HealthEdge Source Solution Suite
Analytics
Our advanced analytics suite equips health plans with powerful tools to improve payment integrity and operational efficiency. Featuring real-time data, financial impact insights, and advanced modeling capabilities, it provides actionable intelligence through user-friendly dashboards and detailed reports.
These tools support key decisions like shaping medical policies, renegotiating provider contracts, and addressing billing trends across your network. Built for strategic decision-making, our solution drives smarter outcomes and delivers meaningful improvements to your claims operations.
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Recognized by Gartner for 6 consecutive years in the Gartner report as a Sample Vendor for Prospective Payment Integrity
Features
Financial Impact Insights
Gain real-time insights into the financial impacts of edits, and analyze denials and claim adjustments
Monitor Mode
Monitor and analyze the impact of standard or custom edits on claims without disrupting processing
Enterprise Benchmarking
Reprice production claims using analytics to compare values to Medicare and Medicaid baselines, providing insights for contracts, fee schedules, and market opportunities
What-If Modeling
Simplify contract changes by analyzing claim impacts, generating variance reports, and quickly updating through integrated workflows and analytics
Batch Modeling
Model data using existing or customized edit and pricing configurations to fit your use case
Retroactive Change Manager
Analyze historical production claims to identify retroactive policy and rate changes under CMS and state guidelines
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Check out the advanced tools and seamless workflows behind HealthEdge Source™, and discover a smarter way to tackle claims management and financial decision-making.
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Why We’re Different
Comprehensive Data Access
HealthEdge Source provides access to historical fee schedules dating back 10 years, which is essential for accurate contract modeling and reimbursement projections.
Ease of Use
The platform offers simple download capabilities for data and reports, along with an intuitive interface for modeling contracts and forecasting reimbursements.
Transparency and Flexibility
HealthEdge Source redefines traditional claims editing by offering a more transparent, flexible, and efficient system, fostering a more agile enterprise.
Continuous Innovation
We work closely with clients to address their current needs, while anticipating future requirements, ensuring continuous innovation and exceptional customer support.
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
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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
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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