External data management for health plans

The trusted foundation for external healthcare data

Health Data Innovations (HDI) began with a challenge from one of the nation’s largest health plans.

They needed a better way to manage healthcare data from outside their own systems. That challenge led HDI to pioneer External Data Management for healthcare – the ongoing capability to acquire, validate, resolve, and deliver trusted external healthcare data, transforming disparate data into a single source of truth for every downstream system.

More than 16 years later, that same health plan continues to trust HDI with this critical work. Today, we apply the expertise developed through that long-standing partnership to health plans across the country, removing the burden of managing complex external healthcare data internally.

Build Your Foundation

Built for the external data your organization doesn’t control

Claims data provides one of the most complete views of the care patients receive beyond your organization’s walls.

When external healthcare data is reliable, leaders can confidently measure performance, forecast results, and make better decisions across the enterprise.

The better the foundation, the greater the value every downstream system can deliver.

Your data and analytics teams should be improving performance – not chasing data issues.

Value-based care depends on reliable claims data, yet many health systems still work with incomplete, delayed, and inconsistent claims feeds across payers.

Without a dedicated capability, managing external healthcare data becomes an ongoing operational burden. Data and analytics teams spend valuable time chasing data issues instead of improving value-based care performance, supporting providers, and delivering strategic insights.

The impact reaches far beyond the data team. Unreliable claims data can affect attribution, risk adjustment, quality measurement, network leakage, care gap tracking, utilization reporting, and contract performance. It increases manual reconciliation, reduces confidence in reporting, and can ultimately weaken financial performance under value-based care contracts.

Every new payer, contract, and data source increases the complexity.

Continuous management.
Proven every reporting cycle.

External healthcare data doesn’t operate on a single schedule. Third parties deliver data daily, weekly, or monthly.

HDI continuously monitors expected file deliveries, validates incoming data, detects missing or delayed files, identifies unexpected changes, investigates anomalies, and delivers trusted healthcare data for your enterprise environment.

Whether data arrives every day or once a month, every reporting cycle is managed with the same proven methodology and expert oversight.

The HDI Advantage

The HDI Advantage combines purpose-built technology, proven data management processes, and hands-on healthcare data experts – one integrated capability for External Data Management.

See how

Purpose-built technology

Purpose-built technology for predictable, repeatable healthcare data transformation.

  • Speed
  • Scale
  • Security

Proven processes

Processes refined through thousands of real-world healthcare data scenarios.

  • Operational Excellence
  • Adaptability
  • Dependability

Hands-on healthcare data experts

Experienced healthcare data experts who become an extension of your team when expertise and judgment matter most.

  • Confidence
  • Collaboration
  • Expanded Capacity

Built on more than 16 years of payer experience

For more than 16 years, HDI has continuously managed one of healthcare’s most demanding external healthcare data environments.

That experience has shaped every validation, business rule, exception workflow, and process behind the HDI Data Management Model – helping health plans receive reliable, consistent data as vendors, layouts, and business requirements evolve.

Trusted external healthcare data starts with experienced people who understand what’s required to keep it that way.

Build the Foundation. Build the Future.

Trusted healthcare data starts with experienced people who understand what’s required to keep it that way.

Let’s talk about your healthcare data challenges.

FAQs

Health Data Innovations (HDI) was founded when one of the nation’s largest health plans needed a better way to manage external healthcare data. That engagement became the foundation for HDI’s External Data Management capability. More than 16 years later, that same health plan continues to trust HDI to manage this critical work.

Today, we apply the expertise developed through that long-standing partnership to health plans across the country, removing the burden of managing complex external healthcare data internally.

External Data Management is the ongoing capability to acquire, validate, resolve, and deliver trusted external healthcare data. HDI transforms disparate healthcare data from third-party sources into a single source of truth and keeps it current for every downstream system and team that depends on it.

HDI delivers reliable carved-out benefit claims data for health plan administrative service only (ASO) divisions that need to integrate that data into their own systems to create complete records of member care. HDI’s External Data Management capability absorbs the operational burden of ongoing delivery of this carved-out benefit data. The flexibility of The HDI Data Management Model allows us to support unique client requirements beyond traditional healthcare data use cases. For example, one health plan relies on HDI to consolidate enrollment and contribution data from multiple health plan affiliates for delivery to a single flexible spending account administration platform.

HDI manages a broad range of external healthcare data, including pharmacy claims data, laboratory data, historical claims, eligibility, Health Risk Assessments (HRA), biometric data, care management data, provider files, and other third-party healthcare data.

HDI acquires, validates, and prepares historical healthcare data from previous carriers so health plans have trusted data available as new members begin coverage. This helps support care management, member outreach, underwriting, and other business functions from the beginning of the relationship.

HDI supports client-specific processing schedules, including daily, weekly, twice-monthly, monthly, and other reporting cadences. Our Data Management Model continuously monitors expected deliveries and manages every reporting cycle using the same proven methodology.

HDI continuously tracks expected file deliveries and validates every dataset before it reaches downstream systems. We identify missing or delayed files, unexpected population changes, financial variances, duplicate data, layout changes, and other anomalies. Our hands-on data experts investigate the root cause of all exceptions and help drive resolution before unreliable data reaches your enterprise.

Yes. HDI delivers trusted external healthcare data in the format required by each downstream system. Whether your organization uses an enterprise data warehouse, analytics platform, actuarial tools, care management applications, or custom environments, HDI delivers a single source of truth that can be loaded where you need it.

Integration platforms move data between systems. HDI continuously manages external healthcare data after implementation. We monitor expected file deliveries, validate data quality, investigate exceptions, resolve issues, and deliver trusted healthcare data every reporting cycle. Technology automates predictable work while healthcare data experts manage the exceptions.

Managing external healthcare data requires more than technical integration. Every reporting cycle introduces changing layouts, business rules, schedules, missing files, and data quality issues that require continuous monitoring and specialized healthcare data expertise. HDI removes that ongoing operational burden so your internal teams can focus on higher-value initiatives.