According to the Annual Payer Market Planning Report from HealthEdge®, technology modernization is one of the top concerns for health plan leaders. Modern healthcare technologies are characterized...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreAs we approach 2025, health plan executives are facing new challenges and opportunities. The HealthEdge® Annual Payer Market Planning Report 2025 outlines the top priorities, investments, and...
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In the complex landscape of U.S. healthcare, payers face pressures from all directions. Stakeholders are looking for ways to streamline workflows so they can minimize errors and accelerate time to...
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Artificial Intelligence (AI) is transforming payment integrity in the health insurance industry, particularly in detecting and preventing fraudulent payments and waste. As fraudulent claims become...
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Maternal morbidity rates in the U.S. are in the spotlight—particularly the disparities many Black women face compared to their white counterparts. Despite advances in medical technology and...
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In the rapidly evolving landscape of healthcare technology, staying ahead of competitors requires organizational commitment to modernization. Investing in a modern healthcare core administrative...
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See what 3,500 consumers say about their healthcare experiences
Read the report!Health plan administrators must adhere to the complex guidelines related to payment integrity, operational efficiency, and regulatory compliance. The claims process is intricate, and the sheer...
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In today’s rapidly evolving healthcare landscape, solutions such as GuidingCare are at the center of innovation in how health plans operate efficiently, adapt to regulatory changes, and improve...
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Investments in new technology are only as valuable as the training provided to the people who use it. Organizations that prioritize employee training in technology adoption can experience the most...
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In the dynamic healthcare industry, staying current with the latest technology and regulatory changes is essential, especially with a mission-critical care management solution such as...
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Healthcare regulations continue to evolve, reshaping how health plans operate and do business in a competitive market. Amid rising costs and regulatory pressures, healthcare fraud prevention is...
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At HealthEdge®, we are continually seeking ways to improve our users experience and help maximize the value customers get from our solutions. That’s why we designed the HealthEdge Help Center, a...
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Member satisfaction is vital for health plans to grow communities and improve outcomes. At the AHIP Consumer Experience & Digital Forum (CDF) 2024, Susan Beaton, Vice President of Health Plan...
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The ever-changing healthcare landscape requires health plans to have access to the insights and agility necessary to control costs, embrace change, and move quickly to take advantage of new...
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Latest Release: 2024 Gartner® Hype Cycle™ for U.S. Healthcare Payers Gartner has published its highly anticipated Hype Cycle for U.S. Healthcare Payers. HealthEdge® was recognized as a Sample...
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Healthcare is experiencing a significant digital transformation, and the HealthRules® Payer Machine Readable Files (MRF) Suite is at the forefront of this revolution. This innovative software...
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A modern care management business intelligence (BI) platform can play a crucial role for health plans. Business intelligence tools help support quality initiatives, manage population health, and...
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When it comes to claims processing, it’s easy to look at an error rate of 3-7% and be satisfied with your progress. But if you dig deeper, you may see a different, more concerning picture. Every...
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The traditional post-pay model has long been the standard in healthcare claims adjudication. However, it can result in significant administrative burdens and increased costs for healthcare payers....
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In a dynamic marketplace, member engagement helps strengthen healthcare market competitiveness for healthcare payers. Health plans that leverage digital engagement solutions can enhance their...
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