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.
Intelligent Core Administrative Processing System (CAPS): Connected, Fast, and Adaptable
Next-gen is now. For healthcare payers, it is not enough to automate existing processes — enGen’s modern core administrative processing system (CAPS) is fundamentally reshaping healthcare administration. With our award-winning CAPS solution, enGen Payer, you can automate processes to save costs, drive innovation, explore market expansion opportunities, and embrace next-gen capabilities now.
enGen’s Payer Platform gives you the capabilities you need to serve your providers and members. Our system integrates core administrative functions — benefit configuration and product setup, member enrollment, claims processing, and billing — for smooth interoperability.
We're not just automating processes; we're reimagining the healthcare experience through the power of intelligent automation and data-driven insights. With surging costs and rising member expectations, enGen delivers a solution designed to empower health plans for success.
Flexible and scalable CAPS features
With a flexible and scalable architecture and AI-assisted processing, enGen’s CAPS gives you advanced capabilities now and lays the foundation for innovation in the future.
Benefits and outcomes with enGen Payer
Choosing a CAPS that reduces risk and maximizes your client satisfaction is vital to your success. Your system should give you optimal outcomes now. enGen Payer facilitates:
- Regulatory compliance: Ensure you are aligned with evolving, complex industry regulations so you can be confident about compliance.
- Data-driven insights: Gain actionable insights from your data with our intelliGen analytics tool — optimize processes, reduce costs, and improve member outcomes.
- Integrated member data: Our member engagement hub combines data management, decision management, and robust analytics across multiple channels.
- Ease of reporting: Reporting dashboards in our intelliGen self-service tool keep you results-savvy and audit-ready.
Build from a future-ready foundation
As the industry evolves and your business grows, your needs will change. enGen Payer gives you the flexibility to scale up your system as you expand your market reach.
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.
FAQ
A core administrative processing system (CAPS) or core administrative processing solution encompasses software and services to process administrative tasks for healthcare payers. A payer’s CAPS will configure and manage benefit products, enroll and bill client organizations, enroll providers and members, send premium invoices, process and pay claims, support seamless electronic data interchange, ensure regulatory compliance, and analyze data for reporting.
Payers should clarify their needs and requirements before exploring a CAPS purchase. Choose a CAPS that will make your operations more efficient via automation and responsible use of AI. Your system will need to integrate with other vendors’ solutions and provide interoperability across systems. Your CAPS should be flexible to adapt to market changes and scalable as you grow. Compliance, risk reduction, and data security and privacy are vital. Research the vendor’s quality measures and brand reputation as you compare options.
A payer platform is a healthtech solution that streamlines and automates administrative, financial, and clinical processes for a health insurance company (a payer). A payer platform also can optimize provider interactions, member benefit and care communications, and clinical and business outcomes.
