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Healthcare Payers


Our renowned solutions for healthcare payers are designed to revolutionize your operations, drive efficiency, and enhance member experiences. From streamlined claims processing to advanced analytics and member engagement tools, Sonata Software empowers you to stay ahead in the rapidly evolving healthcare landscape, delivering exceptional value to your clients and ensuring your organization's success.

Healthcare Payers

World Class Service Offerings for Payers

Sonata Software's seamless claims administration solutions and industry-proven frameworks aim to streamline and automate these processes, ensuring accurate and timely claims processing while minimizing errors and improving operational efficiency.

Provider Engagement & Credentialing

Our solutions enable payers to engage with providers and streamline the credentialing process, reducing administrative burden and improving compliance.

Provider Network Management

Sonata offers end-to-end solutions for managing provider networks, including contract management, claims processing, and performance assessment.

Revenue Cycle Management

Our revenue cycle management solutions help payers optimize claims processing and improve financial performance while reducing administrative overhead.

Business Process Improvement

Sonata's business process improvement solutions help payers identify and eliminate inefficiencies in their operations, improving productivity and reducing costs.

Encounters & PDE Management

Our solutions enable payers to manage encounters and PDE data, improving compliance and optimizing revenue.

MSP Validation

Sonata's MSP validation solutions help payers identify and manage Medicare Secondary Payer (MSP) cases, ensuring compliance and reducing financial risk.

Pricing Management

We offer solutions to help payers optimize pricing and improve financial performance while maintaining compliance with regulations.

Financial Reconciliation

Our financial reconciliation solutions help payers manage financial transactions and improve accuracy, reducing errors and improving compliance.

Claims Processing / Medicare / Medicaid

Sonata offers end-to-end solutions for claims processing, including Medicare and Medicaid claims management.

Performance Assessment

Our performance assessment solutions help payers track and measure performance metrics, identifying areas for improvement and optimizing operations.

Medical Management

We offer solutions to help payers manage medical costs, including utilization management, disease management, and case management.

Risk Adjustment & Revenue Optimization

Our risk adjustment and revenue optimization solutions help payers identify and manage risk, optimizing revenue and improving financial performance.​​

Claims Administration

Sonata Software's solid foundation for policy administration solutions helps healthcare payers effectively manage policies, streamline operations, and ensure accurate policy administration for their members.

Member Retention & Recapture​

Strategies to retain and recapture members through personalized engagement solutions.​

​Membership & Enrolment Administration​

Streamlined management of membership and enrolment processes for healthcare payers.​

​Benefit Administration​

Streamlines benefit processes, enhancing member satisfaction and operational efficiency.

Member Outreach & Care Coordination​

Proactive member communication and coordination with providers for improved care outcomes.​

Sales and Agency​

Optimizes sales operations, empowering payers to improve agent productivity and revenue generation.​

Rating and Underwriting​

Risk assessment, pricing analysis, underwriting rules implementation, and rating calculations.​

Policy Administration 

Sonata Software's comprehensive financial administration solutions enable payers to optimize revenue cycles, improve financial accuracy, and gain valuable insights for financial decision-making.


Automated billing solutions for healthcare payers, ensuring accurate and efficient revenue generation.

Cash Application​

Offers streamlined cash application processes, improving financial controls and accelerating revenue recognition.​

Corporate Financials​

Provides financial management software for healthcare payers, enabling better financial visibility and informed decision-making.​


Assists payers in optimizing capital resources through effective capitalization strategies and financial planning.​

Financial Administration 

Sonata Software's operational excellence across enterprise solutions enhances organizational efficiency, facilitates data-driven decision-making, and supports seamless integration across different functions.

Connected Interoperability

Enables seamless data exchange for healthcare payers, promoting efficient workflows and improved care coordination.​


Provides tailored CRM solutions to enhance member engagement and optimize sales and marketing efforts.​


Leverages advanced technologies to unlock insights, enabling data-driven decision-making for improved operational and financial outcomes.​ ​


Sonata Software's trusted and exceptional compliance solutions assist payers in maintaining compliance, protecting member data, and mitigating compliance risks.

Sonata Software understands the compliance challenges faced by healthcare payers. With our cutting-edge healthcare solutions, including a configurable data privacy solution, we empower payers to meet regulatory requirements while driving business growth. Our customizable solutions address specific payer needs, such as streamlining claims processing and optimizing provider network management. Partnered with an industry-leading data privacy solution, we ensure comprehensive compliance across diverse healthcare offerings.​

  • Compliance Oversight & Management​
  • SOX
  • State Compliance​
  • ACA
  • CMS
  • ICD-10
  • HL7
  • X12
  • EDI
  • ANSI
  • PHI
  • IRS
  • FWA
  • MLR
  • QHP
  • PCMH
  • FHIR
  • SOC 2
  • HHS