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Healthcare Payer Solutions & Administration Software | Salesforce CA
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Build trusted member relationships with Agentforce.

Curate trusted, member-centric experiences in every interaction with humans and AI agents working together to serve members, providers, brokers and partners on a unified platform. Automate workflows across enrollment, claims management, and member engagement to boost productivity and long-term satisfaction all with an industry-specific, AI-powered healthcare CRM.

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Leading payers trust Salesforce to deliver smarter operations and connected member experiences.

Humana [Humana]
CDPHP [CDPHP]
Sentara Health [Sentara Health]
Community Health Choice [Community Health Choice]
United Health Group [United Health Group]
AXA Health [AXA Health]

Streamline member journeys from enrollment through ongoing care management.

Scale contact center experiences.

Guide members through a connected health journey and transform interactions into trusted relationships.

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Give Customer Support Teams the Tools They Need to Succeed

Empower service teams with the right tools for success. Improve service team productivity with intelligent workflows powered by Agentforce. Automate caller validation, streamline relationship mapping, track interactions seamlessly, and simplify call wrap-upsall within a connected, AI-driven platform.

A portal that verifies patient information shows name, last 4 digits of social security number, birth date, member ID, and zipcode. [A portal that verifies patient information shows name, last 4 digits of social security number, birth date, member ID, and zipcode.]

Ensure Positive Customer Experiences

Easily audit caller interactions to ensure compliance and maintain a high standard of quality across the spectrum of digital channels.

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Personalize Member, Provider, and Third-Party Partner Interactions

Create personalized inbound and outbound interactions with real-time 360-degree views that offer relevant member, provider, and third-party partner information.

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A portal that verifies patient information shows name, last 4 digits of social security number, birth date, member ID, and zipcode. [A portal that verifies patient information shows name, last 4 digits of social security number, birth date, member ID, and zipcode.]
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Strengthen provider networks.

Leverage the power of a single, connected system to quickly grow, manage, and improve collaboration across your network of quality providers.

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Harmonize Provider Network Contracting

Manage the contract lifecycle, track negotiations, and capture communications to support strategic provider relationship management decisions, while optimizing reimbursement rates and ensuring regulatory compliance. Leverage a 360-degree view of each provider with unified data across channels.

A performance dashboard shows a new scheduled appointment and a received document portal. [A performance dashboard shows a new scheduled appointment and a received document portal.]

Automate Credentialing and Monitoring

Accelerate provider credentialing from weeks to days and improve data quality with direct-to-source integrations, automated primary source verification, and continuous ongoing monitoring.

A dashboard shows a prompt to add contacts to campaigns, and displays a recommended journey. [A dashboard shows a prompt to add contacts to campaigns, and displays a recommended journey.]

Simplify Provider Data Management

Consolidate provider information into a single operational data layer, enabling roster management, data validation, and seamless integration across systems to improve operational efficiency and maintain accurate provider directories.

A personalized home page for providers to see the status of their aplication and conveniently manage their data. [A personalized home page for providers to see the status of their aplication and conveniently manage their data.]

Offer On-Demand Self-Service

Enable providers to see the status of their applications and conveniently manage their profiles, issue resolution, and care processes with intuitive, easy-to-use portals focusing on a better provider experience, higher provider engagement.

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A performance dashboard shows a new scheduled appointment and a received document portal. [A performance dashboard shows a new scheduled appointment and a received document portal.]
A dashboard shows a prompt to add contacts to campaigns, and displays a recommended journey. [A dashboard shows a prompt to add contacts to campaigns, and displays a recommended journey.]
A personalized home page for providers to see the status of their aplication and conveniently manage their data. [A personalized home page for providers to see the status of their aplication and conveniently manage their data.]
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Promote integrated care management.

Empower care teams to achieve cost-effective outcomes and experiences.

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Promote Safety and Reduce Readmissions

Conduct comprehensive medication reviews, reconcile therapies, detect drug-to-drug interactions, and document discrepancies and recommendations.

A dashboard shows a comprehensive medical review and medical distribution. [A dashboard shows a comprehensive medical review and medical distribution.]

Source and Unify Data to Drive Insights

Unify sources of member health data like claims, labs, pharmacy, EMR, assessments, and social determinants to drive stratification insights.

A care plan wizard dashboard with a pop-up to add social determinants of health. [A care plan wizard dashboard with a pop-up to add social determinants of health.]

Engage Members for Optimal Outcomes

Calculate unified health scores, identify at-risk members, and enroll them in care programs to address their needs and improve adherence.

An engagement overview and a pop-up of customer details including their journey. [An engagement overview and a pop-up of customer details including their journey.]
A dashboard shows a comprehensive medical review and medical distribution. [A dashboard shows a comprehensive medical review and medical distribution.]
A care plan wizard dashboard with a pop-up to add social determinants of health. [A care plan wizard dashboard with a pop-up to add social determinants of health.]
An engagement overview and a pop-up of customer details including their journey. [An engagement overview and a pop-up of customer details including their journey.]

Streamline benefit sales and administration.

Transform quoting, enrollment, benefits management, and renewals to seamlessly convert and retain members.

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Visualize and Improve Plan Performance

Accelerate your leads and relationships with actionable data and predictive AI for small and large groups.

A user interface that explains benefits and administration. [A user interface that explains benefits and administration.]

Maximize Sales Productivity with Assistive Tools

Save your sales team time with automated emails and next best actions that leverage account insights.

A group sales dashboard shows automatic generation of email by Einstein assistant. [A group sales dashboard shows automatic generation of email by Einstein assistant.]

Simplify Plan Shopping

Provide a seamless enrollment experience for your employee admins and brokers with options to quickly filter, compare, and check out.

An interface shows medical plan shopping for health insurance with selected plans, available plans, and best match. [An interface shows medical plan shopping for health insurance with selected plans, available plans, and best match.]
A user interface that explains benefits and administration. [A user interface that explains benefits and administration.]
A group sales dashboard shows automatic generation of email by Einstein assistant. [A group sales dashboard shows automatic generation of email by Einstein assistant.]
An interface shows medical plan shopping for health insurance with selected plans, available plans, and best match. [An interface shows medical plan shopping for health insurance with selected plans, available plans, and best match.]

Modernize utilization management.

Speed time to care with electronic intake, review, and tracking of prior authorizations, concurrent or retro-reviews. Automate workflows and leverage AI to drive reporting and compliance throughout the authorization process. Proactively mitigate against SLA breaches and ensure timely responses that are customized to member plan and service.

Automate Omnichannel Intake

Eliminate back-and-forth processes with DaVinci-compliant FHIR APIs, enabling providers to electronically submit and track requests in real time. Equip admin teams with a unified view of all member interactions, documentation, and automated form field extractionenhancing accuracy and efficiency across channels.

Electronic prior auth and text extraction [Electronic prior auth and text extraction]

Streamline Care Decisions

Intelligently route and prioritize requests to the appropriate reviewers to ensure rapid responses. Assess medical necessity with evidence-based criteria to enable appropriate care determinations. Promote transparency into approved, denied, and appealed claims with real-time coverage alerts.

Prioritized care requests, recommendations, and notifications [Prioritized care requests, recommendations, and notifications ]

Drive Efficiencies and Optimize Value Networks

Leverage AI-powered insights to identify historical diagnosis patterns and determine auto-approval rules for common procedures. Use predictive analytics to manage network adequacy, make intelligent decisions to improve program effectiveness, and maintain compliance for regulatory standards.

SLA breach predictions and services pathway recommendation [SLA breach predictions and services pathway recommendation]
Electronic prior auth and text extraction [Electronic prior auth and text extraction]
Prioritized care requests, recommendations, and notifications [Prioritized care requests, recommendations, and notifications ]
SLA breach predictions and services pathway recommendation [SLA breach predictions and services pathway recommendation]
Build your payer solution with the following Salesforce products:

Build your payer solution with the following Salesforce products:

Health Cloud

Connect data and teams, automate processes, and personalize engagement on a single, intelligent platform to improve outcomes.

Learn more

Data 360

Empower teams to engage customers at every touchpoint, with relevant health insights and contextual data in the flow of work.

Learn more

MuleSoft

Integrate data from any system and automate complex tasks to deliver connected customer experiences, faster.

Learn more

Einstein AI

Create customizable, predictive, and generative AI experiences to fit all your business needs safely.

Learn more

Analytics

Help your entire team find important answers and start making data-driven decisions.

Learn more

Marketing Cloud

Personalize customer experiences and optimize each campaign with data-first enterprise solutions for any channel and device.

Learn more

Sales Cloud

Grow your health business with enhanced productivity, intelligent sales, and streamlined forecasting.

Learn more

Learn new skills with free, guided learning on Trailhead.

Keep up with the latest payer trends, insights, and conversations.

Forrester [Forrester]
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Learn how Salesforce empowers healthier connections.

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Salesforce for Payers FAQ

What is Health Cloud?

Health Cloud is a healthcare payer administration software that allows health plans to influence better health decisions, improve the member and broker experience, and reduce the cost of care through collaboration. Learn more.

Why are healthcare payer solutions important for my business?

Payers need a single source of truth for all their member, broker, and provider data. Rather than siloed point solutions, it is crucial to have a consolidated view of everything on a connected platform. This drives productivity and optimal services and outcomes.

What are the benefits of healthcare payer administration software?

Health Cloud advances the ability of healthcare systems to drive stronger member relationships with out-of-the-box functionality. With it, organizations can manage the entire member journey from prospect to enrollment, provider selection, benefits administration, service, care support, billing, and more.

How do I choose the right healthcare payer solutions and administration software for my business?

Look for a solution architected for flexibility with tools that help you deliver innovation quickly. Consider the total cost of ownership of any healthcare solution including the ability to integrate with other digital and third-party solutions, uptime, access to advanced features, ongoing support, and implementation.

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