Revolutionizing Healthcare for Health Plans: The Allymar Health Advantage

Allymar Health enables growth-oriented MA plans to compete and outperform in the middle market by providing an integrated fabric of Core Admin and Care Management solutions to power their operations.

Best-in-class technology offerings
Increased risk score accuracy
Decreased OpEx
Increased compliance
Innovation tied to value outcomes
Single point of accountability

How Allymar Health works with Health Plans

Allymar Health brings expert advisory services, owned technology and BPaaS offerings and pairs these with industry leading Medicare Advantage technology in one centralized platform. Our health plans benefit from:

Data Aggregation

Data Aggregation

We aggregate, normalize, and unify structured, unstructured, and semi-structured data into our common data platform using the latest technology tools and standards such as FHIR and HL7.

Clinical Insights Engine

Clinical Insights Engine

We identify confidence-adjusted and evidence- based care gap opportunities for every member by leveraging out clinical data repository of over 100M EMR and medical charts.

Patient Data Profiles Integrated into your Workflows

Patient Data Profiles Integrated into your Workflows

Member and provider level curated data profiles are available in a variety of formats to enable payer and provider workflow integration.

Prospective and Retrospective Services

Prospective and Retrospective Services

We offer a full suite of managed services using our AI risk tool to accurately capture documented conditions and identify additional opportunities for prospective provider assessment, including 2-way review and risk mitigation.

Performance Management and KPI Tracking

Performance Management and KPI Tracking

We provide a self-service and interactive reporting platform that allows your organization to manage RAF performance which includes operational, program/campaign level and financial reporting packages to identify progress towards achieving your RAF objectives.

Access to best-in-class technology offerings

Allymar Health empowers health plans to improve patient care with
real-time actionable data provided at point of care.

This allows our Health Plan Partners to:

Improve RAF accuracy
Be fully compliant and secure
Access the best enterprise technology partners in one simplified platform

Allymar Health offers an unparalleled level of experience and data allowing for better modeling and AI delivery

Allymar Health empowers health plans to improve patient care with real-time actionable data provided at the point of care.

500+ Allymar Healthcare professionals providing products and services***
20,000+ healthcare professionals with 500+ licensed medical professionals

Healthcare management consulting


Health intelligent operations centers


Health customers (through our Partner Network)


Health patent


Enrollment and billing technology


Claims and payments system


Provider portal (through our Partner Network)


AI charts


Clinical records

Take unstructured data from all sources and have it pulled into coding recommendations, care gap opportunities and next steps for patients.

Our Approach

Allymar Health provides a future-tech ready Enterprise Medicare Advantage Platform that offers intelligent, multi-tenant capabilities in Risk Adjustment, Quality, and Core Admin.

Tailored to the unique needs of growth-oriented plans.
Market-leading, secure services at scale designed for small to mid-sized health plans.
Fully auditable, traceable solution to maximize compliance with federal and state regulations.
The Allymar Health platform allows health plans to focus on healthy patient outcomes.

Streamlined vendor governance


Improve coding efficiency up to 99%


Achieve quality metrics across your plan and be fully complaint


Achieve quality metrics across your plan

Impact for Health Plans :

10-15% Increase In Risk Adjustment Accuracy*
20-30% decrease in admin expenses

Allymar Health's Medicare Advantage Suite

Call Center & Core Operations
  • Risk Diagnostic
  • AI Chart Review
  • Risk & Quality Analytics
  • Member And Provider Outreach Services
  • In-Home Assessments
  • CAHPS Survey
Core Admin
  • Core Admin Diagnostic
  • Enrollment And Billing
  • Claims And Payments
  • Member Service
  • Customer Service
  • Appeals & Grievances
  • Broker Management and Commission
Health Management
  • Utilization Management
  • Care Management
  • Clinical Insights & Diagnostics

Applied Intelligence & Analytics

Artificial Intelligence
Artificial Intelligence


Pharmacy STARS Reporting

CMS / HHS Submissions

Member Engagement

Provider Engagement

Analytics & OS

AI / Chart Review

OCR & Workflow

Reporting & Analysis
Reporting & Analysis

Performance Dashboard

Data Warehouse

Data Quality & Standardization


Analytics & Bi

How the Allymar Health Platform works

Mrs. Johnson


Understanding the Patient

  • Ingest various structured & unstructured data into the Risk Al Platform.
  • EHR, Claims, Labs, Supplemental Data, etc.

Recapture/Suspect HCCs and Quality Gaps in Care

  • Risk & Quality Reporting Suite
  • Risk Al Platform generates suspect diagnoses and gaps based on machine learning algorithms trained on millions of data.

Point of Care HCC and Gap Closure + Phys. Engagement

  • Provider sees patient in the office and is notified of recapture suspect dx + quality gaps within EHR and captures the diagnoses.

EHR Chart Retrieval

  • EHR Retrieval
  • Fax, Mail, Call Center, Onsite as Needed

Al-Assisted Risk + HEDIS Coding

  • Code charts using Al-assisted coders on the Risk and HEDIS AI Platform.
  • Concurrent Review

Encounter Submissions & Fallout Analysis

  • Submit at 95%+ accuracy with insights into encounter and dx fallout

Financial Projections

  • Estimate incremental financial impact based on payment year
  • RAF accruals & revenue forecasting

Head-to-head competition

In four (4) recent ‘head-to-head’ comparisons with ‘market leading’ competitors, our AI outperformed on accuracy and total value.

We have ‘won’ 100% of the ‘head-to-head’ comparisons in the mid and large market.

*These numbers are based on previous work engagement, and each work engagement will have varying results based on partner and their specific population.

Schedule a Demo

During this 30 minute meeting, a member of our team will explain the opportunities we can offer through a video conference call.

*Performance is based on that of the partner and their population and therefore performance may vary
*** This includes the Allymar Health team and Allymar Health’s partners.