Department / Workflow

Key Processes

Enterprise Software Vendors (URLs)

Enrollment & Eligibility

Member onboarding, eligibility verification

HealthEdge (https://www.healthedge.com), TriZetto QNXT (https://www.cognizant.com/trizetto), Plexis (https://www.plexishealth.com)

Claims Management

Adjudication, repair, payment integrity

NewgenONE (https://newgensoft.com), Pega (https://www.pega.com), HealthEdge (https://www.healthedge.com)

Provider Lifecycle Mgmt (PLM)

Provider onboarding, credentialing

NewgenONE (https://newgensoft.com), VerityStream (https://veritystream.com), symplr (https://www.symplr.com)

Appeals & Grievances (A&G)

Member/provider disputes, case tracking

NewgenONE (https://newgensoft.com), Pega (https://www.pega.com)

Care/Utilization/Disease Mgmt

Care coordination, UM/CM/DM workflows

ZeOmega (https://www.zeomega.com), Casenet TruCare (https://www.casenetllc.com)

Compliance & Audit

HIPAA, CMS, NCQA reporting

Simplify Healthcare (https://www.simplifyhealthcare.com), NewgenONE (https://newgensoft.com)

Department / Workflow

Key Processes

Enterprise Software Vendors (URLs)

EHR/EMR

Clinical documentation, interoperability

Epic (https://www.epic.com), Cerner/Oracle Health (https://www.oracle.com/health), Meditech (https://www.meditech.com)

Scheduling & Appointments

Patient access, calendar management

athenahealth (https://www.athenahealth.com), Allscripts (https://www.allscripts.com)

Revenue Cycle Management (RCM)

Billing, claims, denial management

Change Healthcare (https://www.changehealthcare.com), Waystar (https://www.waystar.com), Experian Health (https://www.experian.com/healthcare)

Clinical Departments

Oncology, cardiology, radiology workflows

Philips IntelliSpace (https://www.philips.com/healthtech), GE Healthcare (https://www.gehealthcare.com)

Diagnostic Imaging & Labs

Radiology, pathology, lab workflows

Siemens Healthineers (https://www.siemens-healthineers.com), Roche Diagnostics (https://diagnostics.roche.com)

Care Coordination

Interoperability, discharge planning

Epic Care Everywhere (https://www.epic.com), Innovaccer (https://innovaccer.com)

Department / Workflow

Key Processes

Enterprise Software Vendors (URLs)

Clinical Trial Mgmt (CTMS)

Trial planning, site mgmt, patient recruitment

Medidata (https://www.medidata.com), Oracle Siebel CTMS (https://www.oracle.com/industries/life-sciences)

Lab Mgmt (LIMS)

Sample tracking, data integrity

LabWare (https://www.labware.com), Thermo Fisher LIMS (https://www.thermofisher.com)

Regulatory Affairs

FDA submissions, compliance

Veeva Vault RIM (https://www.veeva.com), ArisGlobal (https://www.arisglobal.com)

Manufacturing (MES)

Batch production, quality assurance

Siemens Opcenter (https://www.plm.automation.siemens.com), Rockwell Automation (https://www.rockwellautomation.com)

Enterprise Resource Planning (ERP)

Finance, supply chain, HR

SAP S/4HANA (https://www.sap.com), Oracle NetSuite (https://www.netsuite.com)

Commercial & CRM

Salesforce automation, KOL mgmt

Veeva CRM (https://www.veeva.com), Salesforce Health Cloud (https://www.salesforce.com)