In a recent webinar hosted by the Association for Community Affiliated Plans, Anna Dunn, the president of Health Services for Children with Special Needs (HSCSN), shared her experience...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreAccording 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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As 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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See what 3,500 consumers say about their healthcare experiences
Read the report!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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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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