HealthEdge Source Solution Suite
Editing
HealthEdge Source™ Editing is powerful payment integrity solutionthat combines advanced editing tools, history-based capabilities, and customizable edits to enhance payment accuracy and integrity for health plans.
With robust self-service capabilities, your team can create and modify edits tailored to their specific needs, without relying on third-party services. This flexibility empowers health plans to quickly update rules, adapt to changing regulations or contractual terms, and improve overall workflow efficiency.
Learn More“If there’s an edit conflict, HealthEdge Source is the source of truth.”
- VP of Operations, Mid-Sized Regional Health Plan
Recognized by Gartner for 6 consecutive years in the Gartner Hype Cycle report as a Sample Vendor for Prospective Payment Integrity
Features
Comprehensive Content
Our content libraries support government, clinical, billing, and validation edits across all lines of business.
Cloud-Based
As a cloud-based solution, HealthEdge Source provides content updates every two weeks to ensure access to the latest fee schedules and policy updates without manual IT intervention.
Custom Edit Creation
User-friendly user interface empowers your team to create and deploy custom edits in minutes, rather than months.
History-Enabled
History-based editing for claims allow for accurate adjudication by analyzing up to 39 months of historical data.
AI-Powered Precision
Now enhanced with agentic AI, the solution excels at identifying coding errors, verifying clinical accuracy, and evaluating medical necessity.
Audit Support
Our Audit Trail offers a centralized view to track, review, and document claim-level edit details for transparency and compliance.
Integrated Third-Party Edit Libraries
The solution integrates native and third-party content for an all-in-one solution to streamline healthcare payment workflows.
Monitor Mode
The solution allows your team to monitor and analyze the impact of standard or custom edits on claims without disrupting processing.
Request a Demo
Discover how we can help transform your payment integrity processes with advanced editing tools, seamless customization, and unmatched efficiency.
REQUEST A DEMO
Why We’re Different
Our Expertise
With 28 years of experience, we deliver technology solutions that address inefficiencies in healthcare claims payments.
Speed and Accuracy
HealthEdge Source delivers unmatched speed and accuracy, processing claims in under 200 milliseconds with over 90% auto-adjudication rates and 99% accuracy.
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.
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.
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 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
LEARN MORE