MedHOK’s Unified Payer Platform provides functionalities throughout the entire continuum of care, across both Medical and Pharmaceutical care for all lines of business. MedHOK aggregates data from a payer’s many disparate sources, applies algorithms to cleanse and normalize data, and feeds it into an end-to-end SaaS-based platform, creating a true, enterprise-wide surveillance platform. This unique, one-of-a-kind marriage of medical claims, pharmacy, and lab data, enables payers to identify and target member health risks, intelligently trigger workflow interventions, improve quality of care, and positively impact revenue—and do so from a single platform.

MedHOK's spectrum of applications cover all of the functionalities needed for value-based healthcare management:

• Member Engagement - Enrollment, Eligibility, Sales and Marketing, Grievances, Appeals, Member Portal, and 360Member
• Medical/Rx Care - Care Management, Disease Management, Model of Care, Utilization Management, Pharmacy Prior Authorization, Medication Therapy Management, Specialty Pharmacy Management, Pharmacy Appeals, Drug Utilization Review, and External Review
• Pay for Quality - HEDIS, Stars, Gaps in Care Management, Pay for Performance, Risk Adjustment & Data Validation, Process Improvement/Root Cause Analysis, and Financial Reconciliation
• Stakeholder Collaboration - Provider Disputes, Provider Portal, 360Provider, Compliance Action Tracker, and Compliance Reporting