HCAA Sponsorship Guide Fall 2022

SPONSORSHIP GUIDE FALL 2022

Welcome to HCAA’s Annual Digital Sponsorship Guide. We at HCAA have had an amazing trajectory of successful conference events. We know this success could not have happened without the partnership of our sponsors. Since its inception in 2020, our Digital Guide has focused on providing another opportunity for our amazing Sponsor Partners to let you know about their very valuable products and services. We invite you to please take time to use it to find out more about what they offer! Remember, here at HCAA, it is always about “the value of connection”!

Carol Berry, Crolla,

HCAA CEO Susan

Executive Director

Sponsorship Guide Table of Contents A&G Healthcare .................................. 4 AccessHope ..................................... 88 Advanced Medical Pricing Solutions (AMPS)........... 6 aequum, LLC .................................... 88 Alaffia Health .................................. 88 AMC Health ..................................... 89 Beacon Technologies Group, Inc. .................... 8 BillingNav .................................... 89 Care Valet 89 Cedar Gate Technologies ......................... 10 Change Healthcare 12 ClaimLogiq ..................................... 14 Cognizant 16 Community Health ............................... 18 CVS Health 20 DataPath, Inc. ................................... 22 ECHO Health Inc. 24 Employer Direct Healthcare, LLC ................... 26 Frazier Healthcare Partners 90 Goodroot, Inc. ................................... 28 Health Payer Consortium 30 Hines & Associates, Inc. ........................... 32 Homestead Smart Health Plans 90 Ikigai Growth Partners ............................ 34 Imagine360 36 IngenioRx ...................................... 38 Javelina from Mphasis 40 JMS and Associates ............................... 42 Magellan Rx Management. . . . . . . . . . . . . . . . . . . . . . . . . 44 MedWatch ...................................... 46 Medxoom ...................................... 48 Optum Rx ....................................... 50 Payer Compass .................................. 52 Payer Matrix .................................... 54 Planwatch ...................................... 90 Renalogic ...................................... 56 Ringmaster Technologies, Inc. 58 Russell, Oliver & Stephens. . . . . . . . . . . . . . . . . . . . . . . . . 91 Serve You Rx 60 Southern Scripts ................................. 62 Swiss Re Corporate Solutions 64 TALON ......................................... 66 The Phia Group 68 TPAC ........................................... 70 True Captive Insurance 72 Valenz .......................................... 74 VBA 76 Virgin Pulse ..................................... 78 Walmart Health 91 WEX, Inc......................................... 91 WithMe Health 91 WLT Software, Inc. ............................... 80 Zelis 82 Zipari .......................................... 84 Zywave Insurance Solutions 86

ag h e a l t hcare.com healthcare AG& PAYMENT INTEGRITY SIMPLIFIEDAG-OONv1.3When it comes to solving the problem of rising healthcare costs, you need a team behind you that can provide real solutions. That’s why we’re #TeamA&G. NO COST IM P LEMEN TATION AN D FR EE ANA LYSIS A free analysis can be performed on your previously paid claims. And when you’re ready to start, we provide a simple and streamlined implementation, all at no cost. Connect with us today to see what A&G can do for you, and start getting the savings you deserve. That’s the A&G Difference. Ad van ce d Er ro r D ete cti on A& G ' s i ndustr y le adi ng s ystem finds more er ror s t ha n an y p ro duct on t he mark et t od ay T ha nks t o p owerf ul i nteg ration with m ost ma jor adjudica ti on systems, you c an en joy the benefi t s of such enh anced e rror de t ecti on w i t h i m m ed iate t urn aroun d, m i nim al i m p act to your existing wo rk flow, a nd seamless t ra nsi ti on . Bi ll R e vi ew T his s olu t i on of f er s exte nsive facility-based B i l l Re v i ew se rv i c es tha t c an b e tailo red to yo ur spe c i fic n ee d s Ea c h c l aim i s rev i ewed b y c er tifi ed pr of ession al cod ers, nurs e aud i t ors, p hysicia n co ord i nators, and c on t racting s p ecia l i s ts, all usin g t he late st s of t ware sy s t em s t o m ax im i z e the be s t p os s i ble s av i ng s on lar ge d ollar c l aims. R e f er e n c e -B as e d Pri ci ng Th i s so l ut i on util i z es a r eal-ti me pricin g en g i ne to d ete rmin e th e pr ic e for a p ro c ed ure , a nd g i v es you th e ab i l i t y to se t t he p er c entage th at w or ks bo th for yo u, and y ou r p rov i d er s N o m atter wha t percentag e y ou s et , y ou ha ve c omplete c on t ro l of your p ricin g . Additionally, t his can be customized s p ecifi c al l y to an y pr ovide rs o r grou ps, d epe nding o n y ou r ne ed s. R epr i c i ng claims h as n eve r b een f aster or sim pler. Out-of-Network Services Long-standing relationships with Preferred Provider Organizations (PPO) Networks along with A&G's proprietary national network, Amera-Net Provider Network, along with with and expert team of negotiators ensures an unparalleled answer to obtaining substantial repricing results, and no balance billing, on out-of-network claims.

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providing visibility

On-demand platform into data, more. Team Members with Healthcare Options resources offering a variety of care options to optimize savings, schedule procedures, and check

Insight Delivering True Transparency Next-generation portal and analytics

Connecting

Enhanced Member Advocacy Providing Faster, More Frequent Communication contact with members by returning calls within 24 hours and more frequent communication throughout the process. Response Reducing Member Abrasion Settlement early in the process once a balance bill is received, reducing member abrasion.

Powering Healthcare Year Founded 2005 1+ BILLION Claims Managed Annually 600+ Number of Clients Average Facility Savings 73% Average Plan Savings Over PPO 26% Average ReimbursementMedicareRate 146% sales@amps.comwww.amps.com Make your healthcare dollars go further. Cost Containment Experience Impacting Savings 16+ years of experience and historical reimbursement data resulting in transparent pricing that’s fair for all. Physician-led Medical Bill Review Confirming Accurate and Reasonable Pricing 30+-member physician panel reviews claims at the line item level, resulting in an average of 10% savings on hospital and facility claims.

and

Stop Loss Coverage Optimized for RBP Performance Programs with some of the largest stop loss carriers in the industry, creating competitive pricing and tailored to AMPS’ RBP performance, historical data and enhanced analytics.

eligibility.

Care Navigation

Additional

Savings Opportunities

Accelerated

Enriched Member Experience

A non-traditional PBM (Drexi) enabling savings with transparent pricing and pass-thru on prescription medications at more than 65,000 pharmacies.

Centers of Excellence

Cost

Rapid

Management Solutions

AMPS Connect Enabling Smarter Healthcare Decisions application allowing members to compare providers, schedule procedures, submit balance bills, and communicate with the AMPS’ Member Advocacy team.

Mobile

Second opinion review allowing access to a high-quality network to address misdiagnosis, over utilization, sub-optimal treatment and overpricing.

Pharmacy Solution Providing Transparent Pricing and Better Benefits

Improving Patient Care

claims flow, performance metrics, real-time trends, claim-level

Healthcare

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CONTROL OF HEALTH CLAIMS MANAGEMENT Beacon is a market-leading software firm specializing in health claims management solutions for Third Party Administrators. SpyGlass, our innovative, cloud-based claims processing software, paired with HIPAA Director and Compass Code Edits, provides an easy-to-use, dynamic platform that maximizes automation, streamlines operations, and boosts business performance to help our clients reach new levels of productivity. Contact us to learn more about the ways Beacon can help you take control of your health claims management. The future is getting brighter...

ClaimsFully-IntegratedAdministration EDIAll-In-OneGateway Clinical Code Editing beaconspyglass.com

TAKE

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type.DIY

MEMBER DATA ENRICHMENT

PRE - CONFIGURED DASHBOARDS & REPORTS

Create custom reports and visualizations on the fly with an easy-to-use tool designed for the non-technical user. Monitor performance indicators and correct undesirable trends.

Conduct population risk stratification to identify specific cohorts that need to be monitored and reported on.

Visual, Sharable Benefits Analytics

COHORT IDENTIFICATION

Cedar Gate Healthcare Benefits Analytics is an employee benefits analytics and reporting application for self-funded employers, their payers, and their broker/consultant advisory partners seeking to meet the plan sponsor’s clinical and financial performance goals. It enables benefits managers to tailor plan parameters and model performance based on the characteristics of the member population. Visual dashboards distill the data into prescribed actions, preventing clients from getting lost in the analysis. Focused reports track the efficacy and impact of care management activities and point solutions by monitoring performance indicators in member cohorts. Unlike the competition, the Healthcare Benefits Analytics tool is built for self-service plan design and reporting, reducing or eliminating the need for additional consultants or vendors. It pulls data from a common data lake that is shared by Cedar Gate’s Care Management application, ensuring the accurate translation of data to insights, and insights to action. The application is cloud-based and built on a next-generation NoSQL database for rapid interpretation of unstructured data. It enriches member data to identify savings recommendations and generates visual dashboards that communicate insights and key points to all stakeholders.

MEMBER, PLAN & BENEFITS BENCHMARKING Render stunning visuals with over 100 out-of-the-box clinical and financial reports and dashboards that communicate key facts to an array of stakeholders. Compare real-time performance against Cedar Gate’s proprietary commercial benchmark dataset of over 11 million members — by region, state, MSA and industry DASHBOARD & REPORT CREATION COST, QUALITY, TRENDS, & COMPARISONS

Augment member data with over 5,000 types of data enrichment.

PLAN & BENEFITS MODELING Test changes to plan elements based on the member population profile to generate recommendations that will have the greatest clinical and financial impact.

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1 Inspiring a Better Healthcare System Our Network Spans: 15 Billion BILLING ANNUALLYTRANSACTIONS $1.5 Trillion HEALTHCARE CLAIMS ANNUALLY 1 Million PHYSICIANS 125,000 DENTISTS 39,000 PHARMACIES 6,000 HOSPITALS AND HEALTH SYSTEMS 700 LABORATORIES 2,400 PAYER CONNECTIONS 1 in 3 PATIENT RECORDS PASS THROUGH HEALTHCARECHANGESYSTEMS Change Healthcare is a leading healthcare technology company focused on insights, innovation, and accelerating the transformation of the healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system. Our platform and comprehensive portfolio of software, analytics, technology-enabled services, and network solutions drive improved results in the complex workflows of payers and providers by enhancing clinical decision-making; simplifying billing, collection, and payment processes; and enabling a better patient experience. Our Focus Enhancing the Healthcare Experience OptimizingPerformanceFinancial TransformingEffectivenessOperationalandCare

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Creating a best-in-class technology platform that enables Payers to maximize their Payment Integrity efforts through a first-of-itskind SaaS, Services or Hybrid model of engagement 866 - 634 - 1638 WHAT'S NEW? ClaimLogiq and Medliminal have merged together, combining their industry leading technologies under one platform, offering unique, transparent, and real-time payment integrity solutions to help drive true value, while savings millions of client dollars. WHY CHOOSE US ? More than just a vendor we are a partner every step of the way while assisting in the ultimate goal of reducing healthcare costs for every member and client ITEMIZED BILL REVIEW DRG REVIEWS ANALYTICS CURRENT OFFERINGS ClaimLogiq's automated itemized bill editing includes customizable denial libraries, and feature rich review functionality that improves the IBill review speed and accuracy across all team members. Experience smarter software adaptations combined with industry experts that can be implemented as an in house software solution, outsourced services, or combination of the two. NLP Platform configured to specific Payment Integrity Solutions www.claimlogiq.com < 15 MINUTE IBILL REVIEWS PAY/PEND RESPONSE IN <0.5 SECONDS SAAS, SERVICES, OR HYBRID MODELS FLEXIBLE PRICING, FOR MAXIMIZED SAVINGS THE CLQ DIFFERENCE

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For more information about TriZetto QicLink Core Administration capabilities, please visit: ww w cognizant com/trizetto/core -administration/qiclink

Accelerate speed to market enhance revenue growth and reduce costs by administering multiple lines of business on a single platform. Reduce administrative costs through greater auto-adjudication, integrated workflow Leverage the modularity of the solution to reduce your cost of ownership by using only Enhance your customers’ experiences with leading benefits management capabilities and clear, comprehensive data views for your ser vice representatives.

TriZetto QicLink is an end-to-end claims processing and administration solution. Its advanced functions, automated processes and integrated workflows equip you to manage diverse lines of business while achieving optimal efficiency. The platform delivers an affordable solution with the features typically used

The healthcare industry offers third party administrators (TPAs) increasing business opportunities as well as challenges in meeting customer expectations, complying with new regulations and controlling costs.

TriZetto ® QicLink™ Core Administration C o p yrigh t 2021 , C ognizant

Gain efficiency with highly configurable and flexible benefit designs that support the rapid introduction of new

Achieve higher business per formance and outcomes with QicLink With the QicLink platform, you can focus on business growth and delivering positive customer experiences. Our end-to-end turnkey solution enables your organization to:Grow and compete integrated par tnerships with a national PPO and dental networks, as well as telemedicine, data analytics, clinical editing, electronic payment/remit and out of-network contracting solutions.

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Community Magazine Group creates custom health and wellness magazines for some of the largest employers in Western New York and Western Pennsylvania. We offer a full suite of print and digital publications, along with wellness survey and engagement tools. GET REAL RESULTS! In Western New York and Southwestern Pennsylvania, Community Magazine Group wellness engagement has led•toQuadrupling of participation in employee wellness programs • Reduction in annualized cost increases from 13% to 3% HEALTH AND WELLNESS YOURPUBLISHMAGAZINE!OWN Want healthier employees? Need to lower the cost of benefits? Learn how your organization can take control of employee wellness. Contact publisher MARK HORNUNG at (773) 573-9794 and mhornung@cmgms.com.

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We are proud to support Managed Healthcare Executive® Yes, we serve millions of people in thousands of locations across the country. But what really matters is the size of our heart. Because every day, in every way, we are passionate about bringing our heart to every moment of your health.™ withHealthheart

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CDH | HSA |dpath.com/tpa-summitCOBRA

DataPath creates innovative solutions that empower third party benefits administrators to go beyond the competition. In fact, we built the industry’s first all-in-one CDH, HSA, and COBRA/Billing platform and deliver industry-leading customer support. We’re always looking for new ways to provide a better, more satisfying experience because when our clients succeed, we do too.

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Enjoy the simplicity of a single payment solution. Convert costly check payments to a true electronic payment platform Eliminate the pain, risk and time involved in the 1099 process Offer customized, consolidated family EOBs No setup or implementation fees INCLUDEDSERVICES Print and postage expense Bank Systemfeesaccess to ECHOSoft and ECHO Unified Interface 1099 MISC processing for all ProviderpaymentsSupport Center Provider Portal CARD | DIGITAL CARD | DIGITAL WALLET | ACH | EFT | VIRTUAL CHECK | PAPER CHECK Payers and administrators who implement ECHO Health typically see well over 90% adoption of electronic payments in the first month, driving substantial savings. ECHO Is The Industry Leading Digital Payment Solution. sales@echohealthinc.com | echohealthinc.com

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HIGHLIGHTS • Able to seamlessly integrate entire network with full access for any RBP or TPA • Licensed as a TPA allowing us to process and pay our bundled providers • Our own NPI number allows for easy set up as a Network option for members • Willing to go 100% at risk for the cost of all surgical procedures, regardless of venue / facility type or location • Will accept 185% of MCR allowed reimbursement for all surgical procedures, and cover any costs owed to a provider above 185% of MCR • Average member travels less than 50 miles for their Surgical Procedure Offer clientsyourthe best of all benefits. Control costs. Improve outcomes. Increase transparency. With SurgeryPlus, employee members gain access to high-quality and carefully selected surgical providers plus a dedicated Care Advocate. In turn, employers realize over $100 in savings per employee on surgical spend on plannable procedures. Offer your clients SurgeryPlus starting today. © SurgeryPlus. All rights reserved. COMPLICATION RATES Procedure SurgeryPlus Industry Avg. Total Joints 0.32% 8.0% Spine 0.81% 13.7% Bariatrics 0.92% 8.4% Avoided Procedures: • 30% of spine consultations • 20% of total joint consultations IMPLEMENTATION TIMELINE Need to re-do the implementation timeline, 2-4 weeks contracting, 2-4 weeks operational set-up (coinciding with contracting), 1 week of cross training, one week of case testing, go live PLAN DESIGN RECOMMENDATION • Waive member cost share on non-qualified plans • Waive coinsurance on qualified plans • Incentives: reduced deductibles, HSA contributions, cash BY THE InvestmentReturnNUMBERSon3.7x Avg. Client ROI 52.3%BundledRates Contract-to-ContractSavingsonSurgicalProcedures StructureFee$0 Administrative Implementation& ComplicationRate<1% Complication + Readmission Rate GuaranteedSavings$115 Avg. PEPY Savings ≈99%SatisfactionClient ClientRateRetention

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Our veteran experience combined with data driven decision making produce an average of 30% savings that can be reinvested in your business. CHOICE • Over 200 potential savings combinations • 9 Pre-negotiated PBM contracts, 6 specialty solutions and 3 Integrated cash solutions • Fully transparent line by line re-price analysis LEVERAGE • Strength and negotiating power through our large network and relationships • Access to superior pharmacy benefit contract options with solid economics, definitions and optics to mitigate pharmacy spend SAVINGS • Continually finding new ways to save and enhance access • Advisory services to drive down cost and continually work on our client’s behalf to mitigate Rx spend • Clinical team and robust programs increase quality of care and affect Rx trends PBM TRANSITION • Ensure all implementation items are completed prior to the effective date • Assist PBM and Client to map current benefit design to new benefit build out • Work with prior PBM to get all necessary transition files transmitted to new PBM MEMBER SERVICE • Proactively identify and address member disruption with white-glove transition plan • Proactively identify any member challenges throughout the year to ensure best in class service and support UTILIZATION & RECONCILIATION • Perform annual financial reconciliations to ensure all contractual guarantees are met by PBM • Provide market updates on any new programs available to help reduce cost • Provide detailed reporting on claim utilization, high cost claim reviews, and cost projections RENEGOTIATIONS • Execute market checks to ensure the client is receiving best is class terms and pricing • Utilize pharmacy experience as leverage in PBM renegotiations Scope of Services & Benefits World Class ManagementImplementation,andConsultingCustom Pharmacy Benefit Contracts & Solutions MemberServiceTransitionPBM Utilization Reconciliation& Market Checks Renegotiations& © Copyright 2021 CoeoRx

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EXPERT MEDICAL BILL REVIEW We ﬁnd savings others miss. SPECIALTY CONTRACTSNETWORKRBPSOLUTIONSOUTOFNETWORKSERVICESWe save you time & eﬀort, improve patient outcomes & generate defensible savings. healthpayerconsortium.com 844-888-1HPC Client First, Always. +

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A nationwide leader delivering health care solutions and services that matter to you and your members, including: • Comprehensive Payer, Member, Provider Services • Preventative, Pre-Treatment, Treatment & Post-Treatment • Cost Containment, Utilization Management & Case Management • URAC Accredited Whether guiding a member through their healthcare experience, ensuring quality care at the right cost, negotiating complex claims settlements, or simply routing claims to an appropriate primary or out-of-network cost containment option, Hines has a full suite of care management services to cover your needs. At Hines, we provide you with a customizable solution at each step. Through our fully integrated set of o erings, we can also partner with you to provide a full network or RBP replacement product, putting you back in the driver’s seat and giving you full control, with less noise, while delivering the same or better ﬁnancial results. Let’s build a better solution for you and your members together OUR SOLUTIONS P R O V I DER FOCUS CLIENT/MEMBER FO C U S Hines offers you the customer service excellence you’ve come to expect from us across the nation – and much more! Hines is committed to delivering best-in-class healthcare solutions with optimal outcomes. We help your members get to the Right Place, at the Right Time, for the Right Care, at the Right Cost. Opus 360 is our comprehensive suite of innovative, non-restrictive, cost avoidance and cost reduction solutions that can serve as an alternative to a traditional Primary PPO Network or RBP solution. Payer Consultation & Analytics Plan NetworkMarketingDesignDevelopment Preventative Maternity Management Wellness, Prevention and Chronic COVIDPredictiveManagementConditionModelingEducationProgram Pre-treatment Utilization MedicalConciergeDirectionalManagementCareServicesSecondOpinion Treatment Behavioral / Mental Health Specialized Case Management Nurse Consultation Services Upfront Negotiations Post-treatment First Level Negotiations Primary Network Access Out-of-Network Solutions ComplexNegotiationsClaims Management Reporting 800-735-1200 hinesassoc.com ACCREDITEDACCREDITED

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Too many TPAs limit their own revenue, their value to their customers, and their ability to di erentiate their services by not taking advantage of innovation opportunities. Every employer client represents an opportunity to establish a special relationship between you and each employer by presenting opportunities for additional value, quality improvements, and cost savings that your competitors can not or are not doing. Ikigai Growth Partners evaluates hundreds of early-stage ﬁrms to ﬁnd the few hidden gems that can add value to all of your relationships: • Digital direct contracting, DPC networks, vendor management, and bundled services • Surgical optimization; faster recovery with almost no opioid utilization • Caregiver support services for employees supporting aging loved ones • Remote musculoskeletal (MSK) triage and virtual expert support • Virtual group mental health therapy • Cardiovascular care reimagined • Virtual allergy immunology care • Blockchain marketplaces for collaborative credentialing and provider directories • More Don’t limit your organization to only those standard services and o erings that mimic your competitors. Add value to your relationships through innovation. Come explore with us. Michael ikigaigrowthpartners.commbrouthers@ikigaigrowthpartners.comIkigaiFounder/PrincipalBrouthersGrowthPartners

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We are fixing health insurance by putting control back in your hands and reducing cost by up to 30%. By helping you navigate complexity. And by protecting your employees’ well-being and budgets. 360-degree member support A deeply supportive member experience provides personal, proactive services for the entire healthcare journey. Care navigators guide your employees to the right care. Our advocacy team makes sure they pay a fair price. Price Provideprotectionaccessto quality care, with protection from overcharges. Reference-based pricing with artificial intelligence (AI) shields employees from skyrocketing healthcare costs and preserves plan Customsavings.plan design Build a plan that best suits you and your employees — including customized programs for pharmacy, stop loss, wellness and more. FULL-SERVICE HEALTH PLAN A comprehensive solution with the savings of reference-based pricing built in Built-in Cost Containment. Concierge Level Support. Flexible Health Plan Solutions info@imagine360.com | imagine360.com Your health plan can do better. We promise.

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ENGINEERING CONNECTED EXPERIENCES FOR SMARTER, EFFICIENT PAYER ENGAGEMENT Provider Credentialing Automate & Reduce the enrollment and credentialing process by 40% EnrollEnrich.io Enrich member experiences while reducing enrollment efforts and errors by 30% Member/provider “super App” Redesign provider engagement with AI-enabled smart integrations AuthEnrich.io Transform experience across stakeholder spectrum with Pre authorization For more details, contact T J Ruesch Vice President, Healthcare Sales, Mphasis Javelina tj.ruesch@eldocomp.com 602.604.3100 javelina.mphasis.com

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We’ve been in your shoes so understand.we 37735 Enterprise Ct. Ste 400 • Farmington Hills, MI 48331 Are you looking for a true extension of your team? See, at JMS we start as a true partner from the very beginning. We have over 300 subject matter experts, and many of them have sat on your side of the desk before. So your challenges? We get them. And it doesn’t hurt that we’ve been around for 45 years. Experience streamlined solutions tailor-made for you. Administrative Professional Technical Mail Room Services & Fulfillment Online Data Entry OCR (Optical Character Recognition) Storage, Retrieval, & Shredding Network Claims Re-Pricing Scanning & Imaging Offline Data Conversion Document Image Hosting & Retrieval Provider & Member Maintenance and Matching Health Plan Benefit Building Health Plan Benefit Auditing Health Plan Benefit Testing Claim Examining Claim Eligibility,AuditingEnrollments, & Cobra FSA, HRA, HSA and DCA Claims Examining Call Center Management Services 1099 Solution Technical Support ADHOC Reporting Custom Software & Web-Based Solutions Managing Your Claims Platform Conversion Supportive, Reliable and Driven by You.

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Magellan Rx Management is a next-generation pharmacy beneﬁt manager on a quest to evolve and inspire the pharmacy industry and lead the world to a healthier future. Connect with us at HCAA and see how we can help manage the total cost of care for your members through: Proven specialty drug savings solutions Comprehensive employee assistance programs Multi-faceted diabetes management and prevention options LEVEL OF CARE A WHOLE NEW

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MedWatch Improving Health. Enhancing Outcomes. Increasing Savings. Comprehensive Services Across the Healthcare Continuum 321-249-9179 sales@urmedwatch.com urmedwatch.com 06/24/2022 Pathways Concierge & Member Advocacy Cost & Quality Transparency Tools In & Out-of-Network Claim Savings Lifestyle Wellness Management Virtual Primary Care EAP with Behavioral Health Support Biometric Testing & Health Assessments 24/7 Physician Telemedicine with optional Behavioral Health Support Nurse Advice Call Line Utilization Management for In & Outpatient Services Medical & Surgical Procedure Precertification Mental Health & Substance Abuse Precertification Pathology & Diagnostic Reviews for Early Identification High-CostRadiologyDiagnosticSavings Bundled Surgical Solutions Baby & Me Maternity Management Dialysis Claim Savings Kidney Care & End Stage Renal Disease Medical Case Management Large Claims Management Specialty Case Management Oncology Care & Oncology Networks Neonatal Case Management Transplant Care & Transplant Networks Trauma & Rehabilitation Case Management Bio-Tech, Infusions, Specialty Drug Reviews Chronic Disease/Condition & Comorbidity Management Chronic Condition Case Management (CCCM) Medical Necessity Reviews 24/7 Diabetic Monitoring & Intervention Pain Management Mental Health & Substance Abuse Case Management Oversite Case Management Bundled Pharmaceutical Solutions Medical Transport Cost Containment Low-Risk Preventive & Advocacy Programs Mild-Risk Programs Moderate to Higher-Risk ProgramsHigh-Risk & Complex Case Programs

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Optimize your healthcare benefits experience now Are you a self-funded employer, TPA or broker looking for a better solution for today’s workforce? Medxoom dramatically improves the healthcare benefits experience fo your members By unifying all key components of your health benefi Medxoom helps match members with the best price vs quality prov driving greater member satisfaction and cost savings. Medxoom does t hard work of integrating all the disparate pieces of the benefits ecosys into one member optimized experience The Problem Healthcare coverage is too expensive. Employers are finding it • 8% Y0Y increases in premiums • 250% increase in deductibles 21 43 Medxoom Solution Pricing • Call or Click for Provider Cost & Quality • Procedure, Test & Bundle Price Comparisons • Clear Picture of Member Responsibility Communications • Group & Personalized Messaging • Concierge Savings & Appointment Alerts • Unified In App, SMS & Email Messaging Identity • Digital ID Cards • Member Claim History • Coverage Details & Plan Docs Payments • Integrated Member Net Due • All-Digital Plan to Provider Payments • Payment Card & Financing Options Modern Member Experience Increased Engagement Cost Savings Tools Comparison Shopping Measurable Savings Save 10 30%+ =

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Putting employees in control Employer visibility into healthcare costs is key to an effective reference-based pricing program. But that’s just the first step. Because employees ultimately drive your healthcare spend, it’s crucial that they also have insight into costs so that they can make smarter decisions about their care.

How

For more information, call 1.833.MYPAYER or visit PayerCompass.com. CompassConnect Features STEP 1 Access the tool dashboard on any device Navigates care through data intelligence Acts as a member resource for plan details and care history Supports plan health and administration Delivers healthier outcomes through digital comprehensive member consumerism CompassConnectEmployeePriceTransparencyTool

STEP 4 Select your provider and receive care STEP 2 Search by

STEP 5 Rate your provider and care experience STEP 3 Compare providers by

CompassConnect is an extension of our patient advocacy services that expands accessible care options to help your employees find conveniently-located providers by specialty and compare them by both the cost and quality of their services. Aggregated information from Payer Compass proprietary data and multiple third-party sources provide cost averages for specific procedures on a provider-byprovider basis. By comparing RBP-friendly providers, employees can make better-informed decisions about who they see and how they spend their healthcare dollars. This leads to increased member engagement, overall improved population health, and reduced healthcare costs for your organization. With the CompassConnect rating feature, employees can rate their provider across a number of factors after they receive care. Back-end reporting of member-specific care metrics combined with these ratings can help you reduce waste and better understand which providers offer the most value to your highest-utilization employees so you can better adjust plan terms to meet their needs. Does CompassConnect Work? provider, specialty, quality rating, and location procedure

cost and quality ratings STEP 6 Member and ratings data makes for smarter plan administration Consumers who prefer digital healthcare solutions 1 ~ 70% Consumers who are concerned about at least one type of medical expense 2 72% 1, 2 insights/healthcare-consumerism-2018https://www.mckinsey.com/industries/healthcare-systems-and-services/our-

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Driving Healthcare Savings to New Heights

CONFIDENTIAL Company Snapshot

Payer Matrix was founded in 2016 as we saw a critical need for a solution to address the rising specialty drug costs and their impact on plan budgets. Our founder and the senior management team have significant experience in the healthcare industry, focused on specialty pharmacy, home infusion, and employee benefits. This experience gives us the unique ability to provide specialized patient advocacy services and ultimately reduce the drug spend to the plan in a meaningful way. As a company, we’ve invested in our human capital, infrastructure, and processes to ensure consistent and quality service. We employ over 100 full time staff dedicated to alternative funding and member services, operating out of four offices providing national coverage. All services are performed in house by Payer Matrix employees, and no member services are subcontracted. Our coordinators have the experience and expertise to drive market leading performance and results.

Our team of Reimbursement Care Coordinators are at the heart of our operations and work directly with members, plan sponsors, physicians, and other providers to provide concierge-level patient advocacy resulting in best in class member experience. Members experience a seamless transition to our program and clinical treatment plans remain the same there is no compromise in clinical care whatsoever. We also believe that if we don’t do our job and save the plan money, we don’t get paid. Our performance-based pricing model has no upfront fees for implementation and onboarding or any fixed monthly fees for comprehensive reporting and analytics. Our results speak for themselves. About Us 350+ Plans on Specialty Drug List Focused on 300+ single source specialty brands, including rare/orphan drugs

In100+Covered325on4,000service+MembersSpecialty,000+TotalLivesDedicated-houseFTEs

Strong Partnerships Established partnerships and integrations to streamline operations (PBMs, TPAs, Stop loss) Payer Matrix, LLC (877)

rate >$100

in plan savings

Alternate Funding/Sourcing Leverage several forms of assistance, including PAP, CAP, foundations, and other methods www.payermatrix.com305-6202>90%fundingsuccess million

Finding a Strong Partner

Our History

Specialty medications have provided significant clinical breakthroughs in a variety of disease states, but that clinical success came with a very high price tag. Typically, only 2 3% of members and 1% of claims account for 35-60% of prescription drug spend for an average self funded plan. Our patient advocacy program specifically addresses specialty drugs for both the pharmacy and medical benefits and provides significant potential savings to the plan.

Real Savings and Best-in-Class Service

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Prevent, delay, stop, or reverse kidney disease with ImpactCare. The only program of its kind, ImpactCare combines early identification with specialized clinical intervention and management. Registered Nurses work with members to slow the progression of kidney disease, preserve or improve kidney function, improve overall health, and reduce the cost of care for members who might otherwise progress to end-stage renal disease. 99.7 percent of participating members have avoided dialysis.

Early, specialized clinical intervention

Navigate members to lower cost, highquality treatments

The costs of chronic kidney disease (CKD) and dialysis are catastrophic for health plans and their members, but proactive and preventative action pays off Renalogic enables health plans to identify and get ahead of hidden CKD risk. Renalogic’s flexible repricing solution, ImpactProtect, protects self-funded plans from devastating, high-cost dialysis claims.

By analyzing biomarkers, claims data, and member and provider-reported information, ImpactIQ identifies health plan members with diagnosed CKD, undiagnosed CKD, and those with an increased risk of developing CKD due to comorbidities and health trends. Identify hidden CKD risk

SCAN TO LEARN MORE Renalogic • Phone: 888.808.9380 • Renalogic.com • Sales@renalogic.com

Over the past 20 years, Renalogic has saved clients more than $760 million on billed charges. Today, Renalogic works with over 400 self-funded plans across the country.

Clients save 82 percent on net claims. Reduce catastrophic claim costs

AdvocateCare ProtectIQ Protect Plan Assets and Reverse the Progression of Chronic Kidney Disease

ImpactProtect typically saves clients between $100,000 and $200,000 per member and keeps claims’ costs below the stop-loss specific deductible.

ImpactIQ enables third-party administrators to identify, stratify, and quantify the hidden risks posed by CKD.

ImpactAdvocate is a comprehensive advocacy program that helps members traverse the challenging healthcare Supportinglandscape. members with Stage 4 or higher kidney disease, ImpactAdvocate helps members understand their clinical and coverage options, as well as which treatment options might yield the highest quality results at the lowest costs.

Managing chronic disease conditions can be overwhelming and confusing for plan members.

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Copyright 2022 Ringmaster Technologies®, Inc. All rights reserved. Built exclusively for Stop-Loss IncreaseYourTopLine! It’s theStepSimple!IntoRing! Ringmaster Technologies will help you get there by utilizing our transformative technology built exclusively for Stop-Loss. Ringmaster Technologies is a cloud-based, healthcare software provider. We build our products exclusively to simplify, enhance and drastically reduce the complexity and time necessary for Stop-Loss quoting, contracting, and policy administration. Our cloud-based Stop-Loss products include: Connect with us today to learn how our suite of products will increase your top line. 330.648.3700 • rmtsales@ringmastertech.com • www.ringmastertech.com Market Bind Administer Renew

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©2022 Serve You 220125SA(0522)Rx For a quote or meeting, email sales@serveyourx.com. ServeYouRx.com Bigger isn’t Better. Better is Better. Next time you bid a PBM contract, give us a shot. Let us show you how some of the smallest things can make all the difference in the world. At Serve You Rx, it’s the little things that make all the difference. Being big has nothing to do with being better. Rather, we argue that huge PBMs rarely care about the little things – which, actually, are a pretty big deal. • Quick responses to service requests • Adaptable and easy data exchange by accepting your eligibility and accumulator file formats • Full customization of plan designs, including specialty drug management and carve-out solutions • Nimble to accommodate tight implementation timelines (no cut-off at 90 days) • Flexible billing practices and contracts, including TPA master agreement option • Collaborative and cooperative with your third-party vendors • Transparent pricing so you know where dollars are going

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Plan sponsor is charged the exact price the pharmacy is paid. We pass all discounts and rebates that we secure at 100% to the plan sponsor. southernscripts.net

100% Pass-ThroughTransparent,Pricing&Rebates

A customer-focused transparent and pass-through approach. A full suite of innovative tools and programs. Signiﬁcant savings. This is a better way to manage your pharmacy beneﬁts.

(800) 710-9341 solutions@southernscripts.net

LowestApproachNet-Cost Our robust clinical management program and high-performance drug formularies deliver the lowest net cost to protect plans from unnecessary expenses.

A Different Kind Of Pharmacy Beneﬁt Manager

Southern Scripts is a proven partner to a growing number of plan sponsors across the nation. We’re helping them drive dramatic results. We can do the same for you. All-Inclusive Administration Fee No additional fees for prior authorizations, step therapy, reporting, ID cards, or any other plan feature/bene t for standard PBM services.

Southern Scripts is a leading pharmacy bene ts manager (PBM) founded by pharmacists to reinvent the traditional PBM approach. Our innovative pass-through PBM model and exible solutions empower plan sponsors to achieve maximum cost savings, decreased risk, and optimum versatility in plan design to achieve true patient-centered clinical care at the lowest net cost.

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Corporate Solutions Insurance products underwritten by Westport Insurance Corporations and North American Specialty Insurance Company. © Swiss Re 2021. All rights reserved. Employer Stop Loss: Limit Health Care Exposure. Advancing Self-funding Together. You want unparalleled customer service. Employers need the right stop loss coverage. At Swiss Re Corporate Solutions, we deliver both. We combine cutting-edge risk knowledge with tech-driven solutions and a commitment to put our customers first. We make it easy to do business with us and relentlessly go above and beyond to make stop loss simpler, smarter, faster and better. We’re addressing industry inefficiencies and customer pain points, moving the industry forward – rethinking employer stop loss coverage with you in mind. corporatesolutions.swissre.com/esl

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Are your groups PROTECTED? Ask yourself the following questions: Are our groups safe from the financial penalties? Does our transparency partner take care of multiplexing and layering all our negotiated rate agreements, so the shopping experience identifies ONLY the correct price based on the plan documents? Can our system deliver the required shopping experience including accurate estimates of encounter costs both at plan-level and subscriber level all with network guidance? Are eligibility updates, plan design feeds, consumption accumulators, QPA, and Advanced EOBs fully automated? Have we protected ourselves and our clients from costs for accessing and downloading publicly accessible files? Have we architected a compliance solution that scales and will work for the long-term? 1 2 3 4 5 6 YourFinesTransparencyAreHere.ClientsAre ON THE HOOK. They WILL Hold You Accountable. Your clients are facing potentially budget-breaking penalties of $100 per member, per day fines if they fail to comply with the mandates. Your clients could be OVERPAYING for healthcare by 40% or MORE due to extreme price variations in the Yourmarketplace.clientsarefacing record employee attrition. THE FACTS TALON protects your clients from overpaying for care while integrating seamlessly into existing TALON’sarchitectures.MyMedicalShopper platform empowers members to take an active role and make smart decisions about their own care. TALON’s platform was the model used when Transparency in Coverage was defined under the ACA. Deliver a 20-40% Reduction in Medical Cost and Premiums, and Achieve Full Compliance Let’s talk TODAY! TALONhealthtech.com The Time to Act is NOW. CONTACT SALES, sales@TALONhealthech.com • 603.292.3020

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Phone: 781-535-5600 Email: info@phiagroup.com Website: phiagroup.com THE PHIA GROUP’S SERVICES Learn Plan Save Protect The Phia Group is Empowering Plans to Contain Costs Through Comprehensive Consulting, Legal Expertise, Innovative Plan Design, Superior Claim Negotiation & Unrivaled Recovery Services Independent Consultation & Evaluation (ICE) General Consulting & Third-Party Agreement Review Family & Medical Leave Act - Policy Review & Drafting Phia Document Management® (PDM) & The Flagship Template Plan Drafting Services - Including Wraps & SBCs Gap Free Review® - Including Stop-Loss & Employee Handbooks Subrogation & Reimbursement Overpayment Recovery Claim Negotiation & Sign-Off (CNS) Phia Unwrapped - Out of Network Solution Plan Appointed Claim Evaluator® (PACE) Balance Bill Resolution & Reference -Based Pricing Support Patient BalanceDefenderBillSafeGuard Protect:Learn:Plan:Save:

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At TPAC, we’re changing the way healthcare is financed, disclosed and delivered. Contact us today at info@tpac.com. You’ll Mind Us Telling You NO WE DON’T THINK tpac.com NO ExperienceClaims TPAC can provide a quote based on population demographics. NO QuestionnairesIndividual Save your team the hassle of collecting employee responses. NO Problem We face challenges directly and work with you to find solutions.

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Find the best pathway to control and stability for your clients’ health plan costs.

By providing strategic guidance and consultation throughout the year, our team of experts facilitates informed, data-driven decisions and helps build a stable health plan that is customized for your clients’ unique needs. Our investment means we are motivated to work closely with the group to optimize the plan, control high-cost claims, and give employees the best healthcare at the best cost.

With True Captive’s True FundedTM program, small to mid-sized businesses receive access to the self-funded model traditionally reserved for the largest employers. We are the only captive in the country that invests up to 95% of the required collateral in each of our member groups – easing the transition to self-funding, sharing the risk, and creating true alignment.

Learn more about the True Captive difference – schedule a discovery call today at 913-370-7123!

Partner with the country’s fastest-growing healthcare captive.

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for smarter, better, faster healthcare.

•

Learn more about how Valenz engages early and often Contact us today at (866) 762-4455 or visit us

Vālenz® simplifies the complexity of self-insurance by offering an end-to-end Healthcare Ecosystem Optimization Platform that manages the cost and quality of care for employers and their members. To balance the relationship between healthcare quality, advocacy and cost, the Valenz enterpriselevel solution suite aligns the member, provider and payer. Supported by a dynamic, innovation-first culture and steadfast commitment to data transparency and decision enablement Valenz drives value across clinical and member advocacy, network development and the validation of integrity and accuracy (VIA) of claims.

•

Experience the Vālenz® Healthcare Ecosystem Optimization Platform

at valenzhealth.com.Clinical and Member Advocacy Validation. Integrity & Accuracy √ Concierge–level navigation √ High quality providers/centers of excellence √ Care management programs √ Disease-specific programs √ Behavioral health √ Virtual care √ Credentialing √ Compliance Management √ High Quality Provider Networks √ VMS® Repricing √ Bill Review √ Payment accuracy & integrity √ Claim Review 8:1 ROI Care Navigation & Management 20–40% Ecosystem Savings Improvements 061722

(866) valenzhealth.com762.4455

Instead of year-over-year increases in healthcare costs, plan sponsors realize improved cost-savings and member health outcomes with Valenz. It’s time to simplify the complexity of self-insurance with: Unbundled solutions for greater control over cost, quality and utilization Network innovation to lower costs of care A better member experience and deeper engagement for improved care outcomes Access to real-time data to improve payment accuracy, and predict and control plan costs

•

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HEALTHCARE TECHNOLOGY That Moves You Forward vbasales@vbasoftware.com | 1.866.731.1571 | vbasoftware.com No matter what your technology needs are, VBA has a solution for you. Highly configurable and scalable across multiple lines of business, VBA provides solutions for claims administration, member engagement, customer service, business insight and more. WHY CHOOSE VBA? Flexible Choose fully integrated or standalone solutions Evolving Software releases per year10+ U.S. Based Staff, development and support100% Reliable 99.999% uptime Highly Configurable To support many lines of business Thousands of APIs Available to seamlessly integrate with your existing architecture Experience how powerful VBA’s solutions can be for your business. Schedule a demo today to learn more. Administer multiple lines of business on a single, easy-to-use platform VBASoftware Personalized online experience for Members, Providers, Employers and Brokers/Agents VBAGateway Gain actionable insights to manage population health VBAnalytics Multi-channel solution with IVR, Live Chat, Text and Emails VBAVoice Enable interoperability with thousands of APIs to create your own user experience VBAPI

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Introducing Virgin Pulse Predictive Analytics Tools Empowering data-driven plan designs, confident program selections, and benefits initiative success Our predictive analytics tools help clients optimize, save, and avoid costs when designing and evaluating their benefits programs. More than 60% of employees have trouble drawing meaningful conclusions from their data. Using our analytics offerings, you get the tools you need to monitor costs and better understand – and solve for – emerging risks within your populations. The world’s #1 health and wellbeing platform, now even better with predictive analytics tools. Ready to make a change? Let’s talk. Visit us at table #2 or at virginpulse.com 275 million Consumer and SDoH data points 1500+ Predictive Models Risk + Receptivity + Impactability

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WLTSOFTWARE.COMSteadfast Service for Adaptive Solutions Our administration and processing capabilities encompass a range of benefit and claims types from standard Medical, Dental, Vision, and Prescription Drug to FSA, HSA, HRA, COBRA, Disability, and HMO Capitation. In addition to the core features of our systems, we offer a wide range of supplemental solutions to further enhance the functionality of our systems including: ( UCR and Medicare Referenced Pricing ( Benefit Plant Informatics ( Plan Modeling ( CDH Benefits Card ( Medicare AdministrationSupplement ( Mobile-responsive Web Portal Realize a cost-effective, straightforward, and efficient approach to benefit and claims administration with the MediClaims system’s core features including: ( Multi-Line Benefit Eligibility Management and Reporting ( Integrated EFT and EDI Routing ( Premium Billing and Agent Commissions ( W2 and 1099 Reporting ( CMS Reporting ( Consumer Driven Healthcare ( Precertification and Case Management ( Provider Data Management ( PPO Administration and Repricing ( Automated Claim Adjudication ( Workflow Management ( Capitation ( Currency Conversion Claims SoftwareManagement

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OUT OF NETWORK Solution Brief zelis.com © 2022 Zelis Out-of-Network Solutions Achieve the optimal balance between savings and abrasion with a combination of savings channels, experience, analytics, and continuous improvement – all orchestrated by technology for the best results on every claim. Claim Intake Optimal Savings Zelis IDR SupportZelis Claim Settlement Flexible Options &AnalysisEvaluation • Net Cost of Claim • Client Parameters • NSA Status Select and Apply Optimal Savings Channel OONOtherNSA PricingMarket-BasedMedianINN Rates Market-BasedPricing NetworksNegotiations Repriced ClaimReturned If Provider Seeks ArbitrationIf Provider Disputes •E•EOBOP NotOON/NSA NSA Provider & Market Insights Zelis Dynamic Optimization Engine Outdated reimbursement strategies lead to overpaying on out-of-network claims, and the difference can mean millions of dollars. The most successful cost management programs include a combination of savings channels orchestrated by technology, experience, and analytics. The Zelis model uses our dynamic optimization engine called ClaimPass. Its adaptive configuration allows clients to set parameters and tolerances, balancing savings with abrasion to define the best outcomes based on plan goals. Zelis’ multi-layered approach dynamically drives each claim to the optimal savings channel, delivering quality savings on every claim. Our continuous analysis of results is used to inform and enhance all solutions and services. BALANCED Approach Finds the optimal mix of savings and abrasion PRECISION Focus Applied at the claim-byclaim level SMART Adaptation Uses market, provider, and situation-specific factors FLEXIBLE Tailoring Configured to client parameters and tolerances Experience savings on all out-of-network claims. Get started with an impact analysis by contacting surprisebilling@zelis.com 1As defined by the Requirements Related to Surprise Billing, Part I Interim Final Rule. with care. Pay for care,

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Breakthrough Complex Challenges Zipari’s Solutions Support TPAs with: Learn more and schedule a demo: cx@zipari.com Zipari is the first and only CX platform built exclusively for health insurance. PlatformPowered Secure Compliant& DeploymentRapid ReadyLaunchtoBuilt-in Workflows Seamless Implementation

Superior Member Experience Reduce call center utilization, boost self-service engagement, and improve member satisfaction scores with a solution that delivers personalized next-best-actions and relevant communications to members via their preferred channels and gives TPAs unparalleled insights.

Grow

At Zipari, we create targeted solutions and deliver data-driven insights that help TPAs: Drive efficient growth with streamlined and holistic acquisition and retention tools Deliver better consumer experiences that are engaging, efficient, and personalized Guide healthier member actions, influenced by prioritized and sequenced recommendations Orchestrate operational efficiencies across sales and service with unparalleled consumer insight

Comprehensive Sales Experience membership, increase retention, and optimize sales operations with integrated, comprehensive sales technologies that automate processes and alerts to fuel revenue streams and help TPAs close deals faster.

THE ONLY CX PLATFORM BUILT FOR THIRD PARTY ADMINISTRATORS

The price of doing business can be high for TPAs — and so are the stakes — growing membership in an increasingly competitive environment, creating efficiencies and managing operational costs, and delivering concierge engagement and best-in-class call center experiences.

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Content Not sure how to engage and educate your prospect and clients? Integrate your content with the insurance industry’s most comprehensive content library in a single, easy-to-use content management platform for client-facing professionals to build internal expertise and deepen client trust.

Are you challenged finding and writing new business, while providing the best service to renew current clients? Enable your agency with world-class technology to automate your everyday tasks, so that you can deliver superior value to your prospects and clients.

Sales & Renewal

Discover the right solutions for your business. With Zywave, you can transform the way you acquire new prospects, service existing clients and market your organization. Zywave Cloud Solutions

Claims & Loss Analytics

Client Services Do your clients need a trusted advisor? Help them discover consulting and fee-based service opportunities by providing your clients the self-service resources and tools they need to stay compliant, manage risk and build a better workforce.

Growth-Driven

Do you have the answers to the analytical questions your clients are asking? Whether your clients need help evaluating their benefits or P&C claims, show off your ex pertise by deciphering their data. Insurance Solutions

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88 | HCAA Executive Forum Sponsorship Guide Fall 2022 Company alaffia health Additional 2022 Sponsors

HCAA Executive Forum Sponsorship Guide Fall 2022 | 89

90 | HCAA Executive Forum Sponsorship Guide Fall 2022 Company

HCAA Executive Forum Sponsorship Guide Fall 2022 | 91Company ROS attor ney s russell oliver & stephens

SAVE THE DATE! February 20-22, 2023 BELLAGIO – LAS VEGAS | #HCAAEXECFORUM | HCAA.ORG

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