Fueling what matters across every part of the system
Every capability in Infosys Helix is built to move the needle on member experience and on the healthcare challenges that slow it down. Whether it’s cutting through enrollment delays or powering data-driven, connected care, Infosys Helix helps you deliver what really matters: outcomes that work, at scale.
Provider Lifecycle Management
Faster access to trusted providers.
Faster access to trusted providers.
Infosys Helix keeps provider data up to date, so members
always have access to accurate information, making it easier
to find and connect with the right care.
🡒 Cuts down wait time for appointments
🡒 Ensures provider directories are always current
🡒 Reduces back-and-forth for members
Plan Sponsor Hub
Design plans to deliver on their promise.
Design plans to deliver on their promise.
Track how benefits perform in real time and adapt quickly to
what members value most, so plans stay relevant, easy to
use, and better aligned to everyday needs.
🡒 Drive up satisfaction with more intuitive coverage
🡒 Make decisions based on real member behavior
🡒 Close the gap between plan design and plan experience
Every capability. Built to deliver.
From faster enrollment to smarter risk scoring, explore the full range of capabilities that power Infosys Helix. Filter by the outcomes you care about—or by the role you play.
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Enrollment Intake
Automates EDI 834 intake for accurate, timely enrollment. Supports fallout management, audit trails, and alerts to streamline onboarding and improve operational efficiency.
Eligibility Outbound
Shares eligibility data with partners, ensuring providers and members access the most current coverage information to support seamless care delivery.
Engage Member
Enables self-service, personalized recommendations, educational tools, multi-channel outreach, and a virtual assistant (Ask Helix) on the member portal for guided interactions.
Premium Reconciliation
Tracks and reconciles premium payments with automated invoicing, processing, and posting rules, ensuring financial integrity, compliance, and operational accuracy.
Manage Member
Consolidates enrollment, eligibility, benefits, and demographic data into a single system, allowing seamless updates, tracking, and reporting of member status and interactions.
Eligibility Inquiry
Supports EDI 270/271 and portal-based inquiries to validate member eligibility and coverage details, enabling real-time verification for faster service delivery.
SDOH Management
Automates the capture and upkeep of social determinants of health (SDOH) data to support care planning, risk stratification, and plan design with personalized recommendations.
Finance Management
Automates billing, payment processing, and financial reconciliation for member transactions, ensuring accuracy, transparency, and a complete financial view.
Claim Intake
Automates claims submission through EDI 837, reducing manual errors and accelerating claim processing to improve accuracy and operational efficiency.
Paper Intake
Automates intake of claims, appeals, and grievances from paper sources, reducing manual errors and streamlining workflows for faster and more accurate handling.
Claims Status Enquiry
Enables EDI 276/277 transactions for real-time updates on claim status, improving provider-payer communication and reducing manual follow-ups.
Claims Workflow
Manages claims from submission to resolution across all modes—EDI, paper, and DDE—while supporting denials, adjustments, appeals, and resubmissions.
Claim Validation
Applies automated edits to detect and correct claim errors pre-adjudication. Supports configurable rules, vendor integration, status messages, and warnings.
Claim Pricer
Ensures accurate claim pricing using benefits, contracts, and latest codes. Seamlessly integrates with third-party systems for compliant, efficient processing.
Claims Adjudication
Manages all stages of claims processing—eligibility, compliance, pricing, and payment. Supports manual review and final decisions across claim types.
Claims Accumulators
Tracks benefit usage and financial limits across claims. Synchronizes accumulator data across platforms to support compliance and accurate benefit management.
Pre-Paid Claim
Generates pre-paid claims with predefined services and payment values. Enables pricing, medical necessity checks, and cost share calculation in advance.
Claims Payment
Handles disbursement of approved claims, including EDI 835, paper checks, EOPs, and EOBs. Ensures timely provider payment and accurate remittance processing.
Claims Estimate
Generates pre-service cost estimates for providers and members, improving transparency around reimbursement expectations and out-of-pocket expenses.
Encounter Management
Processes encounter data from MCOs and other partners. Configurable intake, validation, and submission support regulatory compliance and data accuracy.
Encounter Analytics
Analyzes encounter data to assess utilization, quality, and provider performance. Enables informed decision-making and supports quality improvement efforts.
Claim Payment Integrity
Validates payments to prevent over/underpayment and ensure compliance with contract terms. Strengthens financial integrity through automated checks.
Claim Extract
Creates 837-format data extracts for reporting and compliance. Supports regulatory submissions and internal analysis of claims transactions.
Dispute Resolution
Manages resolution of claim and provider disputes with configurable workflows, timely updates, and transparent stakeholder communication.
Complaint Intake
Captures and manages member or provider appeals and grievances, initiating reviews with structured documentation and audit-ready workflows.
Complaint Resolution
Oversees grievance and appeal processes, applying defined rules for outcome decisions and managing SLAs, notifications, and communications.
Premium Billing
Automates the generation of billing statements based on services rendered, improving billing accuracy and reducing administrative effort.
Premium Reconciliation
Matches billing and payment records to identify discrepancies, enabling prompt resolution and maintaining financial integrity.
Customer Service
Supports members and providers through unified data capture, omnichannel communication, persona-based insights, and guided service workflows.
Medical Necessity Review
Enables AI-assisted clinical review workflows using guidelines and medical records for prospective, concurrent, and retrospective services.
Provider Application
Offers a guided provider portal for intake, updates, and termination. Features include real-time alerts, configurable workflows, templates, and CAQH integration.
Provider Credentialing
Manages end-to-end credentialing with automated primary source checks, SLA tracking, case routing, dashboards, and built-in communication tools.
Provider Contracting
Handles contract creation, editing, and maintenance with digital workflows, version control, risk classification, and linkage to fee schedules.
Digital Contract Negotiation
Streamlines redlining, negotiation, and finalization with e-signatures, automated workflows, real-time collaboration, and compliance checks
Contract Configuration
Enables tailored contracts with configurable clauses, templates, and business rules based on provider type, geography, and services offered.
Provider Data Management
Maintains a complete Provider360 profile with real-time monitoring, external validations, and insights on referrals, contracts, and recredentialing.
Network Lease Management
Manages leased network setups and integration with fee schedules to maintain payment transparency across direct and leased provider networks.
Fee Schedule Management
Supports ingestion, setup, and AI-driven recommendations for fee schedules across provider types and reimbursement models.
Roster File Management
Uses NLP to ingest and validate unstructured provider rosters. Ensures quality and compliance with automated data checks and enrichment.
Provider Finder
Enables provider search by specialty, location, cost, and quality metrics. Features elastic search, OOP estimators, and preference-based recommendations.
PCP Assignment
Assigns primary care providers based on member preferences, location, or logic. Supports auto-reassignment and mass member movement.
Provider Reporting
Generates insights into provider performance, utilization, and compliance to support network optimization and strategic decisions.
Coder's Desk
Central hub for accurate medical coding with AI-assisted logic, coding guidelines, and integration with external coding partners.
EMR Connect
Integrates EMR systems with payer platforms for seamless data sharing, improving care coordination and clinical collaboration.
Provider Engagement
Supports end-to-end provider lifecycle activities—from credentialing to referrals—through a unified portal with real-time updates and alerts.
Provider Directory
Provides a detailed and dynamic listing of in-network providers. Includes filtering, visibility options, and provider-managed updates.
Prior Authorization
Automates prior authorization requests (EDI 278) with configurable rules, medical necessity checks, workflows, and analytics for faster approvals.
Care Management
Coordinates medical, behavioral, and social care through data-driven planning and AI-powered tools to improve member outcomes and reduce costs.
Clinical Data Repository
Aggregates clinical data from EHRs, claims, and patient inputs to offer a longitudinal health view, supporting care gap closure and insights.
Remote Patient Monitoring
Integrates with wearables to track vitals and activities for home-bound members, enabling proactive care via clinician and care circle views.
Risk Scoring
Calculates member risk using demographics, clinical data, and utilization to prioritize care efforts and predict future health events or costs.
Risk Adjustment
Supports methodologies like HCC, CDPS, and DCG to align reimbursements with member risk, ensuring fair compensation and regulatory compliance.
HEDIS Submission
Enables automated HEDIS data collection and reporting to evaluate care quality and maintain compliance with performance standards.
Member Twin
Creates a longitudinal digital profile with clinical, behavioral, genomic, and cost data, enabling proactive care and personalized engagement.
Medical Policy Management
Maintains and distributes medical policies based on clinical guidelines to ensure consistency in coverage decisions and regulatory compliance.
Broker Commissions
Automates broker commission calculation and payout based on plan sales, ensuring accuracy, transparency, and performance tracking.
Benefit Catalog
Acts as a single source of truth for benefits across medical, dental, vision, and more—from quote to claim—ensuring consistency and clarity.
Plan Documents Management
Centralizes storage and access to plan documents to support compliance, improve visibility, and simplify regulatory and operational reviews.
Plan Configuration
Enables plan customization with configurable benefit structures, inheritance logic, and streamlined setup for faster go-to-market execution.
Product & Plan Design
Supports the creation of diverse health products and wellness programs tailored to market needs, spanning medical, vision, dental, and more.
Plan Sponsor Intake
Streamlines new sponsor onboarding by capturing required data efficiently and configuring enrollment, billing, and ID card setups.
Rate & Quote
Automates quote generation based on selected benefits and pricing structures, helping accelerate plan setup and shorten the sales cycle.
Plan Sponsor Engagement
Auto-generates plan documents like benefit summaries and marketing materials, ensuring consistency, compliance, and reduced manual effort.
