What data format and structure do you require for onboarding?
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We accept standard file formats for claims and eligibility data, including CCLF, 837 EDI, and CSV. No reformatting required, and no complex API integrations to get started.
How much historical claims data is needed to get started?
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We can begin with as little as a single recent quarter for descriptive analysis. Our modeling and forecasting performs best with ~12 months of data. Additional history (2+ years) enhances modeling depth but is not required.
Do you only work with claims data?
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We can work with many types of healthcare data, but claims data alone unlocks significant value: cost trending, PMPM analysis, utilization patterns, provider performance, risk adjustment, HCC identification, care gaps, quality measure tracking, etc. Claims are the fastest path to value, serving core analytical needs across your organization.
Can you handle data from multiple lines of business simultaneously?
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Yes. We can ingest and analyze data across Medicare Advantage, Commercial, Medicaid, ACO/MSSP, and ACA Exchange populations within a single environment.
Can you incorporate other clinical data?
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Yes. We incorporate clinical data from EMR extracts, structured formats such as CCD, and HL7 feeds where available.
What other kinds of supplemental data files can you incorporate?
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We can incorporate eligibility and enrollment files, provider rosters and attribution data, care management enrollment data, revenue and payment data, benefit design metadata, and value-based contract terms. These add context that claims alone cannot provide — accurate member denominators, provider attribution, and program effectiveness measurement. During onboarding, we help identify which files will add the most value for your priorities.
What's the data submission process?
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We typically start with SFTP to get up and running quickly with minimal IT lift. From there, we can layer in more integrated approaches such as direct API connections.
How often should we update data, and how is refresh handled?
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Most clients update monthly; some prefer weekly for fresher data. Once pipelines are established, updates are ingested and available automatically.
What's your SLA for processing updated data files?
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During onboarding, initial processing may take up to 1 week as data is mapped and validated. After that, updates are typically processed within 24–48 hours depending on size and complexity.