Turn member and claims data into coordinated action.
Connect the information behind cost of care, quality, risk
adjustment, and network performance — and act on it continuously.
Streamline how
the plan runs.
Turn fragmented information into a clearer, faster way to make decisions and move work forward.
Reduce administrative burden
Move repetitive investigation, analysis, and coordination out of manual workflows.
Improve financial performance
See the drivers affecting performance early enough to act.
Improve care and quality
Act earlier on care gaps, quality measures, and member needs.
Where Health Plans use Veridian.
From cost of care to quality, risk adjustment, and network performance, Veridian turns connected member and claims data into work teams can act on.
- Identify: Surface what needs attention
- Prioritize: Focus on what matters most
- Coordinate: Route work to the right team
- Execute: Move work through completion
Pinpoint the cost drivers pushing MLR off target.
Close suspected HCC gaps before submission deadlines.
Close HEDIS gaps before the measurement year ends.
Route reviews by complexity to meet CMS turnaround times.
Flag overpayments and coding outliers before and after payment.
Find rising-risk members and route them to the right program.
Steer members toward high-performing, in-network providers.
Spot disenrollment risk and re-engage members before AEP or redetermination.
Systems stay exactly where they are.
Veridian works with your existing infrastructure, connecting information across the systems your teams already rely on.
Keep your infrastructure
Your existing systems, data warehouses, and clinical repositories remain where they are.
Connect across systems
Bring information from existing sources together without rebuilding the infrastructure underneath them.
Operational in weeks
Start running workflows on top of your existing environment without a long migration or replacement program.
Frequently Asked Questions
Run medical economics, payment integrity, risk adjustment, quality and operations on one trusted record. Plans use Veridian to explain cost trend, stop paying claims they shouldn’t, close risk and quality gaps, and automate the operational queues that slow teams down.
Yes. Veridian tracks loss ratios across every product and line of business, and breaks each change in cost into its drivers, such as rate, mix and coding, down to the provider, service and member. It flags emerging trends while there is still time to act.
By catching issues before payment. Veridian checks claims against authorizations, eligibility and contract terms, flags duplicates, unbundling and upcoding, and hands reviewers each case with the evidence attached.
Yes. Every eligibility and enrollment file is reconciled as it arrives, members are matched into a single identity across systems, and discrepancies are flagged before they reach payments, capitation or reporting.
Veridian reads claims, pharmacy and clinical documentation together to surface suspected HCCs, documentation gaps and open HEDIS gaps. Each one is routed to chart review or member outreach and tracked to closure.
Yes. Veridian checks eligibility, benefits and criteria, assembles the clinical documentation and routes each request to the right reviewer, with turnaround tracked against regulatory and contract timeframes. Coverage decisions always stay with your clinicians.
Yes. Simulations project the impact of a rate change, provider contract or care management program on cost, utilization and loss ratios using your own history. Once the change is live, projections are compared with actual results.