One million-plus member health plan simplifies and automates claims and encounter processes to enhance member and provider experiences while reducing costs and improving revenue streams. The Centers for Medicare & Medicaid (CMS) are strongly promoting innovative health operations, data interoperability and value-based reimbursement models. Complying with these emerging regulations requires payers offering Medicare Advantage, Medicare Supplement, Managed Medicaid and related prescription drug plans to modernize their systems and capabilities. That was a difficult challenge for one health payer with more than 1 million members in its government programs.

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