At Clearsense, we understand payer organizations’ challenges in aggregating and managing disparate healthcare data sources while ensuring data quality and trust. That’s why we built the 1Clearsense data platform. The Clearsense Healthcare Data Model drives this platform—a highly mature and robust domain model that aligns with FHIR interoperability standards. With this domain-based model, Clearsense helps payer organizations easily aggregate disparate data sources and focus on utilizing the data quickly. From claims to clinical data, 1Clearsense allows for seamless aggregation, enabling richer data analytics, closure of care gaps, improved risk adjustment, and reimbursement accuracy.
Partnering with Clearsense means accessing our existing relationships with numerous large healthcare organizations. We facilitate seamless data integration, aggregation, and collaboration, minimizing friction in workflows and transactions while ensuring efficiency in data-sharing agreements. Our comprehensive approach manages all transactions and data, from source to target. With data quality and trust as priorities, we enrich shared data with organizational data, third-party benchmarks, and in-line analytics. Data owners have complete control over security and access policies, guaranteeing that only authorized entities can access sensitive information.
With a focus on data ingestion, management, and consumption, the 1Clearsense Platform allows payers to:
- Enable robust data-sharing transactions, including ADT messages, CCDs, and claims.
Aggregate diverse patient and member data into unified domains for analysis, insights, and visualizations of healthcare needs, outcomes, and behavioral patterns.
Act as an all-in-one solution for clinical data aggregation and enforcement of data quality standards in compliance with NCQA’s data aggregator validation (DAV) program.
Continuously monitor changes to data and data quality to produce notifications and alerts, enabling payers and providers to take action on updating provider demographics, credentialing, network assignment, point of care alerts, and other critical information.
Leverage accurate provider data and aggregated clinical data to produce out-of-the-box STAR Rating analytics targeting opportunities to improve performance.
- Produce intuitive visualizations of the member journey that readily identifies trends in cost and utilization.
The Clearsense Approach
1Clearsense, an all-in-one healthcare data platform, aggregates data from various sources and is powered by the Clearsense Healthcare Data Model. This model offers pre-built integrations and accelerators to rapidly implement connections, mapping, and data quality rules, ensuring data lineage and traceability. With payer and provider data residing within the common healthcare data model, organizations can determine the source of truth and assign trust rules.
Collaborating with organizations, Clearsense establishes granular data access policies and assigns security controls. Accessible data can be seamlessly utilized in 1Clearsense analytics, outgoing integrations, and customized applications through 1Clearsense's bring-your-own-tool (BYOT) capabilities.
Seamlessly bring data from disparate systems into a single, unified platform.
Maintain and manage all technical & business metadata, master & reference data, data quality, & analytics governance.
Manage and view data with multiple lenses necessary for clinical, financial, and operational use cases.
Featured Payer Use Cases
Reduce manual transaction processing activities, improve accuracy for optimal claim submission and CMS reimbursement, enhance quality reporting and care gap closure, and shorten critical member and patient follow-up times for improved outcomes.
Provider Network & Data Management
Reduce manual intervention for staff, enhances claims adjudication accuracy, improve network adequacy decisions, enable care gap closure, validate provider credentialing and member assignment, and boost provider performance reporting accuracy.
Target providers for appropriate care for representative populations by geography and demographics, track member journeys to identify at-risk members, reduce utilization with preventative care, identify high-use utilization trends for care coordination, and strategically expand network services to serve members better.
Why Payers and Payviders Choose Clearsense
Facilitating the seamless and transparent exchange of information between healthcare providers and payers in compliance with NCQA DAV certification.
HL7 and FHIR-enabled platform supporting common healthcare messages and transaction types, including CCD, ADT messages, and claims, following healthcare standards, including USCDI and EDI X12.
Velocity and Agility
Leveraging the Clearsense Healthcare Data Model, 1Clearsense scales to accommodate your organizational growth and rapidly responds to market demands with unmatched velocity.