UST HealthProof/HealthEdge has been ranked as the top performer among 20 evaluated firms in a new industry report from Black Book Research focusing on IT consulting for payers, health plans, and insurers.

The research for the third-quarter 2026 report, titled "IT Consulting & Advisor Services: Payers, Health Plans & Health Insurers," utilized 18 key performance indicators specifically designed for payer IT consulting, rather than generic management consulting metrics.

The assessment covered a wide range of critical dimensions, including payer market breadth, core administration modernization, claims and payment integrity, enrollment and benefits configuration, and the integration of utilization management with prior authorization and care management.

Other evaluated areas were regulatory execution and readiness, provider networks and value-based care, member experience, interoperability and payer-provider data exchange, and data, quality, risk adjustment, and analytics capabilities.

The study also examined cloud and enterprise data architecture, implementation and change management, security and risk controls, managed services and production support, AI and automation governance, reusable platform assets, execution governance, and modernization roadmaps.

UST HealthProof/HealthEdge achieved the highest overall satisfaction score of 9.40 out of 10 and led the field in 10 of the 18 KPIs. The findings are based on feedback from 558 payer executives representing 118 organizations, who only rated firms where they had direct, executive-level project experience within the past four years.

Doug Brown, founder of Black Book Research, commented on the necessity for specialized assessment, stating that generic consulting scorecards fail to capture the operational realities of payer organizations.

He emphasized that effective payer consultants must understand the interdependencies between core administration, claims adjudication, benefits configuration, utilization management, provider data, risk adjustment, and encounter submissions, translating this expertise into improved automated adjudication, authorization turnaround, regulatory performance, and total cost of service.

The research identified the areas with the most immediate demand from payers. Preparation for CMS-0057-F, FHIR API, and prior authorization requirements was cited by 84% of respondents as a top priority.

Modernizing core administration, claims, and products was a key focus for 81% of those surveyed, while 78% highlighted the need for advancements in data, quality, risk adjustment, and analytics modernization.

Brown pointed to a major upcoming deadline as a key pressure point, noting the urgent need for payers to meet the CMS-0057-F API compliance cutoff of January 1, 2027.

Affected payers must deploy enhanced patient access, provider access, payer-to-payer, and prior authorization APIs into production while addressing gaps in legacy data, identity, consent, provider attribution, and workflows.

He added that a forthcoming CMS proposal to extend electronic prior authorization to medications further increases the demand for architectural work across both medical and pharmacy benefits without accruing additional technical debt.

For its rankings, Black Book employed a comparative satisfaction model on a 0-to-10-point scale, explicitly excluding ratings based solely on prospect assessments, unimplemented advisory work, marketing impressions, or recommendations from individuals without direct project governance experience.