Security, data and compliance in Payer Contract Lifecycle Management

How Payer Contract Lifecycle Management protects data and supports your compliance obligations.

Security controls

Single sign-on

Staff sign in through your identity provider, so your password and multi-factor policies apply.

Role-based access

What each person can see and do follows their role, facility and payer scope; building a contract model is separate from approving it.

Protected health information

Claims and remittances contain patient information, so Moraph signs a business associate agreement and handles that information under it.

Encryption and keys

Client data is encrypted, with keys Moraph staff cannot use without explicit, time-bound authorization.

Complete audit trail

Every view, change, decision and export is logged with the person and time, and cannot be edited.

Data residency

Data stays in the hosting region you choose: the United States, the United Kingdom or Australia.

Requirements it supports

• HIPAA Administrative Simplification, transactions and code sets (45 CFR Part 162)
• HIPAA Privacy and Security Rules (45 CFR Parts 160 and 164)
• Medicare reporting and returning of overpayments (42 CFR 401.305)
• False Claims Act (31 U.S.C. 3729 to 3733)
• Hospital Price Transparency rule (45 CFR Part 180)
• No Surprises Act (Consolidated Appropriations Act, 2021, Division BB)

The product supports these requirements; meeting them remains your organization's responsibility.

Where it runs

• Moraph cloud: Hosted and operated by Moraph in the United States region. United Kingdom and Australia regions are available for organizations outside the US.
• Dedicated environment: A single-tenant environment for health systems whose policies require isolation, scoped in the proposal.
• With a managed service: Optionally run alongside Moraph support for modeling new contracts and amendments and loading fee schedule updates.

Limitations

• Expected payments are only as accurate as the contract models. Terms are modeled with your team and approved by you, and ambiguous contract language is flagged for your decision rather than interpreted.
• It does not submit appeals or claims to payers. Your team sends appeals and inquiries through your usual channels and records the outcome.
• It is not a billing or claims scrubbing system. It works on claims after they are paid or denied, using data from your billing system.
• Moraph does not hold or collect funds. Recoveries are paid by payers to you through your normal remittance process.
• Identifying an overpayment does not return it. Refund decisions and any reporting obligations remain with your compliance team.
• Some payment methodologies need payer or government grouper and pricer data that you license; these are scoped during implementation.
• It does not provide legal advice on contract terms or disputes. Contract interpretation remains with your contracting team and counsel.
• Results depend on complete claims and remittance data; gaps in feeds produce gaps in auditing, which data quality checks report.