HealthEdge Source Solution Suite
Medicaid Reimbursement
Keeping up with state-specific Medicaid regulations and payment rules can feel overwhelming, even for the most well-run programs.
HealthEdge Source™ Medicaid Reimbursement simplifies this complexity by seamlessly integrating policy edits, pricing algorithms, and rate schedules to process them simultaneously. This approach enhances accuracy and accelerates processing speeds. With comprehensive content covering all provider types and care settings, it eliminates the need to rely on multiple data sources, ensuring Medicaid payment integrity and enabling you to process claims accurately, quickly and comprehensively – the first time.
Best of all, it requires no additional research, maintenance, or IT support from your team.
“Their Medicaid fee schedule methodology takes the guesswork out of everything.”
— Senior Director, Benefit and Provider Configuration, Mid-Sized Regional Payer
“When I think about and contrast and compare Source’s every two weeks update schedule … to doing this manually and understand the requirements and the implications, there's no way a small health plan would be able to stay anywhere near as current. There's just no way to match this.”
— VP of Operations, Mid-Sized Regional Health Plan
Recognized by Gartner for four consecutive six in the Gartner Hype Cycle report as a Sample Vendor for Prospective Payment Integrity.
Features
Medicaid Content
Our subject matter experts research, develop and maintain full coverage of state-specific Medicaid reimbursement rates and payment policy for all provider types.
Cloud-Based
As a secure cloud-based solution, Healthedge Source safeguards your claims data while reducing IT workload and allowing real-time access from anywhere.
Automatic Updates
We provide bi-weekly content updates to keep health plans up to date with the latest policy changes, minimizing manual intervention.
Parallel Processing
HealthEdge Source accelerates Medicaid claims processing by seamlessly integrating state-specific policies, pricing algorithms, and rate schedules. This enables complete reimbursement processing for Medicaid claims with a single API call, tailored to the unique requirements of each state's Medicaid program.
Audit Support
Our Audit Trail tracks every edit, price, and supporting document with precise timestamps, providing full transparency and simplifying security and compliance inquiries.
CMS Reference Tool
Our CMS data reference tool provides a source of truth for all payment policies and edits with comprehensive policy explanation.
Request a Demo
Discover how we can transform your Medicaid payment process. Request a demo now to experience seamless accuracy and efficiency for yourself!
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Why We’re Different
Our Expertise
With 28 years of experience, we specialize in delivering technology solutions that tackle inefficiencies in healthcare claims payments.
Comprehensive, Accurate, and Up-to-Date Content
Our Medicaid content provides comprehensive reimbursement rates and payment policies for all provider types.
Full-Service Delivery
We manage all CMS regulatory updates and maintain the platform with bi-weekly updates, reducing workload for your IT team and improving speed and accuracy.
Transparency & Control
Built from the ground up, HealthEdge Source combines next-generation technology with a unique depth of content to provide unparalleled transparency and enhanced control for payers.
Continuous Innovation
HealthEdge Source has always been at the forefront of innovation, from launching the first cloud-based solution to introducing agentic AI for payment integrity. We're committed to improving our platform to deliver the most innovative tools and features for your health plan.
Payer-Source Integration
Payer-Source is an integration between HealthRules® Payer and HealthEdge Source™ that enables continuous management of payment integrity and core administrative processes.
The solution improves efficiency and accuracy by seamlessly connecting data and workflows. This helps health plans adapt quickly, reduce payment errors, and provide greater value to their members.
HealthEdge Source Solution Suite
HealthEdge Source Medicare Reimbursement
Delivers, manages and maintains CMS pricing data for comprehensive payment accuracy
LEARN MOREHealthEdge Source Medicaid Reimbursement
Pay Medicaid claims accurately, quickly and comprehensively – the first time
LEARN MOREHealthEdge Source Commercial Reimbursement
A dynamic solution that simplifies contract configuration and provides accurate modeling.\
LEARN MOREHealthEdge Source Editing
Advanced editing tools with history-based capabilities and custom configurations to enhance payment accuracy
Learn MoreHealthEdge Source Platform Access
Enabling payers to gain control of the payment ecosystem through radical transparency
Learn MoreAdditional Offerings
HealthEdge Source Analytics
Real-time analytics, comprehensive financial impact insights, and advanced modeling tools delivered through intuitive dashboards and detailed reports to empower strategic decision-making and drive smarter business intelligence
LEARN MOREHealthEdge Source Professional Services
Expert guidance and support to help your team effectively and efficiently achieve organizational goals
LEARN MOREHealthEdge Source Third-Party Ecosystem
Seamless integration of industry-leading third-party solutions enhances payment accuracy and reduces administrative burdens
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