The healthcare experience members expect.

Our integrated solutions provide end-to-end service offerings across front, middle, and back office functions. Whether you need standalone solutions or the full breadth of our ecosystem, enGen drives results.

 

Health Plan & Provider

enGen’s payer and provider platform powers more than any other solution on the market — products and services can be implemented either holistically or modularly.

IT Infrastructure

Provides reliable infrastructure and security solutions for all health care needs.

Operations

Provides world class service delivery and business process services across the entire health care value chain and all health insurance lines of business.

Global Technology & Ops Support

Advances innovation in a 24x7 environment offering flexibility for enGen and scalability for our clients.

Print & Fulfillment Services

Offers the reliability, flexibility, and experience necessary for you to deliver digital, print, and mail services cost-effectively.


Within a complex Core Administrative Processing Solutions (CAPS) market, enGen stands alone with our truly end-to-end platform. 

 

The Payer Platform offers everything payers need to deliver a seamless healthcare experience for members, patients, and providers. Our fully integrated, one-of-a-kind solution uses AI-driven automation to drastically improve efficiency, reduce costs, and go beyond traditional CAPS technology. 

Not just a software solution.

 

The Payer Platform is designed specifically for health plans to manage their entire book of business. We understand the complexities of the payer-provider landscape and offer a tailored solution that encompasses all phases of service, from development and implementation through health plan operations.

Man on phone with family around

We seamlessly integrate with existing systems across front, middle, and back-office. We understand the importance of minimizing disruption, maximizing efficiency, and providing a unified digital platform for members to access personalized experiences.

The Payer Platform unlocks value via our powerful combination of interoperable technology, seasoned industry leaders, and high-performance processes.

 

predictal logo

Whole-person care management


Predictal™ is a configurable solution including Utilization,  Case, Disease, and Grievances Management  and Auto Authorization Hub (AAH, UM, CM/DM, AGM). Choose individual modules or integrate the full solution.

Capabilities

  • Manage pre- and post-service appeals for medical and prescription services.

  • Streamline integration with apps such as Epic and Oracle.

  • Communicate with providers and patients in one place.

  • Use built-in functions to comply with regulatory guidelines (e.g., CMS-0057-F). 

  • View audit history and receive audit support.

Features

  • Manage self-service authorization criteria for streamlined approvals.

  • Create 360-degree member/patient profiles through AI-driven analysis.

  • Build smart, automated workflows using configurable tasks and notifications.

  • Utilize AI to examine, identify, and approve claims to increase authorization rates. 

  • Leverage business intelligence insights through our self-serve reporting and analytics dashboard.

Innovative and modern

3M+ suspends handled through human-led AI

 

Administrative Efficiencies

260M+ claims processed annually

~ 92% of claims volume processed via automation

Optimized authorization savings

71% decrease in average cost per authorization

Increased productivity and efficiency

300% improvement in turnaround time

Faster authorization decisioning

25% boost to real-time decisions through digital authorizations

Competitive Differentiation

2.53M ID cards produced since August 2024

Improved Health Outcomes

~50% increase in RN and MD cases per day

24% reduction in unnecessary ED use in last 2 years 

Products

Predictal connects Utilization, Case, and Disease management into a single, modern system that consolidates member and provider information. Inspired by innovative care delivery models, advanced digital technologies, and data interoperability, Predictal enables business outcomes through streamlined business intelligence and powerful insight capabilities, while simplifying care for members and providers.

This cloud-based solution holistically manages provider activities, reducing administrative burden. Offering enhanced maintenance through intelligent, optimized workflows, Providius enables the more efficient collection, management, and distribution of provider data. By linking multiple applications into one modern, configurable, and streamlined solution, Providius gives health plans and providers the self-service capabilities to manage demographics, contracting, networks, reimbursement administration, and credentialing.

Our Business Intelligence solution provides actionable insights to identify opportunities for cost efficiencies and targets key trends. With innovative and cutting-edge solutions that equip our clients with the information they need, this tool empowers health care payviders to stay ahead of the curve, improve patient outcomes, and optimize operational efficiency.

A testament to our vision of transforming health care through technology, we support our clients with data that helps drive optimization, greater efficiencies, and strategic targeting – everything they need to be successful in today’s marketplace.