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Simintero: Revolutionizing payer Interoperability

Empowering Payers: Unleashing Efficiency and Compliance in Healthcare through Groundbreaking Interoperability Solutions

Simintero for Payers: Transforming Healthcare with Pioneering Interoperability and Compliance Solutions

Are you ready? - CMS' Advancing Interoperability and Improving Prior Authorization Processes Final Rule (CMS-0057-F)

Efficient Prior Authorization & Compliance: Our bundled Simintero solution for Payers revolutionizes prior authorization processes and ensures early compliance with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). By leveraging HL7 FHIR standards, we offer a solution that not only streamlines authorizations but also guarantees adherence to regulatory requirements, enhancing operational efficiencies.

Seamless Documentation & Data Exchange: Our solution automates documentation management and facilitates seamless, standardized data exchanges across the healthcare spectrum. This integration simplifies complex processes, from claims adjudication to compliance and quality assessments, ensuring accurate and timely information flow between payers, providers, and suppliers.

Advanced Decision Support & Program Integrity: With intelligent automation and machine-assisted reviews, Simintero provides advanced clinical decision support, reducing the burden of medical reviews and combating fraud, waste, and abuse. Our technology strengthens program integrity, enhancing payer compliance through digitized rules and simplified documentation processes.

Digital Transformation & Interoperability Excellence: Simintero is at the forefront of digital transformation, driving the adoption of interoperability standards among payers. Our standards-based solution is not only readily available but also customizable, ensuring payers can meet CMS regulations early, maximizing benefits and setting a new standard in healthcare efficiency and collaboration.

Proven Excellence in Healthcare Solutions: Backed by a track record of ‘Exceptional’ performance, Simintero showcases our commitment to innovation, quality, and efficiency. We empower payers to navigate the evolving healthcare landscape with confidence, leveraging our expertise to deliver unparalleled value and transform payer operations.

Simintero for Payers: Transforming Healthcare with Pioneering Interoperability and Compliance Solutions

Interoperability and Compliance Mastery

Ready-to-Deploy Solution: A comprehensive, standards-based solution, available for subscription or custom build, to meet CMS' Final Rule requirements ahead of deadlines.

Flexibility and Customization: Offers the ability to customize and extend functionalities to fill operational gaps and maximize benefits.

Comprehensive Coverage Rules Access

Real-time Rules Retrieval:  Provides instant access to up-to-date payer-specific coverage rules and medical necessity guidelines.

Reduces Provider Burden:  Simplifies submission processes, ensuring documentation meets payer requirements.

Modernized Prior Authorization Processes

Streamlined Workflows: Automates the prior authorization processes, reducing burden and wait times, thus improving provider satisfaction.

HL7 FHIR Compliance: Ensures full compliance with CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).

Machine-Assisted Medical Reviews

AI-Driven Insights: Leverages artificial intelligence for faster, more accurate medical reviews on unstructured documentation.

Standards-Based Interoperability: Utilizes HL7 FHIR standards for seamless, structured documentation exchange.

Advanced Documentation Exchange

Efficient Information Sharing: Facilitates secure and rapid exchange of medical documentation, supporting claim adjudication and compliance.

Program Integrity Support: Enhances reviews for medical necessity, claims, quality, appeals, and fraud prevention through standardized data exchange.

Qualitron: Digital Quality Measures Support

FHIR Specifications Compliance: Supports the collection and reporting of quality measures data using FHIR.

Care Gap Analysis: Identifies and addresses care gaps to improve Value-Based Care outcomes.

Enstellar: HL7 FHIR DaVinci Compliant Solutions

Real-time Responses: Offers machine-assisted reviews and digitized rules for immediate decision-making.

Interoperability Tools:  Includes X12N translators and FHIR viewer for comprehensive data integration.

Digicore: Digitized Payer Rules Artifacts Repository

Interactive Coverage Library: Houses digitized NCDs, LCDs, and billing policies for machine processing.

Enhanced Usability: Employs FHIR Questionnaires for accessible rule navigation and data collection.

Revital: AI-Based Medical Review Tools

Complements Structured Reviews: AI toolset for unstructured documentation analysis, augmenting review efficiency.

Customizable AI Models: Tailored AI solutions to meet specific payer review and analysis needs.

Simintero: Mastering Healthcare's Future with Simplifying Interoperability solutions

Transform your healthcare ecosystem with Enstellar, the gateway to seamless interoperability and FHIR-enabled efficiencies across payer-provider networks.

Navigate healthcare’s complex regulations effortlessly with Digicore, where digitized rules simplify compliance and operationalize coverage decisions in real time.

Elevate healthcare outcomes with Qualitron, where measuring clinical quality transforms to a strategic advantage through precise, FHIR-based definitions, calculations, and reporting.

Revolutionize medical reviews with Revital, leveraging AI’s power to refine decision-making processes, enhance accuracy, and streamline healthcare operations.

Unlock the Future: Revolutionize Your
Payer Operations with Simintero

In the rapidly evolving healthcare landscape, staying ahead means embracing solutions that not only meet today’s demands but also anticipate tomorrow’s challenges. Simintero, powered by Mettle’s deep expertise in healthcare technology, offers payers an unparalleled opportunity to revolutionize their operations. Our bundled solution brings advanced interoperability to your fingertips, enhancing data exchange and streamlining processes like never before.

Why Choose Simintero?

  • Advanced Interoperability: Seamlessly connect with providers and suppliers, ensuring efficient and compliant data exchange.

  • Streamlined Prior Authorization: Reduce administrative burdens and improve turnaround times with our automated solutions.

  • Comprehensive Documentation Management: Automate and expedite the exchange of medical documentation, supporting a range of program integrity lines.

  • Digitized Coverage Rules: Access up-to-date coverage information easily, reducing provider inquiries and streamlining claims processing.

  • AI-Driven Medical Reviews: Enhance review accuracy and efficiency with our intelligent, machine-assisted solutions.

Mettle’s commitment to pioneering healthcare solutions is evident in every facet of Simintero. We’re not just vendors; we’re your partners in transforming healthcare administration. Our deep understanding of payer challenges, combined with our innovative technology, positions us uniquely to help you improve operational efficiency, compliance, and patient care outcomes.

Take the Next Step

Ready to transform your payer operations and lead in healthcare’s digital future? It’s time to explore how Simintero can empower your organization. Contact us today to schedule a demo and discover the full potential of partnering with Mettle. Together, let’s redefine what’s possible in healthcare.

Healthcare Reimagined:
The Simintero Innovations

FHIR Unleashed: Enstellar

Dive into how Enstellar unlocks the full potential of FHIR, facilitating seamless data interoperability and setting new standards in healthcare efficiency.

Rules Redefined: Digicore

Explore Digicore’s revolutionary approach to digitizing healthcare rules, turning complex regulations into streamlined, accessible guidelines for unparalleled compliance ease.

AI-Powered Medical Reviews: Revital

See how Revital leverages AI for machine-assisted medical reviews, boosting accuracy and efficiency in healthcare documentation analysis.

Interoperability Simplified: Simintero

Learn about the Simintero, a bundled solution that combines Enstellar, Digicore, Qualitron, and Revital to redefine interoperability, ensuring a more connected and efficient healthcare ecosystem.

Payer Praise: Celebrating Simintero Success Stories

Simintero has revolutionized our approach to interoperability, streamlining our data exchange processes like never before. Its seamless integration and efficiency have set a new benchmark for payer solutions, making it an indispensable part of our operational strategy.


Thanks to Digicore and Qualitron, navigating complex coverage rules and quality measures has never been easier. Simintero's innovative solutions have not only improved our compliance but also enhanced our decision-making processes, earning well-deserved accolades from our team.

VP of

The transformative impact of Simintero's suite on our prior authorization and documentation workflows has been remarkable. Enstellar and Revital, in particular, have significantly reduced administrative burdens, allowing us to focus on delivering superior patient care.

Dir. Clinical

Learn more about our innovative solutions

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