Payviders are caught between two software worlds. Payer systems know claims, eligibility, and risk; provider systems know clinical care — and almost nothing connects them around a single human who is both your member and your patient. Taction Software builds software for integrated payer-provider organizations that closes that gap: unified member-patient records, combined claims-plus-clinical workflows, integrated risk and care management, and the FHIR-plus-X12 architecture a payvider actually needs.
This is the integrated-org view. See also our payer software, value-based care, and ACO software practices.
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Payer-tech + provider-tech experience · FHIR + X12 EDI expertise · HIPAA + BAA
What Makes Payvider Software Different
Combined Claims + Clinical Data
A payvider has both claims and clinical data, and the value is in bringing them together — something neither a payer nor a provider system does alone.
Member-Patient Unified Identity
The same person is a member on the payer side and a patient on the provider side, with different identifiers. Resolving them into one identity is foundational and genuinely hard.
Integrated Risk + Care Workflows
Risk (a payer concept) and care (a provider concept) have to operate as one workflow, not two systems passing files.
Vertical Reimbursement & Cost Visibility
Because the payvider both pays and delivers, it can see and manage the true cost of care — if the software surfaces it.
Payvider Software Solutions We Build
Unified Member-Patient Records
An MPI spanning payer and provider identities, a combined claims + clinical view, and care-team access controls — one record, governed correctly. Built on our FHIR and HL7 practices.
Integrated Risk + Care Workflows
Care-gap identification from claims, care plans with cost awareness, and provider-member engagement so risk insight drives care action — complementing our payer AI work.
Vertical Cost Management
Cost-of-care analytics, provider performance and cost, and specialty drug cost management, drawing on our healthcare data analytics.
Provider-Member Engagement
Combined member-patient portals (via our patient portal and healthcare CRM work), care + benefits mobile apps (via our mobile app development practice), and provider-initiated engagement that uses both sides of the relationship.
Payvider Sub-Types We Serve
We build for provider-led health plans, Kaiser-style integrated systems, provider-sponsored Medicare Advantage, and ACO + health plan combinations — each blending payer and provider operations differently.
Integration Architecture for Payviders
The architecture is the whole game: a combined claims + EHR architecture, member-patient identity resolution, a unified data lake bringing both worlds together, and a FHIR + X12 combined architecture that speaks both the clinical and the claims languages. This is built on our custom healthcare software foundation.
Regulatory Considerations
A payvider carries both payer and provider obligations: combined payer + provider compliance, CMS interoperability on both sides (Patient Access and Provider Directory APIs as a payer; information-blocking and access as a provider), and Cures Act implementation across the organization — see our overview of 21st Century Cures Act compliance and our HIPAA-compliant development practice.
Schedule a Payvider Software Strategy Workshop →
Frequently Asked Questions
Do you have payvider-specific past work?
Our edge with payviders is that we bring deep experience on both halves — payer technology (claims, EDI, risk, CMS interoperability) and provider technology (EHR, clinical workflows, integration) — and combine them. Payvider is an emerging segment, so rather than claim a long list of named payvider clients, we point to genuine depth on each side and the architecture experience to integrate them.
Can you integrate with our existing payer + EHR stack?
Yes. We integrate with your existing core administrative/claims system and your EHR rather than replacing them, bridging the two with identity resolution, a unified data layer, and combined workflows so the payer and provider stacks operate as one.
Combined data warehouse approach?
We typically build a unified data lake or warehouse that ingests claims (X12) and clinical (FHIR/HL7) data, resolves member-patient identity, and serves combined analytics, risk, and care workflows — so both sides reason from the same source of truth.
Member-patient identity resolution complexity?
It is the hardest part, because payer member identifiers and provider patient identifiers were never designed to match. We implement a master patient index that matches and merges across both identity systems, with the governance to keep it accurate — turning two fragmented views into one trustworthy record.
Schedule a Payvider Software Strategy Workshop →
Reviewed by Taction Software’s payer and provider technology engineering teams. ISO 27001-certified information security management. PHI is handled under a signed BAA — see our data security practice. Many engagements begin with a discovery workshop.