Your partner for managing the complex
healthcare payer enterprise
Welcome to Strategic Healthcare Management Systems (SHMS)
SHMS provides software and services to streamline and strengthen core business processes in today’s challenging, competitive, and changing healthcare payer industry.
Our software platform and service enable payers of all sizes to:
- Be proactive in the management of plan operations
- Streamline core payer business processes such as claims, provider networks, membership, and risk adjustment
- Maximize regulatory compliance
SHMS PAYER PLATFORM
A cohesive approach to all core business processes of a healthcare payer organization using an established, secure, and high-performance framework
Learn more about how SHMS' integrated payer platform provides operational accuracy, consistency, and scalability
An automated data workflow, notification, and auditing system that creates confidence in data exchanges between partners
From EDI transactions (837, 835, 270/271, etc.) to complex custom file formats, find out more about how ESI makes data trading easier
SHMS RISK ADJUSTMENT DASHBOARD
A comprehensive look at both RAPS and EDPS submissions to maximize compliance and reimbursement.
Maximize what matters in risk adjustment using the tools provided as part of the SHMS Risk Adjustment Dashboard. SHMS provides Risk Adjustment submission, auditing, error-resolution, and insight for both RAPS and EDPS.
SHMS RAPID RULES ENGINE
A flexible rules processing engine specifically developed for claims adjudication and repricing
High-performance is just the beginning. Learn more about how an engine designed for high-volume processing benefits organizations of any size.
SHMS has a comprehensive platform for core payer operations as well as products for specific lines of business.”