S558 payer executives assess 20 firms across 18 payer-specific KPIs as 2027 CMS deadlines accelerate consulting demand

CHICAGO, IL / ACCESS Newswire / July 20, 2026 / Black Book Research released its Q3 2026 report, IT Consulting & Advisory Services: Payers, Health Plans & Health Insurers, with industry clients and stakeholders naming UST HealthProof/HealthEdge the top-performing firm among 20 firms evaluated.

The project-verified study uses 18 KPIs purpose-built for payer IT consulting versus generic management consulting measures. They assess payer-market breadth; core administration modernization; claims and payment integrity; enrollment and benefit configuration; utilization management, prior authorization and care management integration; regulatory execution and readiness; provider networks and value-based care; member experience; interoperability and payer-provider data exchange; data, quality, risk adjustment and analytics; cloud and enterprise data architecture; implementation, cutover and change management; security and risk controls; managed services and production support; AI, automation and governance; reusable platform assets; executive governance and value realization; and modernization roadmaps and operating-model transformation.

UST HealthProof/HealthEdge earned the highest overall satisfaction score, 9.40 out of 10, and led 10 of the 18 KPIs. Results reflect 558 payer executives from 118 organizations. Respondents rated only firms with which they had direct executive-level experience on implemented or post-go-live projects during the prior four years.

"Generic consulting scorecards miss the operational realities of the payer enterprise," said Doug Brown, MHA, founder of Black Book Research. "Payer consultants must understand the dependencies among core administration, claims adjudication, benefit configuration, utilization management, provider data, risk adjustment and encounter submissions - and convert that expertise into stronger auto-adjudication, authorization turnaround, regulatory performance and total cost to serve."

Near-term demand was strongest for CMS-0057-F, FHIR API and prior authorization readiness, cited by 84% of respondents; core administration, claims and product modernization, cited by 81%; and data, quality, risk adjustment and analytics modernization, cited by 78%.

"The immediate pressure point is the Jan. 1, 2027, API compliance deadline under CMS-0057-F," Brown said. "Impacted payers must productionize enhanced Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs while remediating legacy data, identity, consent, provider attribution and workflow gaps. The pending CMS proposal to extend electronic prior authorization to drugs further increases demand for architectures spanning medical-benefit and pharmacy-benefit workflows without adding technical debt."

Black Book used a 0-to-10 comparative satisfaction model and excluded prospect-only evaluations, unimplemented advisory work, marketing impressions and references without direct project-governance experience.

Complete report scores can be downloaded at https://www.blackbookmarketresearch.com or requested directly at research@blackbookmarketresearch.com.

About Black Book Research

Black Book Market Research provides independent, vendor-agnostic competitive intelligence, client-experience benchmarking and global market analysis for health technology buyers, vendors, investors and advisers. Its research is based on verified stakeholder feedback, transparent methodology and buyer-relevant performance indicators.

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SOURCE: Black Book Research