Third-Party Ecosystem

Elimination of IT overhead— no custom implementations required

One-stop access to best-in-class third-party content libraries

Automated updates managed entirely within HealthEdge Source

Proactive cost savings and compliance enhancements

Flexibility to customize third-party content

American Society of Anesthesiologists (ASA)

Automates anesthesia billing by applying ASA’s Relative Value Guide® (RVG™) rules, including modifiers, HCPCS crosswalking, and qualifications

Codoxo

Leverages AI to detect fraud, waste, and abuse through medical record analysis and proactive payment integrity tools

Concert Genetics

Automates genetic test classification and reimbursement using proprietary edits to enforce coding and policy standards

FAIR Health

 Integrates market-based pricing data for Medicare, Medicaid, and commercial claims, ensuring region-specific accuracy

MediQuant®

Automates validation of CMS National and Local Coverage Determinations (NCDs/LCDs) at claim submission to ensure compliance

RJ Health

Provides real-time AWP, ASP, and WAC drug pricing data with algorithms for HCPCS/NDC coding, crosswalks, and unit conversions

3M/Solventum

Embeds APR-DRG and EAPG grouping, pricing, and editing for state Medicaid claims, ensuring up-to-date compliance

Additional Solutions

HealthEdge Source can integrate any third-party solution a health plan already uses, eliminating the need to manage separate connections. By handling these integrations, we help reduce IT costs, improve accuracy and efficiency, and ensure better compliance for our partners.