From Administrative Headache to Payment Paradise
Discover how payment integrity analysts use HealthEdge Source to solve complex issues in hours, not months. Real-time data, instant deployment.
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Leveraging AI to Summarize GuidingCare Notes and Empower Care Managers
In today’s healthcare environment, care managers are at the heart of improving outcomes for members with complex needs. Yet, the growing volume of documentation, assessments, and free-text notes...
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AI-Enabled Optical Character Recognition: Transform Manual Processes into Automated Workflows
Fax-based communication and the manual work required to process physical documents remain daily challenges for health plan care teams. Communications related to authorizations, appeals,...
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Enhance Health Plan Payment Integrity with Integrated AI Tools
Operating within the U.S. healthcare industry can be challenging. Decades of layered regulations, siloed processes, and a sprawling network of stakeholders have created an environment where...
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Building a Scalable OCR Pipeline: Technical Architecture Behind HealthEdge’s Document Processing Platform
In our first blog, we explored how HealthEdge’s AI-powered optical character recognition (OCR) platform is transforming prior authorization and other document-heavy workflows. Now, we’re taking...
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Pivot or Fall Behind: Why OBBBA Readiness Defines the Future of Health Plans
The One Big Beautiful Bill Act (OBBBA) introduces far-reaching, fast-moving regulatory changes that demand adaptability from health plans. Some provisions are already in effect, while additional...
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See what 3,500 consumers say about their healthcare experiences
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Automate & Accelerate Health Plan Rules Deployment with HealthEdge GuidingCare®
The healthcare industry is in constant motion. Regulations change and care models evolve, while competitive pressures and member expectations grow more complex every year. For health plans, this...
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Building Member Trust Using Responsible AI: How to Get It Right
Artificial intelligence (AI) is quickly becoming foundational to the future of healthcare. From automating claims reviews to powering proactive care management, AI has the potential to help health...
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AI Adoption Across HealthEdge: An Inside Look at the Marketing Team’s AI Adoption Journey
I recently had the opportunity to sit down with the HealthEdge Marketing team to understand how they’ve been adopting AI and how that evolution reflects the broader organizational shift toward...
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How HealthEdge’s AI Platform Revolutionized Prior Authorization with Intelligent OCR
By Ethan Zhu + Justin Wolkowicz From Burden to Breakthrough: Tackling Document Chaos with AI At HealthEdge, our AI-first approach isn’t about abstract promises. It’s about solving real, persistent...
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From Vision to Value: Scaling AI at HealthEdge
At HealthEdge, our AI Team was created with a clear mission: to accelerate the innovation and adoption of AI technologies that deliver real value for both our customers and our internal teams....
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Health Plan Tactics for Medicaid Retention after the One Big Beautiful Bill Act (OBBBA)
Extensive legislative reform is shifting the healthcare landscape. The One Big Beautiful Bill Act (OBBBA) introduces significant changes to eligibility requirements across Medicaid, Medicare, and...
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A Care Management Guide for Health Plans: Navigating the One Big Beautiful Bill
The One Big Beautiful Bill Act (OBBBA) is reshaping healthcare, especially for Medicaid and Medicare plans. With tighter budgets, closer oversight, and an emphasis on population health in rural...
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Modernizing Prior Authorization: A Critical Step Toward Delivering Higher-Quality Care
Healthcare payers are under increasing pressure to integrate and unify digital solutions so they can streamline workflows and improve operational efficiency. With the passing of the...
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How Advanced Payment Integrity Strengthens Transparency and Collaboration Across the Healthcare Ecosystem
Increasing rates of claims denials cause operational bottlenecks and financial consequences across the healthcare system. In 2024, the initial claims denial rate rose to nearly 12%. Denied claims...
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7 Ways a Modern Core Administrative Processing System Can Improve Margins & Efficiency
Health plans are grappling with the challenge of reducing operating costs without sacrificing clinical outcomes. At the heart of this challenge lies the core administrative processing system...
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‘All In on AI’: A Conversation with the HealthEdge® Vice President of Product Management
As artificial intelligence (AI) rapidly transforms healthcare, many leaders are asking what it really means to go all in. For HealthEdge®, it means embedding practical, responsible, and...
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Improve Claims Operations & Efficiency with HealthEdge Source™ Professional Services
Maintaining efficient claims processing workflows can become an overwhelming task for many health plans. Claims teams have to process every claim accurately and on time, keep up with changing...
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How to Improve Provider Relationships with a Next-Generation Provider Data Management Solution
For many payers, maintaining accurate provider information is complicated. Managing disparate data sources, analyzing information, and reviewing existing records can feel like trying to solve a...
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What Medicare, Medicaid, and Dual Eligible Members Want from Their Health Plan: Key Findings from the HealthEdge® 2025 Consumer Study
In today’s evolving healthcare landscape, understanding what members want and need is more important than ever. To uncover those insights, HealthEdge conducted its 2025 Healthcare Consumer Study,...
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