Automate payer workflows to improve outcomes and manage cost.
Agentic AI across risk adjustment, quality management, utilization management, and more to help health plans reduce manual work, improve decisions, and deliver better outcomes.
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Smarter, faster decisions powered by unified data

Unified data turns fragmented payer information into actionable intelligence, helping health plans improve accuracy, accelerate performance, and support compliance across programs.
Maximize Financial Performance
Improve risk accuracy, close quality gaps, and reduce administrative spend with unified data and AI-driven automation.
Automate Decisions
AI agents support intake, evaluation, and communication so teams can focus on judgment, not manual work.
Stay Compliant with Confidence
Designed to support CMS, NCQA, and URAC requirements with audit-ready traceability at every step.
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Designed to support CMS, NCQA, and URAC requirements with audit-ready traceability at every step.
Risk Adjustment
Capture risk accurately and reduce manual effort.
Close HCC gaps and reduce audit risk with an AI-driven risk adjustment
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Risk Analytics and Dashboards
Chart Retrieval and Coding
Prospective, Concurrent Review, and Retrospective Reviews
Multipoint Gap Closure through point of care, member outreach, pharmacy, and homes
Quality Management
Close more care gaps and improve Star ratings
Enhance Star ratings by closing care gaps faster with AI-powered quality management
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Quality Analytics and Dashboards
Chart Retrieval and Abstraction
Prospective Review, Concurrent Review, and Retrospective Reviews
Multipoint Gap Closure through point of care, member outreach, pharmacy, and homes
Quality Management
Close more care gaps and improve Star ratings
Enhance Star ratings by closing care gaps faster with AI-powered quality management
Learn more
Quality Analytics and Dashboards
Chart Retrieval and Abstraction
Prospective Review, Concurrent Review, and Retrospective Reviews
Multipoint Gap Closure through point of care, member outreach, pharmacy, and homes
Utilization Management
Automate utilization management
to approve faster, review smarter, and stay compliant.
Use AI-driven utilization management to reduce authorization costs, improve efficiency, and support more timely care decisions.
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Multi-Channel Intake and Clinical Data Extraction
Automated Medical Necessity Evaluation
Clinical Review Workflow with Physician Oversight
Automated Provider Communication
Compliance, Analytics, and Reporting

Automation that helps teams focus on what matters

AI across key payer programs
AI agents support payer workflows to reduce manual effort and improve consistency across teams.
More accurate gap and opportunity detection
Advanced analytics surface HCC gaps, quality opportunities, and authorization inefficiencies accurately.
Works with your existing systems
Bi-directional integration with 200+ EHRs and existing payer systems, with no rip-and-replace required.
Scale without adding headcount
One unified data foundation across programs, with AI agents that scale as your volume grows.
Enterprise-grade security
HIPAA, HITRUST, and SOC 2 Type II certified to support enterprise healthcare operations.
Compliance and audit readiness
Designed to support CMS, NCQA, and accreditation requirements with full traceability at every step.

An integral part of the value-based care suite

Population Health Analytics

Population Health Analytics leverages the full power of the Data Activation Platform to deliver actionable insights that drive performance in value-based care.
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Risk adjustment

Transform your risk adjustment program with intelligent workflows and real-time insights that improve coding accuracy and patient outcomes.
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Quality management

Align payers, providers, pharmacies, and members to drive measurable improvements in quality performance.
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Care Management

Innovaccer's Care Management Copilot uses advanced AI to automate documentation, generate care insights, and predict patient risk.
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Actuarial Intelligence

Build predictable revenue models, strengthen contract negotiations, and maximize financial performance in value-based care.
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SPOTLIGHT
Empowering health plans to improve member outcomes through value-based pharmacy programs
EmblemHealth, one of the nation's largest nonprofit health insurers, partnered with Innovaccer to launch New York's first pharmacy value-based arrangement focused on improving health outcomes for members with diabetes and hypertension.
INNOVACCER SERVES EMBLEMHEALTH BY:
Building a unified data foundation to power pharmacy quality programs and care management initiatives that connect pharmacies, providers, and care teams in delivering coordinated, whole-person care.
Augmenting and automating pharmacy engagement, quality reporting, and care team workflows to enable timely interventions and close critical care gaps for chronic conditions like diabetes and hypertension.
Why did Emblem Health choose PQS by Innovaccer?
Read the press release

Leading Healthcare Organizations Choose Innovaccer

“Our partnership with Pharmacy Quality Solutions enables us to strengthen relationships with the city’s pharmacies—the cornerstones of community care—while continuing to redefine the scope and reach of healthcare access for members at every touchpoint.”
Abdou Bah
Chief Health Equity Officer of EmblemHealth
“By making data more accessible and accurate, and using AI in practical ways, we can actually solve the day-to-day challenges that providers and payers face.”
Nick Moriello
President of Highmark Blue Cross Blue Shield Delaware
“By making data more accessible and accurate, and using AI in practical ways, we can actually solve the day-to-day challenges that providers and payers face.”
Nick Moriello
President of Highmark Blue Cross Blue Shield Delaware
Resources
News
Effective Payer-Provider Collaboration - An Activation Agent for Improved Health Outcomes
November 21, 2024
Innovaccer surveyed 65 payer organizations to evaluate provider network management expenditure, network size, and organizational challenges, priorities, preferences, and use cases. This report summarizes the survey results and explores how payer organizations navigate the challenges of networ
News
Improving Payer Risk AdjustmentThrough the Power of Data and Provider Connectivity
August 9th, 2024
As the government tightens and scrutinizes risk adjustment practices in the future, health plans must align their practice with accurate member diagnosis and treatment data.

Learn how to unlock the full potential of your healthcare data

whitepaper

Innovaccer’s Data Activation Platform: What Makes it the Best in KLAS Data and Analytics Platform

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white paper

Five Reasons Why the Modern Payer Needs a Data Activation Platform

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Experience a unified AI platform empowering payers to drive accuracy, efficiency, and measurable outcomes.

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Frequently Asked Questions

Frequently Asked Question

What are Innovaccer’s payer solutions?

Innovaccer’s payer solutions bring together connected capabilities for health plans across risk adjustment, quality management, utilization management, and more.

What workflows do they support?

They support payer workflows across data integration, coding, review, gap closure, authorization, communication, and reporting.

How do they improve performance and support compliance?

They help health plans reduce manual work, improve decisions, strengthen compliance, and maintain audit readiness through traceability, secure interoperability, transparent AI, and human oversight.