Payer Interoperability
In the dynamic landscape of healthcare, payers play a pivotal role in managing patient care and controlling costs.
The Challenge
Problems We Solve
The integration of interoperable systems is crucial for payers to effectively manage health plans, process claims, and collaborate with providers.
CMS Interoperability Mandates
CMS requires payers to make patient data available via FHIR APIs. Meeting deadlines with fragmented, inconsistent data across networks is a major operational burden.
Inaccurate Risk Adjustment
Incomplete clinical data leads to missed HCCs, inaccurate RAF scores, and millions in lost or clawed-back revenue. Manual chart reviews are expensive and slow.
Member Data Fragmentation
Members see multiple providers across networks. Without a unified longitudinal record, care gaps go undetected and quality measures suffer.
HEDIS & Quality Measure Gaps
Supplemental data collection for HEDIS reporting relies on manual processes and incomplete clinical feeds, leading to inaccurate Star Ratings.
The Solution
How Trove Solves It
Connect
ConneXa retrieves member clinical data from 99% of US clinical organizations via CommonWell, CareQuality, and eHealth Exchange.
Resolve & Parse
EMPI resolves patient identity across networks. Trident AI parses all formats — HL7, CCDA, PDFs — into structured FHIR R4 and OMOP.
Enrich & Code
TroveLLM applies clinical AI to extract HCCs, identify care gaps, and add an average of 962 new codes per patient for risk adjustment.
Capabilities
Key Features
Data Parsing and Standardization
Automatic parsing into standardized formats
Value-Added Analytics
Detect flaws in insurance claims and optimize health plans
Plug-and-Play Integration
Seamless integration with minimal downtime
Cost-Effective Implementation
Affordable solutions with nationwide operations
Operational Efficiency
Streamlined data exchange reduces administrative burdens
Enhanced Decision-Making
Accurate, real-time data supports informed decisions
Why Trove
The Trove Advantage
Automated Supplemental Data
Replace manual chart chases with automated clinical data retrieval and AI-powered code extraction at scale.
Accurate Risk Adjustment
TroveLLM captures HCCs that traditional NLP misses, improving RAF accuracy and reducing audit risk.
CMS Compliance Built-In
FHIR R4 APIs, TEFCA-aligned access, and audit-ready logging meet CMS interoperability requirements out of the box.
Member-Level Longitudinal Records
EMPI resolves identity across providers and networks, building complete member records for population health analytics.
Products
Relevant Trove Products
Each product in the Trove platform addresses a specific stage of your data pipeline.
Close care gaps. Improve RAF scores. Meet CMS mandates.
Schedule a demo to see how Trove transforms your healthcare data operations.