Innovaccer Inc
09/28/2026 | Press release | Distributed by Public on 09/28/2026 05:46
Innovaccer for Payers: Solutions, Use Cases & Value
Mastek and Innovaccer have partnered to bring agentic healthcare AI to health systems, payers, public sector, and life sciences organizations across the US, UK, Europe, and the Middle East. For health plans specifically, that partnership centers on Galaxy, Innovaccer's payer solution suite, deployed and operationalized by Mastek inside each plan's existing systems and regulatory environment.
The pressure on health plans in 2026
Health plans are managing more prior authorization volume, more complex risk adjustment rules, and higher member expectations, all at once. CMS-0057-F is now in effect, requiring a decision on urgent prior auth requests within 72 hours and standard requests within 7 days, with the FHIR-based prior authorization APIs due in January 2027. V28, the current HCC risk adjustment model, removed roughly 2,000 diagnosis codes from HCC mappings during its phase-in, tightening how precisely a condition has to be coded and documented to count. And plans rated 4 Stars or above now cover just 63.5% of Medicare Advantage members, down from 90% in 2022.
None of this is solvable by adding headcount. According to BCG's 2026 analysis, AI deployed end to end across payer operations can reduce administrative costs by roughly 40%. Getting there depends on a platform that can actually run inside a plan's existing systems and policies, not just a model that performs well in a demo.
What Innovaccer gives payers
Galaxy is Innovaccer's payer solution suite, built on Gravity, Innovaccer's healthcare autonomy platform. It works the same way across risk adjustment, quality management, and utilization management: unify the plan's clinical, claims, pharmacy, and supplemental data into one governed view of the member, build connected workflows on top of it, and put AI agents to work running those workflows, with people in control of every coding, clinical, and prior authorization decision.
Innovaccer builds and maintains Galaxy and provides AI-powered products built on the Gravity platform. Mastek configures it to each plan's specific policies, integrates it with the plan's existing systems, and supports it after go-live. Galaxy is #1 Best in KLAS 2026 in the Data Analytics Platform for Payers category.
Use case 1: Utilization management and prior authorization
Utilization management is the process of reviewing whether a requested service meets medical necessity criteria before or during care, and prior authorization is its most visible, most time-consuming form. The American Medical Association's 2025 survey found physicians and their staff spend an average of 14.6 hours a week on prior auth alone, and the CAQH Index shows why: a manually processed request costs roughly $3.41 per transaction against $0.05 for one processed electronically, with roughly 65% of prior authorization volume still not fully electronic.
Galaxy UM captures every request, prior authorizations included, across FHIR, provider portal, EDI X12 278, and fax, verifies eligibility, assembles the clinical documentation, checks it against policy, and evaluates it against the plan's own medical necessity criteria. Qualifying requests are approved in real time and tracked automatically. Everything else is escalated to a clinical reviewer with an AI-prepared summary attached. Galaxy auto-approves routine requests and never issues an automated adverse determination; a clinician reviews every potential denial before it is sent back to providers.
Mastek configures and integrates these workflows to the plan's specific policies, lines of business, and state or federal requirements, connecting them to the plan's existing portal and EDI systems and to CMS-0057-F's decision-timeline requirements specifically, so the system reflects how the plan actually operates and meets deadlines it's already legally required to hit, rather than running a generic rules engine.
Use case 2: Risk adjustment and coding accuracy
Risk adjustment determines how accurately a plan's payments reflect the health of the members it covers, and it has gotten harder, not easier. RADV audits are now conducted annually across every eligible Medicare Advantage contract, and starting in CY2027, CMS will exclude diagnoses from unlinked chart reviews from risk score calculations, putting more weight on coding that is tied directly to an actual encounter.
Galaxy's agents surface suspected and undocumented conditions for review and support accurate HCC coding under the V28 model, while coding decisions stay with certified coders. Mock audits and CMS-aligned RADV evidence packs keep documentation defensible year-round instead of scrambled together when an audit notice arrives. In Medicare Advantage plans using Galaxy for risk adjustment, HCC gap closure has improved by 14%.
Mastek connects this workflow to each plan's existing claims and chart-retrieval systems, so the coding support runs against real encounter data rather than a sandboxed model.
Use case 3: Predictive Stars and quality
Star ratings are under real pressure, and catching a measure before the measurement year closes matters far more than catching it after. Galaxy's predictive analytics model which measures and which members are most likely to move a plan's rating before a cut point slips, ranking interventions by their impact on closure and on the rating itself. Chart retrieval and LLM-based abstraction pull the documentation each measure needs and cut down on duplicate chart pulls across teams, while built-in dQM readiness keeps the plan ahead of the shift from optional to required digital quality measures. Multipoint gap closure then runs outreach across provider offices, community pharmacies, and member homes at once, with a person validating closure and reporting throughout.
Plans using Galaxy for quality management have seen Star ratings improve by 0.5 points, and Galaxy's broader care management work has driven a 20% reduction in inpatient PMPM cost, the kind of downstream impact predictive analytics is meant to produce.
Mastek operationalizes the resulting interventions inside the plan's existing outreach channels and reporting cadence.
Why Mastek is the delivery partner
Galaxy solves the technical half of this problem. Getting it to run inside a specific plan's policy engine, state regulations, and existing vendor stack is a separate job, and it's the one that determines whether a deployment actually reaches production. Mastek, as Innovaccer's Platinum GSI partner, handles that half.
Founded in 1982, Mastek operates more than 4,700 specialists across 40-plus countries and serves 275-plus healthcare and life sciences customers spanning payers, providers, pharmaceutical companies, and public health agencies. For payers specifically, that means configuration to the plan's own medical necessity criteria and line-of-business rules, integration with existing claims and chart systems, and ongoing managed services and support after go-live, backed by delivery experience Mastek has built over four decades, not assembled for this partnership alone.
Getting started
Most health plans running Galaxy start in one area, prove the outcome, and expand from there rather than replacing their existing stack all at once. If your plan is dealing with rising PA volume, a RADV audit on the calendar, or a Stars rating that's stopped moving in the right direction, that's usually the right place to start the conversation.
Request a Demo.
See how Galaxy runs inside your plan's own systems, whether the priority is utilization management, prior authorization, risk adjustment, or Stars performance.
Innovaccer Inc published this content on September 28, 2026, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on September 28, 2026 at 11:47 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]