HealthEdge Source Solution Suite
Platform Access
We designed a solution that gives health plans more transparency and control over their payment integrity operations. With advanced analytics, actionable insights, and customizable edits, the HealthEdge Source Platform Access enables health plans to catch and resolve issues early in the claims process. This innovative platform reimagines the claims workflow to overcome persistent challenges and build a better, more reliable payment ecosystem.
Featured in Becker’s Payer Issues: Advice to payers on payment integrity reform
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“All the data has to be there in one spot to support compliance. This requires reducing the number of vendors, the number of upgrades and system changes. That’s what HealthEdge Source delivers.”
Recognized by Gartner for 6 consecutive years in the Gartner Hype Cycle report as a Sample Vendor for Prospective Payment Integrity
Features
Editing Library With History
Access a complete editing library with history, enabling reimbursement, clinical, and coding edits with detailed parameters and exceptions.
Custom Edit Creation
User-friendly user interface empowers your team to create and deploy custom edits in minutes, rather than months.
Advanced Analytics
Embedded analytics suite provides real-time insights to streamline workflows, improve decision-making, and identify claim errors early in the claims cycle.
Monitor Mode
The solution allows your team to monitor and analyze the impact of standard or custom edits on claims without disrupting processing.
Audit Support
Advanced Audit Trail offers a centralized view to track, review, and document claim-level edit details for transparency and compliance.
Expert Support
Our payment integrity experts provide comprehensive support, from reviewing edits and logic to conducting semi-annual health checks to optimize your payment lifecycle.
Unified Experience
Experience seamless automation, centralized data management, and efficient claims processing on a single platform.
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Experience the innovation behind HealthEdge Source and see how unified workflows, actionable insights, and advanced configuration tools can enhance your payment integrity operations.
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Why We’re Different
Our Expertise
With 28 years of experience, we deliver technology solutions that address inefficiencies in healthcare claims payments.
Enterprise Transformation
We drive enterprise transformation by centralizing all aspects of claim operations and leveraging comprehensive business intelligence to deliver an efficient and accurate payment ecosystem.
Transparency & Control
The solution provides payers with greater transparency and control over the claims payment process. By enabling self-service capabilities and offering real-time visibility, it minimizes reliance on third-party services and streamlines operations.
Proactive Payment Solutions
By collapsing traditional silos into a unified, real-time platform, HealthEdge Source helps health plans shift from post-pay recovery to a smarter, pre-pay approach. This proactive method helps reduce waste and lowers administrative costs.
Single Source of Truth
The platform provides a single point of truth for both pricing and editing functions, empowering better decision-making and reducing the need for post-adjudication vendors.
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
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Pay Medicaid claims accurately, quickly and comprehensively – the first time
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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
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Enabling payers to gain control of the payment ecosystem through radical transparency
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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
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Expert guidance and support to help your team effectively and efficiently achieve organizational goals
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Seamless integration of industry-leading third-party solutions enhances payment accuracy and reduces administrative burdens
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