Hexplora Consulting Services Overview
In addition to offering a revolutionary, all-in-one (Data Warehousing, Data Analytics, Enterprise Reporting, Business Intelligence and Predicative Analytics) Healthcare IT solution, Hexplora’s team extends over 15 years of consulting expertise in all facets of IT.
Hexplora is a Minority and Small Business Enterprise certified (MBE and SBE) company offering all of the consulting capabilities of larger firms, with the personal touch and cost savings of an IT boutique.
Our Development and Maintenance services occur onsite and onshore, enabling us to closely partner with our clients on a respective level.
We at Hexplora pride in building long term relations and offering unmatched expertise and service to our clients.
IT Consulting Capabilities include:
Hexplora further specializes in providing enterprise solutions for Healthcare organizations and has a proven history of implementing IT solutions for large payers and health management services companies in the US and abroad.
Our experience spans the full range of business processes and systems that are critical for the operations of all Health plans, ACOs, and IPAs.
Historically, health plans used to place more emphasis on healthcare utilization and cost containment to improve profitability. Therefore, most of the focus was on improving operational effectiveness by managing claims processing and utilization. However, emerging trends in the healthcare industry have significantly altered the priorities for health plans. Employers and governments are increasingly holding payers accountable for overall health and well-being of the member instead of being exclusively focused on paid claims.
Consumerism and Health Advocacy are rapidly driving the use of richer sources of clinical data relegating the use of claims data to a strictly financial role. Enormous amounts of new data are now available for payers including HRA, biometrics, risk scores, diseases, conditions, outcomes, ETG, ERG etc. Integrating all these data subject areas and providing a 360 degree longitudinal view of the member across time is a key information requirement for payers. Due to HIPAA, the Healthcare industry is changing to a standards based Information Management model for data acquisitions and data exchanges. However, there are no standards for unifying data within an organization to support advanced Informatics capabilities including real-time reporting, dashboards, scorecards, analytics, and data mining.
In this new paradigm, payers are now forced to seek competitive advantage through innovative solutions driven by Informatics and intelligent use of data. Hexplora has been in the forefront of delivering projects for large payers encompassing strategy, architecture, design and implementation of very large Enterprise Data Warehouses that can support their full range of Informatics and data requirements.
Hexplora's team of highly knowledgeable professionals possesses outstanding expertise and experience in implementing industry leading solutions that enable ACOs, IPAs, and Payers to leverage Informatics as a strategic asset that can deliver market differentiating capabilities.
Our Comprehensive Healthcare domain expertise covers the following :
  • Provider Organizations
  • ACO, IPA
  • Health Plans
  • Commercial, Medicare, Medicaid
  • Business lines
  • Medical, Pharmacy, Behavioral, Dental, Group Life
  • Healthcare operations and business processes
  • Member Eligibility and Enrollment
  • Providers and Networks
  • Claims Adjudication and Payment
  • Premium tracking and Reconciliation
  • Pharmacy Claims
  • Lab Results
  • Disease Management
  • Case Management
  • Utilization Management
  • Healthcare Transaction Portals
  • Health Risk Assessment (HRA)
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