Payer technology is one of the highest-stakes, highest-budget corners of healthcare software — claims at scale, member and provider engagement, prior authorization, utilization management, and a wave of CMS interoperability mandates landing on tight deadlines. Taction Software builds custom payer software for health plans, TPAs, PBMs, and payer-tech vendors: member and provider platforms, claims and adjudication, prior authorization and UM, and Cures Act / CMS interoperability APIs — with deep X12 EDI and FHIR engineering.
For AI-specific payer capabilities — risk models, claims AI, automation — see our payer AI work. This page covers the broader payer software build.
Schedule a Payer Software Discovery Call → (NDA-protected)
Payer-tech experience · X12 EDI expertise · FHIR & Cures Act specialist · HIPAA + BAA
Payer Software Solutions We Build
Member Engagement Platforms
Member portals, mobile apps (via our mobile app development practice), cost transparency tools, and the Patient Access API (CARIN Blue Button) that the CMS rules require.
Provider Engagement Platforms
Provider portals, the Provider Directory API (Da Vinci PDex), network management, and credentialing — the provider-facing side of the plan.
Claims Processing & Adjudication
EDI 837/835 processing, claims adjudication engines, and fraud detection — the operational core, built on our HL7 and integration engineering.
Prior Authorization
PA workflow automation, the Da Vinci CRD, DTR, and PAS APIs, and provider submission portals — increasingly mandated and increasingly automated.
Utilization Management
UM workflow, medical necessity determination, and appeals management for the clinical-review side of the plan.
Cures Act / CMS Interoperability Compliance
Patient Access API (CARIN BB)
We build the Patient Access API to the CARIN Blue Button implementation guide, so members can access their claims and clinical data through third-party apps.
Provider Directory API (Da Vinci PDex)
We build the Provider Directory API to the relevant Da Vinci guides.
Payer-to-Payer Data Exchange
We build payer-to-payer data exchange so member data follows them between plans, as the rules intend.
Prior Authorization API (phasing in by 2027)
We build toward the CMS Interoperability and Prior Authorization Final Rule, including the Prior Authorization API, whose requirements phase in by 2027 — see our overview of 21st Century Cures Act compliance.
Payer Market Segments We Serve
We build for commercial health plans, Medicare Advantage, Medicaid managed care, third-party administrators (TPAs), and pharmacy benefit managers (PBMs) — each with its own regulatory and operational profile.
Integration Standards
We work across the payer integration stack: X12 EDI (837, 835, 270/271, 276/277, 278), HL7 FHIR for the Cures Act APIs (built on our FHIR API development), the Da Vinci implementation guides, and the CARIN Alliance implementation guides.
Modernization for Legacy Payer Systems
Legacy Mainframe Migration
We modernize legacy mainframe payer systems incrementally, preserving the business logic that runs the plan — see our software modernization practice.
Claims Adjudication Modernization
We modernize claims adjudication so it is faster, more transparent, and easier to maintain.
Data Warehouse Modernization
We modernize payer data warehouses to support analytics, reporting, and the interoperability APIs.
Engagement Models
We work in four common shapes: a custom payer platform build, Cures Act compliance engineering, legacy payer system modernization, and payer-tech SaaS product development — all on our custom healthcare software foundation.
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Frequently Asked Questions
Are you Cures Act compliance ready?
Yes. We build the CMS interoperability APIs — Patient Access (CARIN Blue Button), Provider Directory (Da Vinci PDex), payer-to-payer exchange, and the Prior Authorization API phasing in by 2027 — to the relevant implementation guides, and help you sequence the work against the compliance dates.
Can you work with our existing core admin system?
Yes. We integrate with your existing core administrative / claims system rather than assuming a rip-and-replace, building member and provider platforms, APIs, and automation around the core you already run.
Do you handle X12 EDI?
Yes. X12 EDI is core to payer integration — 837, 835, 270/271, 276/277, and 278 — and we build and integrate these transactions alongside the FHIR-based Cures Act APIs.
Have you worked with TPAs and PBMs?
Yes. We build for TPAs and PBMs as well as health plans, accommodating the distinct workflows — administrative services, pharmacy benefits, and the integrations each requires.
Schedule a Payer Software Discovery Call →
Reviewed by Taction Software’s payer technology and healthcare integration engineering team. ISO 27001-certified information security management. PHI is handled under a signed BAA — see our HIPAA-compliant development and data security practices.