we are the pioneers of healthcare automation

nirvanaHealth uniquely combines deep healthcare domain expertise with proven platform-building experience to deploy robotic process automation (RPA) across the payer and PBM industries

reduce administrative costs by 30% and medical costs by 20% through enterprise healthcare automation

what is RPA?

Robotic process automation, or RPA, creates a digital workforce of software bots that perform core business functions and drive automation. This leads to lower operating costs, reduced avoidable medical costs, improved accuracy, and system-driven compliance.

meet Aria

Aria is the first RPA cloud platform designed specifically for healthcare. It was built to automate the industries of healthcare that are most in need of transformation—payer and PBM.  Aria takes RPA to the next level by integrating machine learning (ML) and artificial intelligence (AI), delivering actionable intelligence to all stakeholders across the administrative and care continuums.

It’s also modular, meaning it can be used as an all-in-one solution, or the modules below can ‘plug and play’ into existing plan sponsor systems.

Aria PBM

Aria Payer

Our Business Solutions

powered by Aria

Pharmacy Benefit Management

National Full-Service PBM

Managed Care Services

Powered by Aria

Accountable Care Services

Avoidable Drug-Impacted Medical Cost Management

Specialty Drug Management

Convert “Buy & Bill” to “Value-Based & Outcome-Driven”

PBM Platform

Membership Gateway

Extract and consolidate information across all departments of the PBM, providing plan sponsors with a 360° patient view that enhances critical health/financial decision-making and results in best outcomes.

PBM Platform

Formulary Management

Model, design, and manage custom drug formularies to maximize clinical and financial outcomes.

PBM Platform

Utilization Management

Customize and automate utilization management programs across prior authorization, step therapy, quantity limits, and more to yield the optimal balance of clinical efficacy and cost management.

PBM Platform

Network & Pricing Administration

Model, design, and manage custom pharmacy networks, while simplifying pharmacy contracting and credentialling.

PBM Platform

Pharmacy Claims Adjudication

Adjudicate pharmacy claims in real-time across all lines of business.

PBM Platform

PDE & Encounter Management

Automate creation and submission of encounters and PDEs.

PBM Platform

Medication Therapy Management (MTM)

Empower plan sponsor staff, pharmacists, and prescribers with the needed tools to work collaboratively to produce low cost and high-quality MTM outcomes.

PBM Platform

Rebate Management

Model, design, and manage pharmaceutical rebate contracting processes to optimally balance clinical efficacy and financial outcomes.

PBM Platform

Pharmacy Care Management

Deliver actionable intelligence to the point-of-care and point-of-sale to improve health and financial outcomes without disrupting professional workflows.

PBM Platform

Integrated Data Cloud Platform

Integrate pharmacy, medical, and lab data to provide market-leading reporting and analytics.

PBM Platform

Accountable Care

Manage the most unmanaged portion of managed care by creating a hospital-like care setting at home.

PBM Platform

Specialty Drug Management

Convert “buy & bill” to a value-based and outcomes-driven specialty management model.

PBM Platform

Mobile Apps & Portals

Provide comprehensive actionable intelligence and transaction information to members, providers, pharmacists, and other care constituents through apps and portals.

Payer Platform

Product Lifecycle Management

Build and manage the product, plan, benefits, and pricing lifecycle.

Payer Platform

Multi-Channel Sales Automation

Automate all possible sales channels from quote-to-card and quote-to-contract.

Payer Platform

Membership Gateway

Automate eligibility, enrollment, and membership reconciliation for all lines of business.

Payer Platform

Payment Gateway

Price, bill, receive payment, reconcile multiple payment buckets, and pay commissions to brokers and agents.

Payer Platform

Medical, Behavioral, & Pharmacy Claims Processing System

Cloud-native platform to administer medical and behavioral health claims adjudication for all lines of business.

Payer Platform

Network Performance Management System

Compute statistically valid cost, quality, and utilization performance of physicians, hospitals, and networks.

Payer Platform

Risk Share System

Identify top-tier physicians and hospitals, contract with them, help to manage the risk collaboratively, and manage financial reconciliation.

Payer Platform

Risk Score Optimizer & Reconciler

  • Prospectively and retrospectively manage risk scores through the transaction cycle.
  • Automated generation of risk score data from multiple data sources, and submission of CMS Medicare PDE & EDPS, state Medicaid encounters & T-MSIS reporting, and ACA EDGE server submissions & QHP/SERFF, as well as comprehensive reconciliation.
Payer Platform

Care Management System

Optimize preventive, episodic, and chronic care and manage the overall disease burden.

Payer Platform

Integrated Data Cloud Platform

Integrate the data universe, including claims data (medical claims, behavioral health, pharmacy claims, lab claims), contractual data (physician contract pricing terms, hospital contract pricing terms, network/repricing terms), pricing data (drug pricing, medical services pricing, bundling/unbundling, premium), and operational data (enrollment, actuarial, risk score).

Payer Platform

Quality Optimizer

Prospectively manage quality scores and tie quality scores to outcomes and incentive payments.

Payer Platform

Accountable Care

Create a platform-driven hospital-like care setting at home to reduce hospital visits and manage the managed portion of the managed care population (5-7%).

Payer Platform

Enterprise Services

Collaborative enterprise-wide service integration to optimize first call resolution for members, employers, brokers, prescribers, pharmacists, and other care constituents.

Payer Platform

Mobile Apps & Portals

Provide comprehensive actionable intelligence and transaction information to members, employers, brokers, providers, pharmacists, and other care constituents through apps and portals.