ClaimSphere Clinical+

JSON twin: https://www.healthaidb.com/software/claimsphere-clinical.json

Company Name

Cognizant

Product URL

https://www.cognizant.com/us/en/industries/healthcare-technology-solutions/trizetto/claimsphere-suite/claimsphere-clinical-plus

Company URL

https://www.cognizant.com

Categories

• clinical Care
• administrative Operations
• patient Facing
• diagnostic Support
• care Coordination
• quality & Safety
• data Management
• data Integration
• value-based Care
• health Data Analytics
• Clinical
• Administrative
• Diagnostic
• Quality Management
• Interoperability
• Analytics

Summary

ClaimSphere Clinical+ is a cloud-based solution by Cognizant that enhances patient outcomes by integrating clinical data with payer systems, supporting value-based care initiatives.

Description

ClaimSphere Clinical+ is a cloud-based platform designed to assist healthcare organizations in transitioning from volume-based, provider-centric systems to patient-centric, health-focused systems. It utilizes evidence-based clinical processes at points of care to support national interoperability standards, promoting value-based programs and improving patient outcomes. The platform aligns payer and provider value-based contracts with quality improvement initiatives, aiming to enhance outcomes and maximize revenue. Key features include assigning accountable ownership of quality measures to providers, delivering real-time actionable insights on patient-level care gaps, and enabling the conversion of clinical data into pseudo claims for payer administrative systems. It supports various value-based programs such as HEDIS®, P4P, STAR, MIPS, and APMs, facilitating payer-provider convergence and improved care coordination.

Api Available

unknown

Certifications

• FDA 510(k)
• CE/MDR
• ONC
• ISO 27001
• HEDIS® Measure Certification

Company Founding

1994

Company Offices

• United States
• India
• United Kingdom
• Canada
• Australia
• Germany
• France
• Italy
• Spain
• Netherlands

Compliance

• HIPAA
• HEDIS®
• HITECH
• SOC 2
• ISO 27001

Customers

• Priority Health
• Ambulatory Practice
• Hospital / Health System
• Health Plan

Data Residency

US/EU regions

Data Standards

• FHIR
• HL7
• DICOM
• SNOMED
• ICD-10

Deployment Model

• SaaS

Features

• Real-time actionable insights on patient-level care gaps
• Support for value-based programs like HEDIS®, P4P, STAR, MIPS, and APMs
• Conversion of clinical data to pseudo claims for payer systems
• Integration of clinical and claims data for actionable intelligence
• Prebuilt workflows for care gap assignment, abstraction, and review
• Efficient collection and analysis of medical records to close care gaps
• Performance-driven provider incentive programs
• Evidence-based clinical processes at points of care
• Alignment of payer and provider value-based contracts
• Improvement of quality of care and patient outcomes

Id

SW1123

Integration Partners

• Inferscience
• Diagnostic Robotics

Integrations

• Epic
• Cerner
• PACS
• Billing Systems
• eISF
• eTMF
• EDC
• CTMS
• FHIR
• HL7
• DICOM
• SNOMED
• ICD-10

Languages Supported

• English

Last Updated

2025-10-11

License

Commercial

Market Segment

• Enterprise
• SMB

Optional Modules

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

Subscription

Privacy Features

• BAA available
• Consent Management
• Anonymization
• Data Minimization

Product Code

SW1123

Product Name

ClaimSphere Clinical+

Ratings

• Best AI Scribe for Physicians (2025) – According to Real Reddit Reviews

Regions Available

• United States

Related Urls

• https://elion.health/products/cognizant-claimsphere

Release Year

2025

Security Features

• Encryption
• RBAC
• SSO/SAML
• Audit Logs
• 2FA
• DLP

Specialties

• General Medicine
• Family Medicine
• Internal Medicine
• Pediatrics
• Geriatrics
• Cardiology
• Endocrinology
• Pulmonology
• Orthopedics
• Neurology
• Oncology
• Gastroenterology
• Rheumatology
• Hematology
• Infectious Diseases
• Psychiatry
• Dermatology
• Obstetrics And Gynecology
• Urology
• Ophthalmology

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• Clinicians
• Nurses
• Patients
• Admins
• Payers

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• I have to edit some things on occasion, but it's well worth it.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "ClaimSphere Clinical+",
  "company_name": "Cognizant",
  "product_url": "https://www.cognizant.com/us/en/industries/healthcare-technology-solutions/trizetto/claimsphere-suite/claimsphere-clinical-plus",
  "company_url": "https://www.cognizant.com",
  "related_urls": [
    "https://elion.health/products/cognizant-claimsphere"
  ],
  "product_code": "SW1123",
  "summary": "ClaimSphere Clinical+ is a cloud-based solution by Cognizant that enhances patient outcomes by integrating clinical data with payer systems, supporting value-based care initiatives.",
  "description": "ClaimSphere Clinical+ is a cloud-based platform designed to assist healthcare organizations in transitioning from volume-based, provider-centric systems to patient-centric, health-focused systems. It utilizes evidence-based clinical processes at points of care to support national interoperability standards, promoting value-based programs and improving patient outcomes. The platform aligns payer and provider value-based contracts with quality improvement initiatives, aiming to enhance outcomes and maximize revenue. Key features include assigning accountable ownership of quality measures to providers, delivering real-time actionable insights on patient-level care gaps, and enabling the conversion of clinical data into pseudo claims for payer administrative systems. It supports various value-based programs such as HEDIS®, P4P, STAR, MIPS, and APMs, facilitating payer-provider convergence and improved care coordination.",
  "categories": [
    "clinical Care",
    "administrative Operations",
    "patient Facing",
    "diagnostic Support",
    "care Coordination",
    "quality & Safety",
    "data Management",
    "data Integration",
    "value-based Care",
    "health Data Analytics",
    "Clinical",
    "Administrative",
    "Patient-facing",
    "Diagnostic",
    "Care Coordination",
    "Quality Management",
    "Data Management",
    "Interoperability",
    "Value-based Care",
    "Analytics"
  ],
  "market_segment": [
    "Enterprise",
    "SMB"
  ],
  "target_users": [
    "Clinicians",
    "Nurses",
    "Patients",
    "Admins",
    "Payers"
  ],
  "specialties": [
    "General Medicine",
    "Family Medicine",
    "Internal Medicine",
    "Pediatrics",
    "Geriatrics",
    "Cardiology",
    "Endocrinology",
    "Pulmonology",
    "Orthopedics",
    "Neurology",
    "Oncology",
    "Gastroenterology",
    "Rheumatology",
    "Hematology",
    "Infectious Diseases",
    "Psychiatry",
    "Dermatology",
    "Obstetrics And Gynecology",
    "Urology",
    "Ophthalmology"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "Subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "Commercial",
  "company_offices": [
    "United States",
    "India",
    "United Kingdom",
    "Canada",
    "Australia",
    "Germany",
    "France",
    "Italy",
    "Spain",
    "Netherlands"
  ],
  "company_founding": "1994",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Real-time actionable insights on patient-level care gaps",
    "Support for value-based programs like HEDIS®, P4P, STAR, MIPS, and APMs",
    "Conversion of clinical data to pseudo claims for payer systems",
    "Integration of clinical and claims data for actionable intelligence",
    "Prebuilt workflows for care gap assignment, abstraction, and review",
    "Efficient collection and analysis of medical records to close care gaps",
    "Performance-driven provider incentive programs",
    "Evidence-based clinical processes at points of care",
    "Alignment of payer and provider value-based contracts",
    "Improvement of quality of care and patient outcomes"
  ],
  "optional_modules": [],
  "integrations": [
    "Epic",
    "Cerner",
    "PACS",
    "Billing Systems",
    "eISF",
    "eTMF",
    "EDC",
    "CTMS",
    "FHIR",
    "HL7",
    "DICOM",
    "SNOMED",
    "ICD-10"
  ],
  "data_standards": [
    "FHIR",
    "HL7",
    "DICOM",
    "SNOMED",
    "ICD-10"
  ],
  "api_available": "unknown",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "HEDIS®",
    "HITECH",
    "SOC 2",
    "ISO 27001"
  ],
  "certifications": [
    "FDA 510(k)",
    "CE/MDR",
    "ONC",
    "ISO 27001",
    "HEDIS® Measure Certification"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "Audit Logs",
    "2FA",
    "DLP"
  ],
  "privacy_features": [
    "BAA available",
    "Consent Management",
    "Anonymization",
    "Data Minimization"
  ],
  "data_residency": "US/EU regions",
  "customers": [
    "Priority Health",
    "Ambulatory Practice",
    "Hospital / Health System",
    "Health Plan"
  ],
  "user_reviews": [
    "I have to edit some things on occasion, but it's well worth it."
  ],
  "ratings": [
    "Best AI Scribe for Physicians (2025) – According to Real Reddit Reviews"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2025",
  "integration_partners": [
    "Inferscience",
    "Diagnostic Robotics"
  ],
  "id": "SW1123",
  "slug": "claimsphere-clinical",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/claimsphere-clinical.json"
  }
}