Confidently Manage Your Health Plan Operations

Technology that Improves Efficiency

Evolent Aldera is a web-based, highly configurable health care claims adjudication platform that includes core administration, portals and health informatics to provide the underlying infrastructure for health plans. The flexible benefit configuration process also enables premium billing, automated non-payment processing, member enrollment data tracking and provider contract management.

Capitalize on New Opportunities, Improve Efficiency and Decrease Costs

Evolent Aldera’s robust capabilities enable all risk-bearing organizations to confidently take on any type of new business while simultaneously automating and streamlining existing lines of business. It allows quick and easy configuration of new benefit plans, provider contracts and workflows. It also auto-adjudicates claims across all lines of business while supporting complex business processes and transactions.

Improve accuracy with real-time automated claims processing

Evolent Aldera gives health plans complete control over the health care claims adjudication process, from setup to processing. A flexible rules engine and integrated workflows reduce duplication errors, and avoid costly clinical reviews and prior authorizations.

Support all risk models from a single platform

Evolent Aldera’s rules-based configurations empower plans to create complex benefit designs, support broad and narrow networks, and manage all risk models from a single, powerful platform.

Engage all constituents in a seamless, connected experience

With Evolent Aldera patients can shop, compare, enroll and print a member identification card in a single transaction. Providers can enter authorizations directly into the portals and submit claims online to simplify payment. Payers can configure rules for on-the-fly changes.

Explore Evolent Aldera within Our Health Plan Services Offering

Increase operational efficiencies with Evolent Aldera

Real-Time Transactions

Equal real-time control and visibility

Rules-Based Configuration

Puts design in business hands

Integrated workflow

Optimizes claim adjudication

API Web Services

Enable quick and easy integration with any third party application

A Single Platform

To support all lines of business

Evolent Aldera Capabilities

Claims Management

With integrated workflows and automation, Evolent Aldera auto-adjudicates health care claims and complex business processes, delivering accelerated and accurate results.

Financial Management

Evolent Aldera provides complete financial administration whether you need to settle a single claim against multiple internal and external funding accounts; manage individual, group or list invoicing; bill simultaneously across multiple lines of business; or execute premium billing.

Customer Service

User-friendly, interactive data views enable customer service staff to quickly and easily respond to member, provider and employer inquiries. System data is updated in real-time, equipping staff with up-to-the-minute information to respond to inquiries and provide a status for claims, billing, payment and other transactions.

Member Management

Evolent Aldera’s member management functionality allows you to more effectively manage and respond to members, while minimizing the administrative burden. Manage identification card requests, reporting needs and member enrollment all while maintaining a time/date sensitive perpetual audit history.

Benefit Plan Management

Evolent Aldera easily supports any combination of benefit classes, fee schedules, deductibles, co-payments or benefit plan administration rules at any level of member or group hierarchy without the need for programmer support.

Provider and Network Management

Evolent Aldera helps alleviate the complexity and inefficiency of traditional provider data management processes. Our complete suite contains all the tools necessary to maintain network hierarchy, contact info, credentialing, reimbursements and contract management across a complex set of financial arrangements.

Group Management

Evolent Aldera makes setting up and serving complex employer groups easy. It is equipped to handle the shift from a defined benefit strategy to a defined contribution strategy. As employer group customers migrate to this new contribution approach, Evolent Aldera ensures you are equipped to handle the transition.

Agency and Broker Management

Evolent Aldera provides you with tools to manage agents and brokers successfully. It allows you to calculate and control disbursement to multiple levels of agencies and brokers, and gives you increased visibility to all employer and subscriber relationships.