensures stakeholders access the most relevant and transparent evaluations available, positioning them effectively to respond to emerging challenges and capitalize on transformative opportunities.' To explore these comprehensive managed care industry studies and access the reports at no cost, visit About Black Book Research For over twenty years, Black Book Research has delivered impartial, robust market research and industry analysis across international managed services, outsourcing and the healthcare technology sectors. Known for transparency, meticulous data collection, and unmatched industry expertise, Black Book is trusted by health plans, providers, technology vendors, investors, and consulting firms globally. Several gratis reports on industry top vendors and current trends are available for download on the Black Book website. Contact InformationPress Office 8008637590 SOURCE: Black Book Research press release
Associated Press
02-06-2025
- Business
- Associated Press
Black Book Research Names 2025's Top Vendors in Risk Adjustment & Coding Optimization for Health Plans and Payers
Advanced Analytics, AI, and Automation Become Essential as Payers Face Increased Scrutiny on Risk Adjustment Accuracy and Financial Performance NEW YORK CITY, NY / ACCESS Newswire / June 1, 2025 / As healthcare payers face intensified regulatory oversight, rising healthcare costs, and the evolving complexities of risk adjustment, Black Book Research today announced its 2025 rankings of the leading vendors in Risk Adjustment & Coding Optimization software. These solutions have become essential for payers seeking accurate, compliant, and financially optimized coding practices across Medicare Advantage, Medicaid managed care, ACA marketplace plans, and commercial insurers. According to Black Book's latest payer survey conducted between Q4 2024 and Q1 2025, with responses from 1,108 senior payer executives, finance officers, and risk adjustment leaders, 92% indicated that advanced analytics and artificial intelligence (AI) tools are now critical for accurate risk scoring, improved coding efficiency, and maintaining regulatory compliance. 'Health plans are urgently investing in technology solutions that provide precise, predictive, and fully compliant risk adjustment and coding practices,' said Doug Brown, President of Black Book Research. 'Optimized coding not only ensures regulatory compliance but significantly impacts financial stability, resource allocation, and member care quality.' Scope and Opportunity in Risk Adjustment & Coding Optimization Software The survey highlights a growing emphasis on several core areas where payer software solutions can dramatically enhance performance: Accurate Risk Scoring: 94% of respondents highlighted accuracy in HCC (Hierarchical Condition Categories) and RAF (Risk Adjustment Factor) scoring as their highest priority. Regulatory Compliance: 89% emphasized the importance of software capable of continuous compliance monitoring, automated audits, and coding validation. Predictive Analytics: 87% of payers prioritize advanced analytics solutions that anticipate risk and allow proactive management of populations. Automated Coding Processes: 70% noted the necessity for automation to reduce manual errors, streamline workflows, and accelerate coding accuracy. Interoperability and Data Integration: 66% reported interoperability as essential, ensuring seamless data flow among providers, payers, and regulatory bodies. Top 10 Vendors in Risk Adjustment & Coding Optimization (Ranked by Client Satisfaction and Performance) Edifecs - Distinguished for its robust interoperability solutions and real-time risk adjustment analytics that streamline payer workflows and ensure regulatory accuracy. Apixio - Recognized for its AI-powered risk adjustment analytics, utilizing natural language processing (NLP) to dramatically improve coding accuracy and risk stratification. SCIO Health Analytics (EXL) - Highly rated for predictive modeling and comprehensive analytics tools that significantly enhance coding accuracy, financial forecasting, and compliance management. Advantasure - Praised for its integrated risk adjustment platform, offering real-time analytics, automated chart reviews, and predictive risk identification. Change Healthcare - Valued for sophisticated coding optimization and analytics capabilities, significantly reducing audit risks and improving revenue accuracy. Innovaccer - Noted for advanced analytics and integrated workflows that seamlessly connect payer data streams, optimizing risk management strategies. Inovalon - Applauded for scalable analytics platforms and comprehensive interoperability, enhancing accuracy in risk scoring and regulatory compliance. Cotiviti - Recognized for its deep analytics and precise data validation, enabling payers to accurately capture risk and streamline coding compliance. Optum - Acknowledged for robust AI-driven risk adjustment and coding tools that integrate seamlessly across payer systems, delivering accuracy and compliance. Talix - Renowned for its innovative NLP-driven risk adjustment solutions that ensure precise coding, reducing compliance risk and maximizing revenue integrity. 'Risk adjustment and coding optimization software has become a strategic imperative for payers aiming to thrive in today's regulatory and competitive healthcare environment,' added Brown. 'Leveraging these technologies positions payers not only to achieve compliance but to realize substantial improvements in financial outcomes, operational efficiency, and member health management.' About Black Book Research Black Book Research provides unbiased, crowd-sourced insights into healthcare technology, services, and outsourcing. Since 2004, Black Book has surveyed over 1 million healthcare technology users and buyers, maintaining strict independence without vendor funding, advisory subscriptions, or performance improvement arrangements. To license the full complete 2025 Risk Adjustment & Coding Optimization report and detailed vendor performance metrics, visit: Media Inquiries: Email: [email protected] Contact Information Press Office [email protected] 8008637590 SOURCE: Black Book Research press release
Yahoo
01-06-2025
- Business
- Yahoo
Black Book Research Names 2025's Top Vendors in Risk Adjustment & Coding Optimization for Health Plans and Payers
Advanced Analytics, AI, and Automation Become Essential as Payers Face Increased Scrutiny on Risk Adjustment Accuracy and Financial Performance NEW YORK CITY, NY / / June 1, 2025 / As healthcare payers face intensified regulatory oversight, rising healthcare costs, and the evolving complexities of risk adjustment, Black Book Research today announced its 2025 rankings of the leading vendors in Risk Adjustment & Coding Optimization software. These solutions have become essential for payers seeking accurate, compliant, and financially optimized coding practices across Medicare Advantage, Medicaid managed care, ACA marketplace plans, and commercial insurers. According to Black Book's latest payer survey conducted between Q4 2024 and Q1 2025, with responses from 1,108 senior payer executives, finance officers, and risk adjustment leaders, 92% indicated that advanced analytics and artificial intelligence (AI) tools are now critical for accurate risk scoring, improved coding efficiency, and maintaining regulatory compliance. "Health plans are urgently investing in technology solutions that provide precise, predictive, and fully compliant risk adjustment and coding practices," said Doug Brown, President of Black Book Research. "Optimized coding not only ensures regulatory compliance but significantly impacts financial stability, resource allocation, and member care quality." Scope and Opportunity in Risk Adjustment & Coding Optimization Software The survey highlights a growing emphasis on several core areas where payer software solutions can dramatically enhance performance: Accurate Risk Scoring: 94% of respondents highlighted accuracy in HCC (Hierarchical Condition Categories) and RAF (Risk Adjustment Factor) scoring as their highest priority. Regulatory Compliance: 89% emphasized the importance of software capable of continuous compliance monitoring, automated audits, and coding validation. Predictive Analytics: 87% of payers prioritize advanced analytics solutions that anticipate risk and allow proactive management of populations. Automated Coding Processes: 70% noted the necessity for automation to reduce manual errors, streamline workflows, and accelerate coding accuracy. Interoperability and Data Integration: 66% reported interoperability as essential, ensuring seamless data flow among providers, payers, and regulatory bodies. Top 10 Vendors in Risk Adjustment & Coding Optimization (Ranked by Client Satisfaction and Performance) Edifecs - Distinguished for its robust interoperability solutions and real-time risk adjustment analytics that streamline payer workflows and ensure regulatory accuracy. Apixio - Recognized for its AI-powered risk adjustment analytics, utilizing natural language processing (NLP) to dramatically improve coding accuracy and risk stratification. SCIO Health Analytics (EXL) - Highly rated for predictive modeling and comprehensive analytics tools that significantly enhance coding accuracy, financial forecasting, and compliance management. Advantasure - Praised for its integrated risk adjustment platform, offering real-time analytics, automated chart reviews, and predictive risk identification. Change Healthcare - Valued for sophisticated coding optimization and analytics capabilities, significantly reducing audit risks and improving revenue accuracy. Innovaccer - Noted for advanced analytics and integrated workflows that seamlessly connect payer data streams, optimizing risk management strategies. Inovalon - Applauded for scalable analytics platforms and comprehensive interoperability, enhancing accuracy in risk scoring and regulatory compliance. Cotiviti - Recognized for its deep analytics and precise data validation, enabling payers to accurately capture risk and streamline coding compliance. Optum - Acknowledged for robust AI-driven risk adjustment and coding tools that integrate seamlessly across payer systems, delivering accuracy and compliance. Talix - Renowned for its innovative NLP-driven risk adjustment solutions that ensure precise coding, reducing compliance risk and maximizing revenue integrity. "Risk adjustment and coding optimization software has become a strategic imperative for payers aiming to thrive in today's regulatory and competitive healthcare environment," added Brown. "Leveraging these technologies positions payers not only to achieve compliance but to realize substantial improvements in financial outcomes, operational efficiency, and member health management." About Black Book Research Black Book Research provides unbiased, crowd-sourced insights into healthcare technology, services, and outsourcing. Since 2004, Black Book has surveyed over 1 million healthcare technology users and buyers, maintaining strict independence without vendor funding, advisory subscriptions, or performance improvement arrangements. To license the full complete 2025 Risk Adjustment & Coding Optimization report and detailed vendor performance metrics, visit: Media Inquiries: Email: research@ Contact Information Press Office research@ SOURCE: Black Book Research View the original press release on ACCESS Newswire Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Associated Press
01-06-2025
- Business
- Associated Press
Black Book Research Names 2025's Top-Rated Utilization Management & Prior Authorization Vendors Across All Payer & Health Plan Segments
AI-Driven and Scalable Solutions Lead the Way as Payers Prioritize Efficiency, Compliance, and Member Satisfaction TAMPA, FL / ACCESS Newswire / June 1, 2025 / Amid escalating regulatory requirements, increasing cost pressures, and rising consumer expectations, Black Book Research today announced the top-rated Utilization Management (UM) and Prior Authorization (PA) technology vendors for 2025. Based on extensive feedback from 1,632 verified payer executives, IT directors, and clinical operations leaders surveyed between Q3 2024 and Q2 2025, the report highlights an industry-wide transition toward AI-powered, interoperable solutions across commercial, Medicare Advantage, Medicaid, and employer-sponsored health plans. 'Health plans across the board are rapidly moving away from manual, labor-intensive prior authorization methods,' said Doug Brown, President of Black Book Research. 'The most successful payers are embracing scalable technologies that integrate clinical decision-making, automate processes, ensure compliance, and dramatically improve both provider and member experiences.' Top 10 Vendors in Utilization Management & Prior Authorization Solutions (Ranked by Client Satisfaction and Performance) These vendors are ranked based on client satisfaction, performance, and their ability to deliver scalable, compliant, and intelligent UM/PA solutions across various payer segments: Cohere Health - Renowned for its AI-driven clinical decision workflows that significantly reduce unnecessary prior authorizations and expedite patient care. MCG Health - Praised for evidence-based clinical decision support that enhances accuracy and consistency across utilization reviews. eviCore healthcare - Noted for extensive benefit management capabilities, especially within specialty care authorization and integration. Agadia - Celebrated for customizable electronic prior authorization tools that streamline approval processes and enhance formulary compliance. Availity - Highly rated for real-time payer-provider automation that minimizes friction and strengthens provider relationships. Infinx - Rapidly growing for its predictive analytics and proactive denial prevention technologies, driving measurable ROI. Inovalon - Distinguished for analytics-driven authorization platforms and deep interoperability with existing payer systems. Cotiviti - Valued for concurrent authorization efficiency and accurate clinical-to-financial data alignment. Onyx - Recognized for its FHIR-based prior authorization interoperability solutions, facilitating seamless data exchange and compliance with CMS mandates. Apixio - Leveraging natural language processing (NLP) to efficiently validate medical necessity and automate chart reviews. Evaluating Vendors on 18 Essential Performance Indicators Black Book's independent research assessed vendors across 18 payer-specific key performance indicators (KPIs), including: Automation and Process Efficiency; Clinical Decision Support; Regulatory Compliance; Integration and Interoperability; Member Experience and Provider Satisfaction; and Return on Investment (ROI). 'It's clear that payers aren't just adopting technology for automation's sake,' Brown added. 'The leading solutions in our survey demonstrated measurable improvements in regulatory readiness, member satisfaction, operational cost savings, and value-based care support.' The comprehensive 2025 Black Book Research report evaluates a total of 20 UM/PA technology vendors serving a broad range of payer segments. The insights are invaluable for payer CIOs, clinical management teams, and procurement professionals seeking scalable, compliant, and intelligent utilization management solutions. About Black Book Research Black Book Research, a division of Black Book Market Research LLC, provides unbiased, crowd-sourced insights into healthcare technology, services, and outsourcing. Since 2004, Black Book has surveyed over 1 million healthcare technology users and buyers, upholding a strict policy of independence with no vendor funding, advisory subscriptions, or pay-to-play arrangements. For the report licensing and detailed vendor performance metrics, visit: Media & Report Licensing Inquiries: Email: [email protected] Contact InformationPress Office 8008637590 SOURCE: Black Book Research press release
