As health plans face mounting cost pressures and an increasingly complex regulatory landscape, one thing has become clear: incremental change is no longer enough. Today’s health plan environment demands transformational solutions, and a growing body of evidence points to the combined power of technology and Business Process as a Service (BPaaS) as the most effective path forward.

The HealthEdge® 2026 Healthcare Payer Survey Report reveals just how urgent the moment has become. Cost containment remains the number one challenge for the second year in a row, while regulatory compliance has surged near the top of the list, driven in part by sweeping changes introduced through the One Big Beautiful Bill Act (OBBBA).

The Market Shift: Cost and Compliance Are Forcing a Strategic Reset

With healthcare costs projected to reach $7.7 trillion by 2032, outpacing both inflation and wage growth, health plans are under extreme pressure to modernize operations while improving compliance and outcomes. According to the HealthEdge survey:

• 85% of health plan executives say regulatory pressures are significantly impacting margins
• 34% are turning to technology like AI and analytics to reduce costs
• An increasing number of health plan leaders are exploring outsourcing and shared services models, recognizing their promise in balancing cost, compliance, and modernization.

The Power of “AND”: Technology and BPaaS Together

Too often, health plans view BPaaS and technology modernization as separate strategies. But in today’s environment, success lies not in choosing between the two—but in using them together.

With the recent merger of HealthEdge and UST HealthProof, health plans now have access to a unified platform that combines best-in-class, AI-powered core technology with proven BPaaS capabilities. This new offering delivers what today’s health plans truly need: a scalable, intelligent, and compliant operational model that can reduce costs, boost agility, and enhance outcomes, all under one roof.

As stated in the official merger announcement, this new entity creates “a disruptive AI-powered healthcare health plan technology and services leader” designed to meet the end-to-end needs of modern health plans. Now, health plans no longer have to compromise between innovative software and high-performing services. They can have both: the platform and the people to drive results.

How the Combined BPaaS Model Works

According to a recent Everest Group report, Next-Generation BPaaS: A New Era of Efficiency for Health Plans, next-generation BPaaS can reduce total cost of ownership (TCO) by up to 50%, drive 95% enrollment automation, and increase claims auto-adjudication to 95% or more, especially when integrated with AI-powered technology platforms.

Here’s how combining BPaaS + technology delivers value across health plan priorities:

• Cost Efficiency: BPaaS embeds automation and analytics into core workflows, reducing manual labor and administrative spend. Pairing this with modern claims and care management platforms further cuts inefficiencies and TCO.
• Regulatory Agility: New mandates like OBBBA and interoperability rules from the Centers for Medicare and Medicaid Services (CMS) require real-time data exchange and governance. With a unified solution, health plans gain built-in compliance frameworks and the agility to adapt to changing requirements.
• Member and Provider Experience: Health plans can scale digital engagement, offer omnichannel support, and integrate provider data—improving satisfaction and reducing friction across the ecosystem.
• Speed and Scalability: With pre-configured, low-code tools and embedded AI, health plans can accelerate implementation, reduce time-to-value, and respond quickly to business changes.

Turning Insights into Action

The 2026 Health Plan Survey makes it clear: health plans are ready for change, but too many are still making isolated, tactical investments. To thrive in today’s climate, they need a cohesive operating model that merges advanced technology with operational execution.

HealthEdge provides this model, now offering an integrated solution that transforms the way health plans operate, enabling them to reduce costs, meet regulatory demands, and deliver the experience stakeholders and members have come to expect.

Download the full 2026 Healthcare Payer Survey Report, The Great Rebalancing: Inside the New Realities Shaping Health Plan Performance, to explore all the insights driving the more than 550 health plan leaders today.

 

Imagine this scenario: A critical exception fires in your company’s observability tool. Someone needs to check the logs, categorize the severity, and create a defect in the systems’ project management and ticketing software. It’s five minutes of work across three systems but if you multiply that by dozens of exceptions daily, your team is spending hours on coordination instead of fixing problems.

At HealthEdge®, we built our AI orchestration platform to solve exactly this kind of multi-system coordination challenge. Instead of manually jumping between systems, you describe what you need in plain language, such as “check the observability dashboard for new exceptions and create tickets for critical issues,” and the platform figures out the rest. It selects the right specialized agents, composes a workflow, and executes it. All in seconds.

Understanding AI Agents

To truly understand how our AI orchestration platform addresses these challenges, it’s important to understand how it differs from the traditional chatbots that most health plans are currently using.

Think of an AI agent as a capable assistant who can perform tasks rather than a chatbot that just answers questions.

In the scenario mentioned above, a traditional chatbot might tell you: “To create a support ticket, go to the Tickets page, click ‘New Ticket’, fill out the form with the customer’s information, and click Submit.”

An AI agent creates the ticket for you.

While traditional chatbots can only respond with text, AI agents can connect to your systems, including customer databases, ticketing platforms, project management tools, and take action. When you ask an agent to “create a support ticket for the login issue reported by Health Plan” it understands your request, identifies which tool to use, calls the appropriate API, and confirms completion.

The Challenge: When Simple Tasks Become Complex Orchestration

A single agent with a few tools is powerful. But business processes rarely involve just one system or one step.

In the scenario we presented above, this simple request requires querying the observability platform, parsing exception data, transforming raw data into ticket format, determining severity levels, creating defects, and tracking processed exceptions.

A single agent handling monitoring, data transformation, and ticket creation would be juggling too many responsibilities. Complex problems need coordination, also known as orchestration, not just capability.

How Our Platform Solves It: The Orchestrator

This is where the unique HealthEdge architecture comes in. Instead of one overworked agent, we have a team of specialists:

• An Exception Checker Agent expert in querying the observability platform for errors
• An Exception Mapper Agent that transforms raw exception data into structured ticket format
• A Defect Handler Agent skilled at creating properly formatted tickets

And an orchestrator that coordinates everything.

When you say, “check for new exceptions and create tickets for critical issues,” our orchestrator analyzes your request, selects the right specialists, creates a workflow, coordinates execution between agents, and returns results. Here is an example of how intelligent orchestration works. The orchestrator isn’t just running a predetermined script—it’s thinking about your specific situation and composing the right solution on the fly.

Dynamic Workflows That Adapt to Your Needs

What makes the HealthEdge approach so unique is the fact that the workflows are created dynamically, not hardcoded. In traditional automation, every scenario needs explicit programming. With our platform, you simply describe what you need: “We’re seeing errors on the observability dashboard. Create tickets for anything that looks critical.”

The orchestrator understands you need exception monitoring and ticket creation, selects the three-agent workflow (Checker → Mapper → Handler), creates a sequential workflow that passes data between agents, and returns structured results.

Sequential execution ensures that each agent receives exactly the data format it needs. The Exception Mapper waits for complete results from the Checker before transforming data for the Handler. The workflow wasn’t pre-programmed. It was composed based on your specific request.

Built for Teams, Not AI Experts

We’ve focused on making intelligent orchestration accessible to teams without requiring AI expertise.

For technical teams adding new capabilities, the process is straightforward: define a new agent with its API endpoint, schema, and description, and it’s immediately available for the orchestrator to discover and use. No complex integration. No workflow rewiring.

For business users, it’s even simpler: describe what you need in plain language, review the proposed workflow, approve and watch it execute with real-time updates, then get your results.

The Path Forward

This technology isn’t about replacing people—it’s about amplifying what people can accomplish. DevOps engineers still make the call on which exceptions need immediate attention. Developers still write the code fixes. Our platform handles the coordination and execution of routine actions that previously required manual orchestration.

When you can solve multi-system coordination challenges in seconds instead of hours, teams stop being constrained by the mechanics and start being limited only by their strategic thinking.

Getting Started: Simpler Than You Think

If your team deals with processes spanning multiple systems, such as exception monitoring, incident management, data analysis, reporting workflows, our intelligent orchestration can help.

All you need is:

• Clear descriptions of what your agents should do (like “query the observability dashboard for exceptions”)
• API endpoints and schemas for your systems
• Integration points (Jira, PagerDuty, Confluence, custom internal APIs, etc.)

The platform handles the complexity: selecting agents from the registry, composing workflows, coordinating execution, and streaming updates. Your team describes what they need in plain language and approves the proposed approach.

It’s a new operating model. And once you experience it, going back to manual coordination feels like returning to DOS commands when you could just click an icon.

To learn more about how HealthEdge’s orchestration platform can transform your team’s workflows, visit our website.  

 

As regulatory and quality expectations intensify, the National Committee for Quality Assurance (NCQA) vendor certification offers health plans a trusted signal that their technology partners can help deliver measurable outcomes for their members. HealthEdge Wellframe™ has now achieved this distinction, demonstrating its commitment to clinical quality, member engagement, and performance improvement.

This achievement not only recognizes the quality and rigor of Wellframe as a digital member engagement platform, but also delivers real benefits to health plans and their members. NCQA’s forward-looking approach pushes health plans to focus on lowering care costs, improving health outcomes, and enhancing the member experience. The NCQA recognitions confirm Wellframe’s commitment to these areas, with the understanding that accomplishing these objectives will require a scalable approach that drives efficiency in population health initiatives.

Why NCQA Certification Matters

In an environment where quality measurement, interoperability, and standardized care practices are rapidly evolving, independent validation by NCQA is more than a badge—it’s an indicator of trust, effectiveness, and alignment with the industry benchmarks that matter most to health plans.

NCQA is widely recognized for setting industry-leading best practice standards in quality measurement. The organization evaluates programs and organizations across the continuum of care, from health plans and providers to digital tools and credentialing bodies.

For digital health solutions like Wellframe, NCQA certification signals that the solution’s evidence-based clinical framework, member engagement processes, and health outcome focused interventions are measured against national best practices.

“HealthEdge® has distinguished itself by earning these certifications for its Wellframe solution. Vendors that have achieved NCQA accreditation and certification statuses by meeting or exceeding our high standards show health plans and others in the industry that they are good partners to support delivering high quality care.”

– Dr. Vivek Garg, President and CEO of NCQA

What Wellframe’s New Certifications Mean for Health Plan Partners

Wellframe earned two NCQA Wellness and Health Promotion certifications: one for Health Appraisals and another for Self-Management Tools.

These certifications validate that Wellframe meets NCQA standards for providing members with accessible, high quality, evidence-based health engagement tools, a distinction that is particularly meaningful as health plans strive to meet quality metrics while supporting members in a more personalized way.

1. Higher Confidence in Quality and Reliability

The Health Appraisal certification confirms that Wellframe enables health plan customers to deliver a digital Health Risk Assessment (HRA) that meets all required NCQA components, scope, and standards. It provides alerts and insights to care teams based on assessment responses.

The Self-Management Tools certification includes NCQA validation that Wellframe’s in-platform health education content meets standards for topics and tools that support member-centric and member-driven care. NCQA reviewed samples of Wellframe’s care programs, goal trackers, educational content, mini-surveys, and encouragement messages. Both certifications confirm that Wellframe regularly updates platform content based on established best-practices, published clinical guidelines, and recommendations from professional organizations. During the survey, NCQA also validated Wellframe’s accessibility for members with disabilities, channels for member and customer feedback, and methods for measuring the platform’s effectiveness.

2. Alignment With Quality Measurement Trends

These certifications also carry operational value. Health plans using Wellframe now qualify for automatic credit during their own NCQA Health Plan Accreditation (HPA) surveys — specifically for Population Health Management Elements A (Health Appraisals) and B (Self-Management Tools). This reduces administrative burden and helps accelerate accreditation preparation, which can meaningfully impact plan operations. And because NCQA is often aligned with the Centers for Medicare and Medicaid Services (CMS) standards, health plans can leverage the NCQA Certification standards to support CMS or state regulatory agency audits.

3. Support for Population Health and Member Engagement Initiatives

Wellframe’s platform is designed to strengthen connections between members and their care teams, promote engagement with personalized content, and deliver timely, actionable health insights. Certification affirms that these capabilities meet the NCQA’s rigorous standards and help position health plans to succeed in their quality and health equity initiatives.

4. Demonstrated Commitment to Privacy and Transparency

As part of the certification process, NCQA evaluated Wellframe’s privacy practices, including data protection policies, access controls, and disclosure protocols. Health plans can be assured that Wellframe meets NCQA’s high standards for handling sensitive member information.

5. Continuous Improvement & Effectiveness Measurement

Wellframe also submitted two quality improvement initiatives to NCQA during the survey process: its Annual Member Content Usefulness Survey and its Care Team Digital Adoption Best Practices program. The outcomes of these initiatives will be reported at recertification in 2027 — reinforcing Wellframe’s investment in ongoing optimization.

Technology Provider vs. Trusted Partner

Beyond the technical achievement, NCQA certification elevates Wellframe’s role as a trusted partner for health plans. Organizations that are recognized by NCQA offer plans a better foundation for:

• Regulatory readiness, reducing risk tied to regulatory audits and accreditation surveys
• Value-based care programs, supporting population health, SDOH initiatives, and preventive care
• Reduced administrative burden, helping teams spend less time validating tools and more time improving outcomes
• Enhanced https://healthedge.com/resources/member-engagement/infographic-improving-member-satisfaction and engagement

“This NCQA recognition is strong validation that Wellframe enables health plans to move the needle on Population Health and Clinical Quality initiatives. The NCQA extensive survey process reinforced the value that Wellframe brings to health plans and renewed our commitment to enhancing trust and credibility with members, payers, providers and regulators.”

– Dr. Sandhya Gardner, General Manager, Care Solutions and Chief Medical Officer of HealthEdge

What Sets Wellframe Apart

Public information suggests that very few digital member engagement and care management platforms have achieved full NCQA certification in wellness, health appraisal, and self-management tool categories. In this context, Wellframe’s achievement stands out as a meaningful level of third-party validation for a digital member engagement solution and signaling that it meets some of the highest independent quality standards available in healthcare today.

Wellframe’s NCQA certifications are a testament to the HealthEdge team’s commitment to quality, evidence-based design, and health plan partnership. It reflects not just what Wellframe does today but how it will continue to help plans improve clinical performance, enhance member experiences, and meet the evolving standards of quality and accountability across healthcare.

Read the full press release to learn more about this announcement and what it can mean for your health plan.

How integrated HealthEdge® technology helps improve member outcomes, reduces spend, and delivers on the promise of coordinated care.

Ask any care manager why they chose their profession, and the answer is almost always the same: a deep desire to help people. What most don’t anticipate are the hours spent manually entering data, reconciling duplicate records, or chasing down missing information instead of with their patients.

Too often, care managers are pulled away from member support tasks to battle escalating administrative demands. The result? Avoidable complications, frustrated staff, disengaged members, and rising costs.

An Expensive Ripple Effect

When a member in need doesn’t know who to call or where to go, they often turn to the most accessible (and expensive) point of entry: the emergency room. For payers, this creates a significant financial burden, as emergency visits and subsequent hospitalizations drive up costs. It can also be difficult to coordinate with a member’s PCP or primary care team after discharge, potentially exacerbating the issue and increasing the likelihood of swift readmissions and compounding expenses.

These avoidable costs can strain health plan resources and impact overall financial performance. But health plans can help break this reactive, costly cycle through proactive measures such as member education, helping coordinate timely follow-up appointments, medication reconciliation, and guidance toward cost-effective care options. By addressing these gaps, payers can reduce unnecessary utilization and improve both financial outcomes and member satisfaction. 

However, care managers are often forced to hunt for crucial information across disparate systems. This lack of integration isn’t just inconvenient—it creates significant risks. Every additional action increases the chance that data goes unseen, instructions get missed, or members receive redundant, and frustrating, outreach. When members receive the same messages and are asked to repeat their medical history multiple times due to system limitations, trust begins to erode. Their engagement drops. And without engagement, care management becomes far less effective.

This fragmentation is equally taxing for clinicians and care teams. When systems slow them down—or worse, prevent them from helping members—providers feel it deeply. And burnout can become contagious.

“At the heart of it, nurses want to provide the best care for their members,” says Jennie Giuliany, RN, and Senior Director of Clinical Care Solutions at HealthEdge. “If they get frustrated because they can’t, it can negatively impact both job satisfaction and member experience.”

The Power of Consolidation and Intelligent Technology

The path to better care begins with data consolidation. When all relevant data lives within a single platform, care managers can move beyond reactive troubleshooting to intentional coordination. This reduces the number of touchpoints required to resolve an issue and eliminates redundant questioning. More importantly, it allows members to feel seen, which is perhaps the most underrated form of care.

Technology plays a key role in helping coordinate care, but not as a replacement for clinical instinct. Instead, modern platforms augment human expertise. For example, the HealthEdge AI Summarizer tool can easily and quickly condense complex medical histories into a digestible view. Evidence-based, best-action recommendations offered directly within the HealthEdge GuidingCare® platform can then lead care managers to the right interventions faster. Business rules engines can further automate tasks that once consumed hours of manual effort. Collectively, these tools reduce the time spent on documentation and free up time for clinicians to connect with members.

GuidingCare’s Optical Character Recognition (OCR) technology can also automatically read and route clinical documents in seconds. Prior authorization requests, faxed records, and other attachments move straight into the right workflow—no manual sorting required. Paired with configurable rules, this helps plans make decisions faster, reduce denials fatigue, and align with evolving compliance needs.

Digital engagement also broadens reach. While some members live on their phones and prefer asynchronous messaging, others crave voice-to-voice reassurance, especially when navigating a new diagnosis. Still others may have limited internet access—a common issue, even in dense cities where infrastructure can block connectivity. In this case, tools like Mobile Clinician, an extension designed for in-home visits without reliable connectivity, allows nurses to complete assessments and auto-generate care plans offline, syncing later. Nothing gets lost and no visit is wasted.

True transformation happens when this ecosystem of tools exists within a unified suite. An end-to-end platform delivers richer analytics, a complete view of member history, and a single source of truth for both care managers and providers. With HealthEdge integrated solutions—GuidingCare, Wellframe™, Mobile Clinician, and robust analytics—health plans gain the full clinical and financial benefit of coordinated care. When HealthEdge systems connect, data becomes actionable instead of simply stored, empowering teams to intervene earlier, engage members more effectively, and reduce unnecessary utilization.

Proactive Care Over Reactive Cost

Connecting critical data unlocks the potential for early intervention. Risk analytics and integrated datasets can identify members who are newly diagnosed, trending toward higher utilization, or likely to slip through the cracks without support. With these insights, care managers can offer resources before member conditions deteriorate—without the mounting frustration of navigating multiple systems. Digital tools can also help care managers identify opportunities for education, medication management, and follow-up appointments with far greater speed and accuracy, thanks to automated workflows and intelligent guidance built into the platform.

As regulations continue to change, plans need to respond quickly. With rapid rules deployment in GuidingCare, teams can update business logic in hours instead of months. Paired with standardized workflows, this helps reduce denials backlogs, support NCQA alignment, and protect reimbursement.

One-stop-shop care management platforms also help coordinate the broader care team, from providers and behavioral health specialists to family caregivers. Centralizing this communication reduces duplicative outreach, minimizes confusion, and reinforces a shared plan of action. With fewer handoffs to manage manually, care managers can better educate, coordinate, and encourage preventative visits that cost far less than acute hospitalizations. Over time, this approach shifts spending from acute care to preventative care—a marker of success.

The Future: Technology That Honors the Human Side of Care

Looking ahead, artificial intelligence (AI) will continue to shape the healthcare landscape. But health plans must maintain caution and ethical standards. Healthcare organizations have historically been hesitant to implement new technologies, which is understandably grounded in the need to protect patient safety and privacy. Today’s AI tools are not designed to replace clinicians but supplement their judgment, point to evidence-based criteria, and simplify regulatory documentation.

“We’re using AI in a way that helps guide clinicians, not replace them,” Giuliany notes. “By reducing the time required to find and cite relevant information, AI can ease administrative weight and improve compliance-driven workflows—especially as regulatory expectations continue to rise.”

At the end of the day, lowering costs through effective care management doesn’t hinge on working harder. It’s rooted in working smarter with technology that supports the human side of healthcare rather than overwhelming it.

Delivering better care shouldn’t mean adding complexity. With the full suite of HealthEdge integrated solutions—spanning care coordination, digital engagement, offline flexibility, and intelligent guidance, plans can reduce avoidable costs while elevating the member experience. Because when clinicians are free to focus on care, better outcomes follow. And better outcomes are always worth the investment.

Ready to make care management work smarter, not harder? Explore how the HealthEdge connected ecosystem can help your teams reduce spend, streamline workflows, and keep the focus where it belongs: better care for every member.

Download the case study: How a Regional Health Plan Unified Care Management with HealthEdge.

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At HealthEdge®, we understand that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate provider directories involves labor-intensive, manual processes that consume valuable staff time.

Provider data management teams process thousands of roster updates annually, including new provider enrollments, terminations, address changes, and specialty updates. Each change traditionally requires manual data entry, taking up to 5-10 minutes per update. When multiplied across thousands of changes per organization each year, the administrative burden becomes substantial.

The challenge extends beyond time investment. Manual data entry introduces room for error, creates processing backlogs, and diverts skilled staff from higher-value work like provider relationship management and network adequacy analysis. Health plans need a smarter approach to handle the growing volume of provider documentation while maintaining data accuracy.

Introducing the PIF Intake Agent

HealthEdge is working to address these challenges head-on with our new Provider Information Form (PIF) Intake Agent. This AI-powered solution automates the extraction of provider information from submitted documents and streamlines the creation of workflow tickets in our Provider Data Management solution.

The PIF Intake Agent is currently deployed within HealthEdge’s internal operations, and external availability is planned for later this year. The current internal deployment allows us to validate performance, accuracy, and integration workflows before broader rollout.

Rather than replacing human judgement, the PIF Intake Agent handles the repetitive extraction and data structuring tasks, presenting organized information to provider data staff for review and approval. It currently processes PIFs for new provider enrollments and termination requests, which can contain information for single or multiple practitioners, as well as multiple service locations within a single submission.

 

The solution intelligently determines the appropriate workflow type based on document content. When processing a submitted form, the AI agent automatically identifies whether the request involves a new provider enrollment or a termination, then executes the corresponding workflow.

How the Solution Works

The PIF Intake Agent operates through a streamlined pipeline that transforms unstructured documents into actionable workflow tickets.

The underlying architecture leverages a Model Context Protocol server that exposes workflow tools to a Large Language Model-powered agent. The agent operates according to carefully crafted prompts that define data extraction rules, required field mappings, and validation logic.

When a provider document enters the system, our OCR pipeline extracts text and structured data from the submitted form.

The AI then analyses this content to identify key information, such as Practitioner names, National Provider Identifiers (NPIs), Addresses, Specialty codes, Effective dates.

The system intelligently distinguishes between individual practitioners and organizations, recognizing when multiple providers or locations appear within a single document.

For specialty information, the system integrates with a specialty translation service that converts human-readable specialty names, like “Family Medicine,” into standardized healthcare taxonomy codes required by the Provider Data Management database.

For complex documents containing multiple practitioners, the agent creates separate workflow tickets for each distinct entity. This ensures that your provider data management staff can process each provider independently while maintaining a clear audit trail that links all tickets back to the source document.

The extracted data flows into our Provider Data Management solution as structured tickets, complete with all required fields populated. Staff members can then review the pre-filled information, make any necessary corrections, and approve the changes — a process that takes seconds rather than minutes.

Integration with Existing Workflows

A key design principle for the PIF Intake Agent was seamless integration with existing provider data management operations. The solution embeds directly within established workflows, requiring no fundamental changes to how teams operate.

The agent interfaces with our Provider Data Management APIs to translate extracted specialty and taxonomy codes into the system’s required format. When a document contains a specialty description like “Family Medicine,” the system automatically maps this to the appropriate code values needed for the Provider Data Management database. This translation happens automatically, eliminating a common source of data entry errors.

Document traceability remains central to the design. Each workflow ticket maintains links to its source document, enabling staff to reference the original submission whenever questions arise. This supports compliance requirements and provides the documentation necessary for audit purposes.

Delivering Operational Impact

The PIF Intake Agent significantly reduces the time required to process provider roster updates. By automating the extraction and structuring of provider data, health plans can handle larger volumes of updates without proportionally increasing staff workload.

Data quality improvements accompany the efficiency gains. Automated extraction eliminates transcription errors common in manual data entry, while standardized field mapping ensures consistency across all processed documents. The human review step maintains quality control while benefiting from AI-prepared data.

Health plans can redirect time savings toward activities that require human expertise: resolving complex provider inquiries, managing network relationships, and addressing data discrepancies that require investigation. The agent handles the routine extraction work, freeing skilled staff for higher-value contributions.

Looking Ahead

The PIF Intake Agent represents one component of HealthEdge’s broader AI platform strategy. The underlying architecture, which combines document intelligence with workflow automation, creates a foundation for expanding AI capabilities across additional use cases.

As we continue enhancing the solution and preparing for its release to clients later this year, we’re focused on expanding support for additional document types, including organization updates and W9 tax forms, thus improving extraction accuracy for edge cases, and adding intelligent routing capabilities that direct complex requests to appropriate specialists. These enhancements will further reduce processing times while maintaining the data quality standards that health plans require.

For health plans seeking to modernize their provider data management operations, the PIF Intake Agent offers a practical path forward — delivering immediate efficiency improvements while establishing infrastructure for continued AI-powered innovation.

Contact HealthEdge to learn how our AI solutions can streamline your provider data management operations.