Health Plan Consulting

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Health Plan Consulting

We understand the challenges healthcare organizations face managing EDI. Plans face complex administrative challenges and tremendous regulatory pressure. Payers manage funding gaps and advance the care of members within a constantly changing ecosystem of operating rules, standards and requirements. At the center, many plans manage a hybrid collection of custom applications and third-party solutions. Experienced healthcare consultants can bridge technical and subject matter gaps to optimize your existing investments and improve operational performance.

Our Approach

At Tallan, we have a dedicated Healthcare technology practice that brings deep technical skillsets with administrative and clinical data expertise. Accelerate and enhance your processes using any combination of our consultants and our products.

We bring a unique combination of technical skills, industry expertise, and products to help your team manage EDI and plan for organizational growth.

Capabilities

Technical
Skillsets
Administrative and Clinical Data Skillsets
Regulatory Compliance Areas
Products
and IP

Technical
Skillsets

Plans face changing project priorities and initiatives on an ongoing basis. An agile response to the various workloads can be challenging for most health plans. Tallan can provide the to push your project through to the end. Our team of experts will bring the following skillsets:

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MicrosoftSQLServer
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Enterprise Data
Warehouse
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Mobile and Web
Access
XML &
XSLT
Decision Services

Administrative and Clinical Data Skillsets

At Tallan, our team brings years of experience to implement and solve common challenges around HIPAA X12 EDI and HL7. We have specialized integration experience for the following standards:

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✓ EDI – 5010 X12

  • Claims and Encounters: 837I, 837P, 837D
  • Post Adjudication Encounters: 298, 299, 300
  • Premium Payments: 820, 306
  • Member Enrollments: 834
  • Acknowledgements: 999, 277CA
  • Payments: 835
  • Realtime Transaction: 270, 271, 276, 277
  • Authorizations: 278

✓ HL7 – versions up to 3.x
✓ FHIR – Up and coming standards

Regulatory Compliance Areas

Administrative and clinical data processing becomes the foundation for health plan processes, but with state and federal compliance regulations, health plans need the right mix of expert staff and solutions. Tallan can accelerate compliance with a mix of our consultants and product IP in the following areas:

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  • Risk Adjustment (RAPS) to Encounter Data Processing Submission (EDPS)
  • State specialty – California including DHCS processes, Texas, Massachusetts
  • CMS encounter submissions for Medicare
  • Provider Claim Attachments
  • Realtime 270/271 Eligibility
  • Assistance with CAQH Core Certification

Products
and IP

Having the right mix of consulting and products is the key to implementing complex healthcare processes. At Tallan, we offer products that are specifically built to accelerate and increase compliance, without a non-invasive implementation.

T-Connect Suite of Products

Client Story

“With Tallan’s architectural guidance and ability to deliver technical solutions, IEHP is able to meet regulatory requirements, throughput, and SLAs is assured, and we expect our EDI administrative cost to be a third of what it once was.”

– Arnold Allende, EDI Manager
Inland Empire Health Plan

Learn More

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