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Claims1™.Codesets automates the ingestion, validation, and deployment of healthcare industry code sets, such as CMS- and AMA-issued code updates.
Eliminate spreadsheets, silos, and bottlenecks—enabling faster go-lives, improved compliance, and consistent operations without slowdowns or delays.
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Drive Precision in Every Code Set Configuration

Link ingestion, verification, and deployment to ensure data integrity throughout your claim systems.
Automated Ingestion. Impact Assessment. Audit-Ready Configuration.

Code Set Management at Scale

Streamline Updates from Start to Finish.

Ingest and deploy CMS- and AMA-issued code (ICD-10, CPT, HCPCS) across every line of business and claim system—eliminating spreadsheets, silos, and manual work for faster, more compliant updates.

  • Automated Ingestion
    Detect and import updates automatically—no spreadsheets or manual intervention required.
  • Impact Assessment
    Instantly identify affected code groups and flag them for review to maintain accuracy and consistency.
  • Real-Time Validation and Simulation
    Validate updates in a safe environment before deployment, reducing errors and downstream rework.
  • Centralized Repository
    Eliminate duplication and conflicting updates with a single source of truth for all code sets.

Audit-Ready and Version-Controlled Updates

Track Every Change with Complete Confidence.

Ensure every change is logged, secure, and compliant—minimizing audit risk and maintaining data integrity throughout the update process.

  • Version Control and Audit Trails
    Maintain complete change history, rollback capability, and audit-ready records for every update.
  • Role-Based Access
    Enable multi-team collaboration with role-based controls to ensure secure, accurate updates.
  • Consistent Compliance
    Meet CMS and AMA standards across all updates, reducing compliance risk.
  • Proactive Oversight
    Avoid audit issues with built-in exception tracking and transparent versioning for every change.

Collaboration Across Teams

Eliminate Silos and Accelerate Decision Making.

Break down silos and support seamless collaboration across product, medical policy, and claim teams—reducing errors and ensuring every update is accurate and aligned.

  • Multi-Team Access
    Support coordinated workflows to keep all stakeholders aligned and eliminate conflicting edits.
  • Streamlined Review
    Simplify review processes to accelerate decision-making and reduce delays.
  • Consistent Data Flow
    Enable accurate updates across lines of business and downstream systems—no custom scripts required.
  • Reduced Operational Overhead
    Free up resources and minimize rework by removing manual processes and redundant data entry.

Compliance and Configuration Controls

Mitigate Risk and Maintain Alignment.

Drive consistency and reliability in every update—delivering accuracy, compliance, and operational confidence.

  • CMS and AMA Alignment
    Ensure updates meet regulatory standards and stay aligned with CMS and AMA requirements.
  • Exception Management
    Identify discrepancies and flag update conflicts before they impact claim processing.
  • Audit-Ready Documentation
    Maintain comprehensive records of every update to support audit and compliance reviews.
  • Continuous Monitoring
    Track update cycles and performance to identify gaps and maintain sustained operational excellence.

Compelling Business Case. Proven Value. ROI in Year One.

Claims1™.Codesets enables health plans to transform code set updates—reducing manual interventions, enhancing data accuracy, and accelerating deployment timelines with precision and control.
Department Cards

Configuration Teams

  • Accelerate update cycle times and reduce manual tasks
  • Standardize updates across platforms and lines of business
  • Minimize the reliance on spreadsheets and manual processes

Compliance and QA Teams

  • Ensure versioned, traceable updates aligned with CMS and AMA requirements
  • Maintain audit-ready logs and change history for every update
  • Eliminate compliance risks from fragmented, manual updates

Product and Policy Teams

  • Streamline update review processes and prevent conflicting edits
  • Enable consistent updates across products and policies
  • Reduce duplicate work and improve collaboration across teams

IT and Admin Operations Teams

  • Maintain data consistency across all claim systems without custom scripts
  • Integrate updates seamlessly with core admin platforms and downstream systems
  • Reduce IT burden with rules-based automation and scalable workflows

Leading Plans Are Already Transforming Codeset Configuration.

Top payers have left behind fragmented spreadsheets and siloed workflows—using Claims1™.Codesets to automate updates, eliminate inconsistencies, and improve operational reliability.
Discover how they streamlined updates, ensured compliance, and achieved faster go-lives with one powerful solution.
See What’s Possible

Leading Plans Are Already Transforming Codesets Configuration.

Top payers have left behind fragmented spreadsheets and siloed workflows—using Claims1™.Codesets to automate updates, eliminate inconsistencies, and improve operational reliability.
Discover how they streamlined updates, ensured compliance, and achieved faster go-lives with one powerful solution.
See What’s Possible

Time to Level Up Your Code Set Updates

Claims1™.Codesets replaces spreadsheets and tedious manual work with precision automation—ingesting, validating, and deploying updates in one smooth flow. Discover how you can speed up deployments, stay compliant, and make every update cycle seamless.
See It in Action

Experience the Power of a Connected Ecosystem

Claims1™.Codesets is just one part of a smarter, integrated platform—connecting seamlessly with Simplify Healthcare’s full suite of solutions to automate updates, maintain compliance, and ensure consistency across every claims system.

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Accelerate health plan operations with AI-powered sales enablement, configurable plan design, automated filings, and CMS-compliant document generation.

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Simplify Provider Lifecycle

Streamline network adequacy, contracting, credentialing, roster files, data management, and claim config with an advanced, modular solution that delivers efficiency and effectiveness.

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Simplify Benefits Inquiry Experience

Deliver accurate, consistent benefits information across all channels—powered by AI-enhanced guidance that improves member experience and boosts NPS.

Explore Xperience1™→

Simplify Document Management

Auto-generate 150+ mandated and marketing documents with built-in 508-compliance, translations, and integrated print fulfillment.

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Simplify Custom App Development

Design and deploy custom apps faster with embedded AI and low-code development—tailored to your organization’s unique needs.

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We don’t just deliver software—we work alongside your teams to guide implementations, simplify adoption, and ensure sustained success.

Explore HealthConsult

Frequently Asked Questions (FAQs)

What payers want to know before automating code set updates with Claims1™.Codesets

What types of code sets can this module support?

Claims1™.Codesets supports industry-wide code sets, including ICD-10, CPT, HCPCS, Rev Codes, DRG Codes, and other CMS or AMA issued terminologies, ensuring your health plan’s configurations remain current and compliant with every update cycle.

Can we see the impact of updates before deploying?

Yes. Claims1™.Codesets provides real-time simulation and preview capabilities, so you can safely validate changes and understand their impact before updates go live—reducing downstream errors and operational risk.

How does the system ensure traceability?

Every change is versioned and logged, with full audit trails and role-based access controls. This ensures every update is transparent, traceable, and compliant—supporting audit readiness and operational integrity.

Does this integrate with our current Claims Admin platform?

Yes. Claims1™.Codesets works seamlessly across leading claim administration platforms and can ingest and export updates in multiple formats. This ensures data consistency and smooth updates across your entire ecosystem.

Is this part of a larger platform?

Yes. Claims1™.Codesets is part of the broader Claims1™ suite, but it can also be implemented independently—offering health plans flexibility to address urgent code set update needs or integrate into broader claims configuration modernization initiatives.