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LexisNexis Risk Solutions Improves Data Quality and Engagement for Health Plans

LexisNexis Risk Solutions is the industry leader in helping to integrate data and insights into existing workflows. By partnering with LexisNexis Risk Solutions,
healthcare payers have reliable access to high-quality, accurate data and analytics to help drive better patient engagement, clinical outcomes and mitigate
potential health risks within their member populations.

Challenges We Address

Patient Engagement

Improve health outcomes, reduce costs, and increase satisfaction with care.

Provider Data Quality

Grow revenue and improve workflows and outcomes with accurate data.

Provider Network Management & Targeting

Improve operational efficiency and anticipate changing market dynamics.

Data Security & Access Management

Ensure people access the right data, while maintaining a positive experience.

Social Determinants of Health

healthcare payerWith LexisNexis, healthcare payer organizations can analyze potential health risks within their member populations based on clinically-validated social determinants of health data found within public records.

This data provides an excellent complement for existing clinical analytics models and can transform the way payers process new enrollees and engage with existing ones. Having access to holistic patient data allows health plans to develop and refine programs that have a positive impact on patient engagement and health outcomes.

Forecast Expenditures Based on Health Outcomes

When healthcare payers do not have a claims history upon which to base potential health risks, an assessment is more complicated. Our Socioeconomic Health Attributes allows health plans to forecast potential risk with unprecedented accuracy.

LexisNexis’s clinical analytics risk models limit dependency on potentially inaccurate claims. Using these models, healthcare organizations are able to:

Glean more realistic views about members' socioeconomic health risk and its impact on their healthcare.

Make proactive interventions by identifying gaps in care and intervening to reduce long-term costs.

Predict total expenditures based on health outcomes.

Validate existing information.

Ensure Your Member Data Stays Relevant

With constant changes in technology, there are any number of reasons why health plans have inaccurate data on members. Our solutions ensure healthcare organizations have accurate contact data on each member, while also providing the means to augment it as needed.

Maintaining the latest contact information on your members can reduce costs, improve HEDIS scores, and diminish fraud. LexisNexis can securely verify an individual's information via our knowledge-based authentication process. This ensures that only the member can access the healthcare portal.

Member Access and Authentication

healthcare payerOur technologies help verify patient identities without sacrificing due diligence to accelerate new member account openings.

Our customizable verification and access solutions adapt to existing workflows, streamline verification processes and connect member medical records.

Provider Data Management

healthcare payerOur solutions allow healthcare organizations to understand their providers with access to the most up-to-date information to lower costs and increase healthcare quality for members. With LexisNexis Risk Solutions, your health plan can nimbly update your provider directory to give members the best user experience.

Ensure Accurate Provider Data and
Directory Accuracy

With LexisNexis Risk Solutions, healthcare payers can check provider information through a thorough record validation process.

Published directories can remain up-to-date, standardized and in-line with regulatory mandates - whether federal or state.

An Increased Level of Insight from
Claims Data

healthcare payerWith instant access to claims data, payers gain insight into patient and procedure volumes with claims-based intelligence about the practitioners and facilities that are providing and influencing care in markets relevant to your networks. This will increase the efficiency and adequacy of health plan provider networks. Contact us to find out more about our Payer solutions to improve data quality and claims management.

Expand Your Markets and Networks with Relevant Market Intelligence

Payers can use detailed market intelligence derived from claims data to assess a market for expansion or acquisition. Claims data on volumes, referral networks, and reimbursement rates can provide a full market view of expected activity and the existing opportunity.

That data can enable an unbiased assessment of existing practice behaviors across payers – physician, facility, and patient volumes; diagnoses and procedures performed; preferred care sites for key services; and key referral relationships – to pinpoint recruitment targets.

Other Markets We Serve


Data management and intelligence solutions improve market share, reduce risk and safeguard patient identities.


Data, analytics and prescriber verification solutions help pharmacies identify ways to reduce fraud and expand market penetration.

Life Sciences

Data management and market intelligence solutions offer life sciences organizations a healthy market advantage.

Other LexisNexis Healthcare Solutions

Insights and Resources

Blog Post

“No Surprises Act” Contains New Provider Directory Verification Regulations

White Paper

Optimizing Provider Network Data to Boost Efficiency, Patient Experience and Compliance

White Paper

Medication Non-Adherence: A Proactive Approach to Reducing Risk


Provider Data Management Strategy


Balancing Cybersecurity and Member Engagement

Blog Post

Getting Started with Social Determinants of Health (SDOH) Programs

Partner with LexisNexis Health Care

We believe in the power of data and analytics
to manage risk & uncover opportunity.

Data for Good: The Case for Operationalizing Social Determinants of Health into Clinical Models

Recognizing the positive benefits for both patient engagement and patient outcomes.
Learn More