Healthcare payers-including health insurers, pharmacy benefit managers (PBMs), third-party administrators (TPAs), and claims clearinghouses-occupy a uniquely vulnerable position in the healthcare ecosystem. You process millions of transactions containing the most sensitive data imaginable: medical histories, Social Security numbers, financial information, and prescription records.

The 2024 Change Healthcare attack demonstrated exactly how catastrophic a breach in the payer ecosystem can be. A single ransomware incident disrupted claims processing nationwide, delayed patient access to medications, and exposed the health information of 190+ million Americans. The ripple effects touched every hospital, pharmacy, and physician practice in the country.

VerSprite has spent over 20 years helping healthcare payers build security programs that protect against these threats-not through compliance theater, but through genuine risk reduction.

Why Attackers Target Payers

Payer organizations are high-value targets because:

• Volume of PHI -A single health plan may hold records for millions of members
• Financial data – Claims processing involves banking information, payment credentials, and fraud-susceptible transactions
• Interconnected systems – Payers connect to providers, pharmacies, employers, and government programs, creating extensive attack surfaces
• Business pressure – Downtime directly impacts members’ access to care, creating urgency to pay ransoms

HIPAA Security & Privacy Compliance

As covered entities and business associates, payers face rigorous HIPAA requirements. We help you build security programs that satisfy OCR expectations while actually protecting data:

• Risk Analysis -Comprehensive assessments meeting 45 CFR § 164.308(a)(l)(ii)(A) requirements
• Administrative Safeguards -Workforce security, access management, security awareness training
• Physical Safeguards -Facility access controls, workstation security, device management
• Technical Safeguards -Access controls, audit controls, transmission security, encryption
• Breach Prevention & Response -Incident response planning, breach notification readiness

HITRUST CSF Certification Readiness

Many payers pursue HITRUST certification to demonstrate security maturity to partners and regulators. VerSprite provides:

• Gap assessments against HITRUST CSF requirements
• Remediation roadmaps prioritized by risk and certification impact
• Control implementation support for technical and administrative requirements
• Audit preparation and evidence collection guidance

Claims System & Member Portal Security

Your core systems process the most sensitive transactions in healthcare. We assess:

• Claims adjudication platforms -Authorization workflows, fraud detection, data integrity
• Member portals -Authentication, session management, PHI exposure risks
• Provider portals – Eligibility verification, prior authorization, claims submission
• API security – FHIR implementations, payer-to-payer data exchange, interoperability interfaces

Third-Party Risk Management

The Change Healthcare attack underscored that your security is only as strong as your vendors. We help payers:

• Assess clearinghouse and claims processor security
• Evaluate PBM and specialty pharmacy vendors
• Review delegated entity security controls
• Build vendor risk management programs that identify high-risk relationships

Our PASTA methodology helps payer organizations understand threats in business terms

Healthcare payers navigate a complex web of federal and state requirements:

Deep Healthcare Expertise We’ve worked with payers for over 20 years. We understand the unique challenges of securing claims data at scale, managing vendor ecosystems, and maintaining member trust.

Risk-Centric Approach Our PASTA methodology translates security findings into business impact­helping you prioritize investments that reduce actual risk, not just audit findings.

Regulatory Alignment Every engagement considers your compliance obligations under HIPAA, HITRUST, state regulations, and CMS requirements.

Practical Recommendations We understand that you can’t shut down claims processing for security upgrades. Our recommendations account for operational constraints and implementation realities.