Conifer Payer Operations for Providers

Conifer Payer Operations for Providers helps you with the necessary technology infrastructure and management oversight to support licensed health plan operations. If you already have a health plan solution, our platform can help you improve performance so you can focus on delivering quality care and pursuing strategic opportunities. Our centers of excellence perform claims operations, eligibility and enrollment, care management (including prior authorization and concurrent review), network management, and customer and provider relations services to meet the needs of your participants and providers.

Key Benefits

  • Launch a health plan or receive delegated risk from a payer
  • Achieve efficiencies by leveraging Conifer Health’s expertise and experience with larger health plan operations
  • Tailor your health plan solution to meet relevant claims processing requirements
  • Focus on the delivery of quality care to members, while managing the financial risk associated with the cost of care

We have URAC accreditation for health utilization management, case management, and transitions of care services.*

URAC Accredited Case Management Expires 10/01/2022
URAC Accredited Transitions of Care Expires 10/01/2022
URAC Accredited Health Utilization Management Expires 10/01/2022

*URAC accreditation through Conifer Care Continuum Solutions, a Conifer Health Solutions, LLC.

Network Management Including Incentive Design

Health plan success starts with the network. Conifer Health can build and manage your health plan’s network to help ensure alignment of clinical and financial goals.

Medical Management

Understanding and coordinating the care of the population is core to driving value in the health system. Our medical management team leverages the strengths of our ConiferCore® Population Health Intelligence platform.

Member Engagement

Conifer Health has the infrastructure to help you provide excellent and attentive service to improve member satisfaction and address member issues as they arise.

Third-Party Administration

Use Conifer Health to deliver superior administrative services that afford competitive advantage to your health plan without having to build the internal staffing and management to perform daily health plan functions.

Financial Reporting and Performance

Manage your health plan’s performance and support compliance with accounting and reporting requirements. Conifer Health can provide proactive reports which help you identify performance opportunities, benefitting from years of health plan experience and benchmarks.

“We knew the sooner we had a platform in place to help guide us in managing the population, the sooner we could achieve the goals of our value-based contracts”

Brian Christoper,
Vice President of Administration,
KentuckyOne Health Partners

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