HealthEdge Source Solution Suite
Professional Services
HealthEdge Source Professional Services offers a comprehensive suite of services designed to help health plans manage costs, implement new technologies, and streamline processes. Our experts offer practical support to simplify workflows and optimize resource use. From contract setup and data analysis to operational advice, these services allow health plans to implement strategies effectively, minimize administrative tasks, and improve overall system performance.
Services
Contract Configuration
We streamline provider contract setup to reduce configuration time by 50%, ensuring accurate claims processing with custom carve-outs and tailored edits.
Contract Maintenance
We manage and update your provider agreements to ensure they stay aligned with changing terms or regulations.
Data Studies
The team analyzes historical claims data and conducts in-depth studies to provide valuable insights that guide informed decision-making for health plans.
Product Education
You can access in-depth training that goes beyond standard implementation, covering specific product components such as configuration design, edit creation, new feature training, and more.
Content Education
We offer educational content on all aspects of policy and payment methodologies, including provider type methodologies, policy-specific details, and CMS updates and revisions.
User-Driven Enhancements
We partner with your health plan to develop new features, enhance functionality, and expand the capabilities of the HealthEdge Source platform.
Continue your digital
transformation
Gain the power to perform enterprise-wide decision support for setting medical policy, contract renegotiations, and analyzing billing and utilization trends.
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Why We’re Different
Design for Excellence
HealthEdge offers a prescriptive, playbook-driven approach that guides implementation decisions to ensure simplicity, scalability, and flexibility.
Agile Practices
We collaborate across business, technical, and operational teams to deliver small, iterative batches based on defined acceptance criteria, creating early wins and building momentum through spikes.
Accelerate Time to Value
We help health plans achieve faster results with a skilled team and scalable solutions. Our experts are fully trained and ready to go, cutting out ramp-up time. We manage services, provide additional support as needed, and ensure configurations and edits are completed efficiently. This helps your health plan meet deadlines and go live seamlessly, with minimal effort required from your team.
Redefine Your Business
Use HealthEdge Source to design your business the way you want it to be, not just how it is today. With our solutions and expertise, you can redefine your processes and reimagine your business for a better future.
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 their IT 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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