What’s Holding Healthcare Payers Back
Disconnected Systems Limit Member Insight
Siloed platforms prevent a complete view of the member, hurting coordination, personalization, and risk management.
Missed Opportunities in AI and Analytics
Despite rich data, many payers still struggle to operationalize AI for fraud detection, risk scoring, claims optimization, and personalized outreach..
Claims Denials and Rework Drain Resources
High denial rates force costly appeals, slow down cash flow, and create friction with providers and members alike.
Outdated Technology Slows Innovation
Legacy systems block digital transformation, data interoperability, and the ability to adapt to market and regulatory changes.
Compliance Burden Continues to Grow
Navigating shifting regulations demands constant vigilance, adding risk and administrative overhead.
Rising Member Expectations Raise the Stakes
Today's members expect seamless, digital-first experiences — not confusing portals, long wait times, and paper-heavy processes.
Conquer “Payer Headaches” With Novel AI-First Solutions
We offer Payers a robust suite of offerings to get started with their transformation journey
FHIR Integration Services
Turn interoperability into a strategic advantage. We help payers unlock real-time data exchange across EHRs, claims systems, and partner platforms using modern FHIR frameworks — improving automation, care coordination, and regulatory alignment.
Member Data Exchange and Claims Automation
Streamline member data exchange and automate claims processes with FHIR-based infrastructure that reduces manual intervention and accelerates payouts.
Prior Authorization and Care Coordination
Simplify prior authorizations and support proactive care coordination by connecting clinical and administrative data — in real time.
Provider Directory Management
Maintain an accurate, compliant, and easy-to-navigate provider directory that supports transparency and interoperability across your network.
Consulting and Operations
Your roadmap to compliance, efficiency, and growth. Our strategic advisory services help you navigate CMS mandates, optimize core operations like claims and data governance, and modernize aging systems with clarity and control.
FHIR Roadmap and CMS Compliance Strategy
Navigate evolving CMS mandates with clarity. We’ll help you define a FHIR roadmap that aligns with your compliance goals and tech maturity.
Data Governance and Security Advisory
Improve how your organization handles sensitive healthcare data with security-first data governance frameworks built specifically for payers.
Claims Processing Optimization
Optimize your claims processing systems to reduce cycle times, minimize errors, and free up your teams to focus on higher-value work.
Digital Development
Deliver intuitive, modern digital experiences that engage members and empower your teams. From self-service portals to intelligent analytics platforms, we build custom solutions that reduce friction, increase transparency, and drive better health plan outcomes.
Member Engagement Portals and Mobile Apps
Deliver seamless, personalized digital experiences that empower members to take control of their health. Our intuitive portals and mobile apps offer real-time access to claims, benefits, providers, and wellness tools — all while reducing support costs and boosting member satisfaction.
AI-Powered Claims Analytics and Fraud Detection
Accelerate claims decisions and protect your bottom line with advanced AI and machine learning. Our analytics solutions flag anomalies, predict denials, and detect fraudulent patterns in real time — giving you actionable insights and reducing unnecessary payout leakage.
Value-Based Care and Risk Management Platforms
Enable smarter contracting and better health outcomes with platforms designed for value-based care. We help you track performance, stratify risk, and align incentives across providers — all while ensuring compliance and maximizing shared savings.
Data Analysis and AI
Transform your data into real-time insight. We design AI and analytics solutions that uncover risk, streamline documentation, and guide smarter population health decisions — all while keeping compliance and scalability at the core.
Predictive Analytics for Population Health
Anticipate population health trends with predictive analytics that help drive proactive interventions and resource allocation.
AI-Driven Risk Adjustment and Quality Reporting
Automate risk adjustment and streamline quality reporting with AI tools that continuously adapt and learn — improving accuracy without adding overhead.
Accelerated Innovation With Pre-Packaged Solutions
Go from start to finish, blazing fast. Utilize our AI powered accelerators to speed up your project – all tested for scalability, security and compliance.
Offer more to your clients
Electronic Health Records
(EHR/EMR)
Know More E-prescribing
(eRx)
Know More Health Information Exchange
(HIE)
Know More Hospital Management
Solutions
Know More HL7
Interface
Know More Laboratory Information
Management (LIM)
Know More Tools/Integrations We Offer
EHR/EMR
Communication Integration
Cloud Platforms Supported
Automation
Mobile Platform Integrations
Compliances
Transformation Stories
Explore some of Pegasus One’s success stories.
Why choose us
When it comes to healthcare payers, we understand the balance you’re managing — reducing cost, meeting regulatory requirements, and improving member outcomes, all at once.
Here’s what makes us uniquely positioned to help:
Got Questions? Let’s Clear Them Up.
We understand healthcare payer challenges inside and out. Here’s everything you need to know to move forward with confidence — faster claims, smarter systems, happier members, and better outcomes.
5-time Inc 5000 honoree (2019, 2020, 2021, 2023 & 2024)
Rated 4.9 stars by clients on Clutch
Part of the prestigious Microsoft AI Inner Circle program.
Part of multiple prestigious civil-society betterment projects
Microsoft Solutions Partner and AWS Advanced Consulting Partner
Apps consistently featured by leading design awards.