Radiance provides health plans with an outcomes‑based payment operating system that centralizes attribution, provider performance tracking, and payment reconciliation. The platform ingests contracts and claims data, validates existing attribution logic, identifies conflicts such as duplicate assignments, and returns audited eligibility and payment files that integrate with a plan’s existing workflows.
Funding
Funding not disclosed
Founders
Product
Problem
Health plans face increasing complexity in value‑based care programs, requiring manual attribution of members to providers, tracking of performance, and reconciliation of payments across overlapping contracts. This manual process leads to duplicate payments, long program launch times, and difficulty maintaining an auditable record of attribution logic.
Solution
Radiance offers an auditable operating system that centralizes attribution management, provider performance measurement, and payment reconciliation for outcomes‑based contracts. The platform ingests contracts, eligibility criteria, claims, and enrollment data, then translates them into a structured, machine‑readable model that replicates a plan’s existing attribution logic. By validating this logic against actual claims, Radiance identifies conflicts such as duplicate assignments, hierarchy issues, and dual‑incentive overlaps, quantifying their dollar impact. Resolved attribution tables and reconciliation outputs are pushed back into the plan’s workflow, enabling real‑time updates and reducing program launch cycles from months to weeks. The system maintains a single source of truth, providing traceable changes and compliance‑ready audit trails for value‑based payment programs.
Target Audience
Primary customers are health plan payors and value‑based care administrators who need to manage large member populations, multiple provider contracts, and complex payment arrangements.
Features
- Ingestion engine that converts contracts, eligibility rules, claims, and enrollment files into a unified, machine‑readable data model
- Validation module that replicates existing attribution logic and runs it against live claims to ensure consistency before deployment
- Conflict detection dashboard that flags duplicate assignments, hierarchy conflicts, and overlapping incentives with quantified financial impact
- Real‑time attribution updates and payment reconciliation outputs that integrate back into the health plan’s existing systems and provider portals
- Auditable system of record that logs all logic changes, conflict resolutions, and data flows for compliance and reporting