HealthEdge Source Solution Suite
Commercial Reimbursement
We use technology to tackle complex challenges in healthcare payment systems. HealthEdge Source Commercial Reimbursement simplifies payment configuration and reduces contract maintenance by up to 90%. It ensures accurate payments at the time of service and improves operations with updated regulatory data, flexible contract setup, built-in analytics, and smooth system integration. This solution provides a reliable and efficient way to manage even the most complicated payment models, while maintaining high accuracy and aligning with government reimbursement standards.
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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.
Customized Configurations
Allows users to set flexible pricing configurations, including freezing rates, creating unlimited payment carve-outs, and handling complex reimbursement scenarios
Enterprise Benchmarking
Provides tools to reprice claims, establish baseline comparisons, and generate multi-dimensional reports for improved analytics and decision-making
Real-Time Claims Insights
Offers real-time insights into claims operations, including data on claims volume and the financial impact of edits, ensuring up-to-date operational visibility
Financial Impact Analysis
Evaluates the financial efficiency of configurations by analyzing the impact of edits in production and enabling "what if" simulations for improved outcomes
Streamlined Workflow
Facilitates seamless updates by integrating claims editing, pricing, and reporting while centralizing claims operations to identify and address root-cause issues effectively
Audit Support
Tracks every edit, price, and supporting document with precise timestamps, ensuring full transparency and simplifying security and compliance inquiries
Why We’re Different
Our Expertise
With 28 years of experience, we deliver technology solutions that address inefficiencies in healthcare claims payments.
All-in-One Solution
Our solution combines claims pricing, editing, and analytics within a single platform, simplifying contract configuration and enhancing automation.
Real-Time Automation
The platform uses real-time automation to streamline claims processing, reduce errors, and cut down on IT and operational work for health plans.
Simplified Reimbursement
We eliminate government rate research and maintenance with content libraries that include reimbursement rates and payment policies for all provider types. Our subject matter experts research and maintain these comprehensive libraries, providing lift to your organization.
Enhanced Accuracy and Compliance
We refresh the solution every two weeks with the latest industry data, including off-cycle changes and CMS corrections. This improves claims processing accuracy and ensures alignment with regulatory updates.
Flexible Contract Configuration
Our user-friendly interface makes it easy for your teams to create and manage provider contracts based on business lines or organizational needs.
Continuous Innovation
Our user-friendly interface empowers 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.teams to build and manage their provider contracts by line of business or any other common group that fits organizational needs.
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 their IT 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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