We came from a payer with provider partners, so our platform was designed from day one to handle large volumes of claims and clinical data in the cloud.
Working with the best
We're proud to work with organizations ensuring standards and consistency across the industry.
Data management is more than compliance
AI, LLM, and analytics projects can't start until you have clean data working for you across a variety of business cases.
Payers & Health Plans
Achieve and maintain CMS compliance
Optimize use of high-value provider networks
Reduce waste generated by phone calls, faxes, and medical records searches
Automate workflows between payers and providers
Administer value-based contracts
Increase HEDIS scores and Star ratings
Provider Organizations
Improve referral management
Reduce waste generated by phone calls, faxes, and medical records searches
Automate workflows between providers and payers
Improve performance on value-based contracts
Improve quality of care, coordination of care, and patient experience
Close care gaps to improve patient outcomes
Introducing the Opala Health Data Sharing Platform
More than compliance. Opala is building a comprehensive platform to help organizations collect, standardize, and consolidate healthcare data.
Master data management
Opala uses predictive and deterministic approaches to master identity and generate a unique identifier. Each organization's data is assigned a unique identifier within Opala's dataset.
Unified patient record
Our Patient Record brings data from across the healthcare landscape into one location, establishing a complete healthcare profile of an individual across care settings, across health plans, and over time.
Event-based notifications
Opala provides broadcast and relay capabilities to distribute information, such as Admit, Discharge, Transfer (ADT), pharmacy, or other standard messages, in real-time to health plans and provider organizations.
Digital vendor integrations
Our platform prepares clinical and non-clinical data for exchange with any third-party party enabling easy and efficient integration and implementation of digital solutions. Wondering if we work with your vendor? Ask. We probably do.
Consent & access management
Opala Consent Management allows individuals to control the scope of data shared with 3rd party mobile applications. Individuals can also delegate access to a personal representative, such as a family member or a caregiver.
Data quality throughout your data
Make your data more actionable by cleaning, enriching, and normalizing your data. Cleaner data ensures cleaner insights that are actionable for your team.
Additional platform capabilities
Patient Access API
Comprehensive patient records combining claims, labs, EHR, and pharmacy data across care settings over 5 years available as FHIR resources, updated continuously, and accessible to patients to import into any third-party app of their choice.
Provider Directory API
Provider network and demographic information available to the public in a standardized format to support innovative consumer tools.
Payer-to-Payer Exchange
Allow members to transfer their claims history from a previous payer to their current one.
Provider Access API
Comprehensive patient records combining claims and clinical data available as FHIR resources for provider use, updated continuously.
Prior Authorization
Health plan clinical review requirements, coverage decision status, and details about decisions available in a standardized format supporting automation across providers and payers. Prepare now so you're ready when mandates are enforced.
Clinical Data Exchange
Historical and current EHR data delivered to health plans for HEDIS, MA Stars, QHP ratings, ACOs, VBCs and to support automation across providers and payers.
Uniroster
Member eligibility and value-based contract patient lists updated continuously and available in a standardized format supporting automation across providers and payers.
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