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What We Do

HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. 

One comprehensive solution. 

The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration.


Seamless. Rest assured that every capability on the platform is designed to work in concert with the other capabilities.

Flexible. Take advantage of multiple APIs that let you easily connect with vendors and decrease time to market.

All lines of business. Cover all your lines of health care business: national, large/small group, individual, ACA, Medicaid, and Medicare Advantage.

The support you need.

 

On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space.


An incomparable heritage. Join a customer base that includes 12 health plans and 11 million members. Leverage our roots in Highmark Inc., a health plan payer with a 75-year history of success.

Innovative. Evolve rapidly with innovations in robotic process automation, digital transformation, and more initiatives that advance quality, cost, and productivity.

Secure. Rest assured that our HITRUST certification can provide the security your members expect.

The outcomes you want.

The Enterprise Health Solution is based on a centralized model so you can realize cost efficiencies through expanded scale and shared investments in market-driven capabilities, innovation, regulatory mandates, security, and technological evolution.


Competitive. Let us make major IT investments that help you compete with commercial carriers.

Accessible.Give members a portal where they can easily find the information they need, using the devices they prefer.

Reliable. Rely on our proven on-time and on-budget migrations when it’s time for your members to come onto the platform.

The Enterprise Health Solution

The Enterprise Health Solution (EHS) is an integrated end-to-end platform that includes three neighborhoods —Market Development, Operations, and Health Care Management—and is supported by Platform Services. 

The EHS Platform is configurable, designed to integrate with the most sought-after third-party vendors. This flexibility gives health plan customers access to key partners in the market, such as 3M, Adobe, Pegaystems, and Salesforce.

The EHS Platform applications and tools offer capabilities, managing functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service.