11 — Technology category · TR-150.40
Health Plan Core Administration Systems
Payer systems of record that hold members, benefit plans and provider contracts and adjudicate medical claims against them, with authorization and premium billing around the core.
- Core Administrative Processing System
- CAPS
- Claims Administration System
- Payer Platform
- Health Plan Administration System
In scope
- Member enrollment and eligibility records
- Benefit plan configuration and accumulators
- Provider contracts and pricing
- Claim adjudication and payment
- Authorization records and premium billing
Out of scope
Example technologies · 3
Well-known technologies in this category, named as facts. Not a shortlist or an endorsement.
- HealthEdge HealthRules Edge
- TriZetto Facets
- TriZetto QNXT