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The healthcare payer market is at a critical juncture, driven by increasing market pressures, consumer demands, and the need for technological modernization. At HealthEdge®, we believe payers have the opportunity to transform challenges into opportunities by leveraging cutting-edge tools and next-generation solutions. With over 110 million covered lives using our platforms and a proven track record of innovation, HealthEdge is uniquely positioned to empower payers to advance administrative efficiencies, improve patient outcomes, and make complex operations more cohesive.

This blog outlines the core components of HealthEdge’s vision, addressing current market forces, the challenges payers face, and how HealthEdge delivers actionable solutions that align with future industry needs.

Industry Pressures for Healthcare Payers

The payer landscape is undergoing an immense transformation, influenced by shifts towards value-based care models, rising cybersecurity threats, and increased regulatory demands around interoperability. Additionally, organizations face growing pressure to contain costs and enhance operational efficiency.

Some of the most prominent payer industry pressures include:

• Decreasing Margins: Payers face significant financial strain due to record-high medical and labor costs and rate changes
• New Products and Value-Based Care: Payers need to manage complexity associated with implementing innovative product design and value-based payments
• Security Risks: Recent cyber security breaches have increased payer focus on ensuring deployment of infrastructure and technology to manage potential threats
• Need for Data Interoperability: Payers are under significant (regulatory) pressure to improve interoperability and enhance patient engagement and outcomes

This is coupled with the emergence of advanced technology:

• Opportunity for AI and Automation: 
  • 97% of payers expect to increase funding for generative AI (approximately 40% spend increase)
  • Critical service cost savings can only be realized with a next-gen underlying code
• Technical Flexibility:
  • 83% of payers expect to increase funding for app modernization (approximately 30% spend increase)
  • Payers can only manage increasing complexity with robust core technology
• Cloud: 
  • 80% of payers expect to increase investments in the cloud (approximately 30% spend increase)
  • Moving to the cloud is essential for payers to maintain robust stability while scaling and managing security
• Mobile and Cross-System Compatibility:
  • 90% of payers expect to increase funding integration tech (approximately 20% spend increase)
  • Payers need a connected system that enables better patient engagement and stakeholder collaboration

These challenges have created an ‘inflection point’ for healthcare payers, signaling a clear need for solutions that offer operational resilience and enable transformational change. The modernization of IT systems is critical for healthcare payer CIOs, with digital payers being 3x more likely to achieve above-industry revenue and margin growth.

HealthEdge’s Vision for an Optimized Future 

At HealthEdge, our vision is to innovate a world where healthcare can focus on people. Our mission is clear: to drive healthcare transformation through a single digital ecosystem that delivers advanced automation and clinical engagement among healthcare payers, providers, and patients.

With a strong foundation of products and a forward-thinking approach to innovation, we aim to revolutionize payer operations while keeping customer needs at the forefront.

The HealthEdge Ecosystem: Delivering Synergies with Scalability

Healthcare payers need a partner that not only understands their challenges but also provides a clear roadmap for overcoming them. HealthEdge delivers this by addressing payer concerns at both the administrative and strategic levels.

Integrated Benefits to Core Operations

Unlike standalone solutions, HealthEdge product combinations result in highly synergistic, integrated benefits to payers’ core operations.

Benefits of Integrated Digital Solutions: 

• HealthRules® Payer + HealthEdge Source™:
  • Accelerates accurate adjudication by incorporating pre-adjudication pricing and editing in one call
  • Reduces strain on payer IT infrastructure by providing integrated support services
• HealthRules Payer + HealthEdge GuidingCare®
  • Ensures appropriate utilization by ensuring utilization and care managers have access to real-time benefits and claims information
  • Facilitates accurate claims adjudication by HealthEdge GuidingCare submitting appropriate claims prior auth information to HealthEdge HealthRules Payer in required format
• HealthEdge Wellframe™ + GuidingCare
  • Decreases duplicate data entry in clinical platforms
  • Integrates and streamlines communication between member, provider and payer
  • Aggregates member data to establish best practices that improve care journey recommendations
• Wellframe + HealthEdge Provider Data Management
  • Synthesizes real-time provider information to ensure the latest credentialing, directories, and repositories are accurate and accessible to members seeking care
• HealthRules Payer + HealthEdge Provider Data Management
  • Eliminates data mismatches in provider information between systems and timely updates provider data in claims processing to reducing claim delays, denials or rework

These synergistic benefits allow organizations to achieve cost savings, improve scalability, enhance compliance and ultimately, deliver better member experiences. Combinations of three or more products further emphasize the value of HealthEdge’s product suite offering and provide outsized returns to payers.

Core System-of-Record and Mission Critical Solutions

HealthEdge provides the core system-of-record and mission critical solutions that enable key payer technology workflows.

HealthEdge Core Solutions

Claims Management

HealthEdge HealthRules Payer helps payers manage and adjudicate claims submitted by providers. It serves as the integrated source of truth for payer tech stacks

Payment Integrity

HealthEdge Source provides a range of pre-pay capabilities with a differentiated pricing solution (and also includes claims editing)

Care Management and Digital Member Engagement

HealthEdge GuidingCare streamlines and automates care management workflows. At the same time, HealthEdge Wellframe enables digital member engagement and integrates with HealthEdge GuidingCare to facilitate clinical and administrative communication with members

Provider Data Management

HeathEdge’s Provider Data Management solution creates a “golden record” of provider data – it ingests, enhances, and distributes provider data to all other required systems and processes.

HealthEdge Enabled Solutions

Business Strategy

HealthEdge HealthRules Payer provides critical business intelligence to shape payer strategy, including analyzing customer segments and identifying profitability improvement opportunities

Product Development

HealthEdge HealthRules Payer and HealthEdge Source provide critical data to inform pricing and actuarial; data also informs refinement of existing products and build of new products

Marketing and Sales

Payers leverage combination of customer and HealthEdge HealthRules Payer data to respond to RFPs and set pricing using data analytics

Enrollment and Billing

Payers enroll members in respective systems to ensure products and benefits are configured properly and submitted claims are paid promptly and accurately via HealthEdge HealthRules Payer

4 Core Pillars of the HealthEdge Innovation Strategy

HealthEdge’s future vision is anchored by four strategic pillars, which serve as guiding principles for our solutions and organizational goals.

1. Touchless Transaction Processing

Our vision is seamless integration, with the long-term benefit of 100% touchless transaction processing in production. We envision a future where all transactions can be processed without human intervention, creating meaningful operational efficiencies for payers.

2. Payment Accuracy Transformation

Our vision is the elimination of payment recoveries with 99%+ payment accuracy. By integrating pricing and edits capabilities upstream, our solutions can eliminate administrative overhead, reduce provider abrasion, and enable accurate payments.

3. Care Integrity Optimization

Our vision is to increase care delivery effectiveness to optimize medical spend and payer performance. Our solutions GuidingCare and Wellframe work in tandem to optimize the care patients receive.

4. AI-Powered Business Intelligence

Our vision is to drive analytics for benchmarking, next-level operational insights, and proactive recommendations. Our approach to AI revolves around consolidating fragmented data and making it actionable, empowering organizations to make data-driven decisions in real time.

A Future Built on Innovation and Collaboration

While the healthcare payer landscape keeps evolving, our commitment to delivering innovative solutions remains constant. HealthEdge’s vision is centered not just on creating premium technology but enabling payers to experience the business attributes of improved end-user and consumer centricity, ever-reducing transaction costs, ever-increasing quality and ever-increasing service levels and business transparency.

Are you ready to explore a smarter, more efficient way forward? Discover how HealthEdge can help your organization adapt, optimize, and thrive amidst today’s challenges.

Contact Us to Learn More

 

Healthcare is at a crossroads. Legacy platforms, endless point solutions, and mounting regulatory pressure are all warning signs on the road to change. The need for transformation is clear, even if the path forward is foggy.

What worked 10 years ago just won’t cut it anymore. Best-in-class point solutions without deep integration are expensive, inefficient, and ultimately unsustainable. Siloed data is a strategic liability in an era where intelligence and automation are table stakes.

So how do we move forward?

The Problem: Fragmentation Everywhere

We’ve been told for years that picking the “best tool for the job” is the smart play. But in healthcare, that’s led us to a situation where every team uses different tools, none of them talk to each other, and the data is scattered everywhere. It’s hard enough to do basic business intelligence when data is stuck in silos, let alone leverage advanced analytics or employ artificial intelligence (AI). The truth is that siloed data never becomes intelligent.

This fragmentation also slows everything down—product delivery, regulatory response, customer experience. And just as AI tools explode into the market, we’re further splintering our infrastructure trying to keep up.

The Pivot: From Point Solutions to Unified Platforms

At HealthEdge®, we believe the only way to solve this is with deep, foundational integration—across data, user experience, and development.

The Experience Platform

HealthEdge is addressing this challenge head-on by bringing its products together into a single, cohesive experience platform. This standardizes the user interface across all applications—delivering consistency in design, workflows, and functionality.

That consistency reduces friction. That’s what the HealthEdge Experience Platform delivers for healthcare operations. Whether you’re a claims processor or an administrator, you know how to navigate, where to click, and how to get things done. It’s intuitive. It’s efficient. It’s scalable.

The Intelligence Platform

On the back end, we’re merging all our data into a unified intelligence layer—a modern data lake and warehouse that supports real-time reporting, cross-platform analytics, and AI-powered insights—all without requiring advanced technical skills.

This platform opens the door to advanced capabilities like touchless transaction processing, where manual workflows, such as claims adjudication, can be significantly reduced or even eliminated through automation and intelligent decision support. This is the foundation of truly intelligent healthcare: built-in AI that reduces manual work, flags inefficiencies, and helps automate decision-making.

The Regulatory Landscape: Interoperability as an Opportunity

Interoperability is often viewed through the lens of regulatory burden, but there’s a bigger opportunity here. By enforcing common standards for data exchange, interoperability done right is a business enabler.

Think of it like a typical USB. At some point, the tech industry decided to stop shipping different cables and adapters for every device. USB became the standard. That’s what healthcare needs and what these new regulations are driving toward.

When data is standardized and systems can plug into each other seamlessly, everyone wins—payers, providers, and most importantly, patients.

The Ecosystem Is the Platform

An ecosystem isn’t a list of vendors. It’s not a hodgepodge of tools that don’t interact or work together. It’s a connected, intelligent, outcomes-driven platform.

Our integration layer, HealthEdge Hub, delivers standardized and documented APIs that ensure seamless interoperability across our entire product suite. And we’re backing it with an integration platform that connects with 200+ healthcare systems out of the box.

When a health plan needs to connect claims data with care management or benefits transparency tools, it’s not a six-month project anymore. It just works.

Repositioning IT: From Overhead to Strategic Growth Driver

Historically, IT has been seen as a cost center—something to manage and contain. But that mindset is changing. With HealthEdge’s integrated platform, CIOs and CTOs are empowered to shift from managing technology to enabling innovation.

That’s the opportunity here. Our platforms give health plans real-world ROI—not just by shaving margins, but by employing a highly integrated, single platform that leverages AI to create next generation experiences, automation, and intelligence in near real-time. The result? Smarter decisions, faster execution, and measurable business value.

The Bottom Line

Healthcare doesn’t need more tools. It needs a better foundation. The future demands a technology foundation that’s unified, intelligent, and interoperable by design.

HealthEdge’s platform-driven approach:

• Unifies user experience across all products
• Consolidates data for meaningful, actionable insights
• Simplifies and strengthens compliance efforts
• Accelerates integration across the entire ecosystem
• Powers automation and intelligent decision-making

This isn’t just an upgrade—it’s a necessary transformation for organizations that want to stay competitive, compliant, and truly responsive to the needs of the healthcare landscape.

To learn more about how HealthEdge is enabling health plans to transform operations and care delivery, view the Converge without Limits video.

 

For modern health plans, enhancing auto-adjudication rates is more than a technical upgrade. It is a strategy for payers aiming to stay competitive by increasing automation, improving efficiency, and strengthening organizational agility.

Current statistics show that a significant 15 and 20% of claims still require manual processing. This not only increases costs by up to $25 per claim, but also extends processing times by days or even weeks. In this blog, we cover why auto-adjudication rates can decrease over time, the benefits of enhancing your claims auto-adjudication process, and how HealthEdge® can help clients unlock the full potential of their health plan technology.

How Do Auto-Adjudication Rates Impact a Health Plan’s Business?

Auto-adjudication rates directly impact a health plan’s operational costs and efficiency. Achieving higher auto-adjudication rates means fewer claims require manual intervention and review resulting in reduced processing times and minimizing the risk of errors. Lower auto-adjudication rates mean more claims require manual reviews, which lead to inflated administrative costs and payment delays.

Manual claims processing can lead to workflow bottlenecks and reduced operational agility. Inefficient adjudication processes also strain health plan resources and can lead to compliance risks and member satisfaction issues. Improving auto-adjudication rates helps ensure the business runs optimally while keeping providers and members happy with timely and accurate payments.

[H2] What Causes a Health Plan’s Auto-Adjudication Rates to Decline?

Auto-adjudication rates are impacted by several factors. Regulatory changes and new payment rules require health plans to update their system configurations to remain compliant. When new payment rules go into effect, some health plans rely on manual reviews until they update internal systems. But over time, manual interventions can accumulate and drag auto-adjudication rates down. Updating configurations to align with new rules can reduce the need for manual reviews and improve payment accuracy.

Some health plans also face auto-adjudication issues when introducing new lines of business. Internal teams may replicate configurations for existing lines of business that are not optimized for the new offering. If not addressed, health plans can face workflow inefficiencies and a permanent decrease in auto-adjudication rates.

A third barrier is that many health plans miss opportunities to leverage the full spectrum of features or capabilities their technology solutions deliver. Staying up to date with system upgrades can enable more streamlined workflow automation and more accessible configurations.

What Are the Impacts of Decreased Auto-Adjudication Rates?

Falling auto-adjudication rates don’t just impact operational efficiency—they impact a health plan’s financial health. Manual claims review costs time and money, which could otherwise be allocated to strategic priorities. It also introduces the risk of human error, which can lead to expensive rework or member dissatisfaction.

Relying on manual reviews also creates inefficiencies in handling claims. For example, reviewers might need to investigate multiple systems to process a single claim. That additional complexity drives up processing times and fragments workflows, making it harder for teams to deliver consistent results.

3 Common Issues That Can Impact Auto-Adjudication Rates

1. Claim Authorization Matching

A claim may be denied if it does not clearly align with the service provided. This is common in areas like inpatient hospital stays or physical therapy services, where the nuances of care delivery can create multiple mismatches.

2. Coordination of Benefits

Effective coordination of benefits means determining the order in which multiple insurers are responsible for a claim. This process is incredibly complex and highly specific to configuration. If the data being fed to the system is delayed, incomplete or inaccurate, it can cause pending claims that require a significant manual effort to resolve.

3. Shifting Regulations

Regulations and payment guidelines are constantly shifting, with some—like the No Surprises Act—directly impacting auto-adjudication rates. When a wide-reaching regulation like this is introduced, health plans may elect to pend relevant claims while they update their configurations to align with the new rules, causing delays.

Improve Auto-Adjudication with Advanced Solutions from HealthEdge

At HealthEdge, we work closely with our health plan partners to understand their holistic needs and how we can support them in achieving their optimization goals. Our Global Professional Services team is comprised of healthcare industry veterans who can partner with your organization to better leverage the HealthEdge solutions available to improve auto-adjudication rates and enhance your claims processes.

What is the Process to Improve Auto-Adjudication with HealthEdge?

We start with an optimization assessment. This is where our internal experts examine a health plan’s existing workflows and configurations and deliver a set of actionable recommendations. Following the assessment, our team can be contracted for additional engagements to support the execution of the optimization assessment recommendations. To start, our team works with the health plan to prioritize recommendations based on their potential return on investment (ROI) and operational readiness. Available resources, like staff availability, often determine both the approach to the engagement and which recommendations get tackled first.

Our team can also offer a collaboration engagement with a health plan’s configuration and testing teams to assist with implementing the suggested changes. This involves developing test cases, running scenarios, and demonstrating proof-of-concept solutions. While each health plan ultimately owns the changes to their operations, our team acts as their guide to help direct the process and maximize results.

This collaborative approach ensures health plans not only address their current challenges, but they are also enabled to future-proof their configurations for ongoing improvements.

One customer was notably struggling to match claims with authorizations. By working with HealthEdge to assess their systems and identify opportunities to improve their claims-authorization matching, this customer was able to achieve a 56% reduction in their pend rate for authorization-related claims—that’s a 56% reduction in claims requiring manual work.

How Do I Know if My Health Plan Would Benefit from Enhanced Auto-Adjudication Support?

The healthcare payer landscape is constantly evolving— and so are the digital solutions available. Most health plans could benefit from regular evaluations and updates to their configurations with a focus toward auto-adjudication improvements. We do see areas where optimization can have a significant impact.

First, health plans undergoing significant growth or bringing on new lines of business typically face challenges that make an optimization assessment especially valuable. The more complex their digital ecosystem, the greater the potential for impactful improvements.

Second, health plans whose systems have not been optimized in several years or who have smaller configuration teams often achieve significant improvements. These organizations are more likely to have areas for configuration improvement that an optimization assessment can help identify and address quickly.

Are you a HealthEdge customer interested in optimizing your claims processes? Contact your Customer Success Executive to learn more about optimization assessment.

In our December IMPACT customer event, we introduced a few key areas of investment at the platform level, and I have some exciting updates to share with you on customer experience, integrations and interoperability, artificial intelligence and automation, and early access Professional Services opportunities.

Customer Experience at HealthEdge®

Quality Center of Excellence

Over the last six months, we’ve been doubling down on quality. For us, that means increasing the levels of automation, deploying a consistent quality platform, enhancing product quality, and reducing the number of bugs making their way into user acceptance testing (UAT) and production environments.

Our Quality Center of Excellence has been focused on:

• Enhanced product quality
• Stable release processes
• Reducing effort spent on UAT
• Defect free user experiences

What we have done:

• Launched an operational platform
• Selected a Test Data Management solution (TDM)
• Established a consistent automated testing framework & process

Our wins:

• HealthRules® Payer: 38% bug reduction year-over-year
• HealthEdge Source™: 30% bug reduction year-over-year
• HealthEdge® Provider Data Management: 100% test automation
• Wellframe™: 60% automation across web & mobile platforms
• GuidingCare®: Quality Assurance (QA) sanity tests caught 14 critical bugs

What’s next:

• Roll out the TDM process for tests with real-world and synthetic data
• Unify our performance testing infrastructure and framework
• 80% test automation across the board
• 80% reduction in defect escape by the end of 2025

HealthEdge User Experience Platform

Our vision is to create something like Microsoft Office – where you go from Excel to PowerPoint to Word – but it still feels like a unified experience, with a comfortable familiarity between the products. We have brought on a new user experience (UX) leader who has been driving the enhancement of the user experience platform.

This platform is enabling us to create a consistent, high-performance, accessible, and modern user experience across products, leading to:

• Increased usability
• Enhanced productivity
• Faster time-to-market

What we’ve done:

• Created a design system to modernize and unify our products
• Published components for the design system in React
• Rebuilt an internal application with these components

Our wins:

• Identified six projects as candidates to adopt our design system in Q2-Q3
• Set up a Continuous Integration/Continuous Deployment (CI/CD) pipeline to automate testing and publishing of new versions of the components

What’s next:

• Consistent and adaptable customer experiences and accelerated time-to-market

Integrations & Interoperability

API & Integration Platform

We have been investing heavily in our new API & Integration Platform. We brought on a new leader and have standardized all our integration work into one workstream. This platform is extending our current integration tooling into a highly secure, scalable, and comprehensive solution for cross product and partner integration.

We have been focusing on providing a world-class API & Integration platform, driven by the following:

• Secure and scalable integrations
• Compliance and governance
• Future-proof real-time architecture

What we’ve done:

• Developed centralized API management and messaging components, with real-time, dynamic messaging
• Built a data integration platform to support data ingestion needs
• Built the streaming platform
• Created FHIR Converter to support electronic prior authorization workflow

Our Wins:

• Real-time messaging platform: Live with integration between HealthRules Payer and Provider Data Management solutions, on track to be live with integration between HealthRules Payer and GuidingCare solutions in April
• Centralized API management platform live with integration between HealthRules Payer and HealthEdge Source
• Live with Salesforce integration for HealthRules Payer customers

What’s next:

• Creating a “marketplace” of point and click integrations
• Standardizing solutions for all data ingestion and extraction needs
• Enhancing FHIR support
• Building enterprise services like identity and tenant management

Infrastructure Center of Excellence

For the past six months we’ve been working on a plan to move our applications to the public cloud. To do so, we have created an Infrastructure Center of Excellence, which is focused on standardizing our infrastructure, DevOps, and Site Reliability Engineering (SRE) to provide you with high application availability, security, performance, and scalability. Our vision is that when we move to the cloud, we have one enterprise way of doing things and it’s a best-in-class enterprise platform, ensuring our long-term scalability and performance.

We’re focused on:

• Enhanced scalability
• Stable releases
• Less effort spent releasing

What we have done:

• Established standards for scalability, security, stability, and monitoring
• Automated routine operations
• Selected enterprise tools for all cloud operations

Our wins:

• Started migrating to an enterprise-wide tool for CI/CD to enable stable releases and processes
• Established enterprise-wide SRE operations for cloud-based products

What’s next:

• Ensuring long-term scalability, performance, and adaptability

Artificial Intelligence & Automation

AI and automation have been another key investment area. We’re working toward a unified generative AI and foundational model platform that will efficiently and safely deliver AI-powered workflows and tools across our products. We have an exciting roadmap of AI advancements planned.

We’re thinking about AI and using AI tools and agentic infrastructure to automate the last part of the manual work during claims processing. We’re working on leveraging enterprise AI and automation internally to improve our efficiency and in our products to improve your efficiency.

Our AI and automation guiding principles are:

• Secure, compliant, safe
• Cross platform opportunities
• Enhanced support, documentation, and training

What we’ve done:

• Launched operational platform
• Prioritized project list for 2025
• Consistent approach to deliver AI driven solutions

Our Wins:

• GuidingCare Member AI Summarizer released in April 2025
• AI Optical Character Recognition (OCR) Fax ingestion solution by July 2025
• Multiple other projects under design and development

What’s next:

• Scale AI and drive innovation across products
• Leverage agentic AI architecture to streamline user workflows for efficiency, accuracy, and speed

Looking Ahead

Data, Business Intelligence, and Reporting

I spoke with a lot of our customers, including CIOs, CTOs, VPs, and technical users. One key theme emerged – data and business reporting are critical, but with so many different systems and pieces of data, consolidating data and getting an enterprise view is difficult.

To help address that, we’re heavily investing in an enterprise-wide data platform to enable business intelligence, analytics, and AI with data aggregated from all products. This will include features like:

• Pricing contract data from HealthRules Payer & HealthEdge Source in July 2025
• History, Audit and Monitor mode data from HealthEdge Source available by August 2025
• Claims history for performance metrics from HealthRules Payer available by Q4 2025
• GuidingCare and Wellframe reporting data in design phase

Driving to 100% test automation

We are making progress on our goal of 100% test automation, increasing the quality within our platform, and getting to a place where we have zero defect escapes across all our products. This year we intend to achieve 80% test automation. Important updates include:

• Quality initiatives focused on test automation prioritized across the enterprise
• Engaged third-party automation specialists to achieve 80% automation goal by the end of 2025
• All products actively working on automating manual test cases with a focus on commonly used features first
• TDM will enable running automated tests against de-identified real-world data and synthetic data further enhancing the effectiveness of automated testing

Our Vision for AI Across HealthEdge

Another key area is Artificial Intelligence. Our vision for AI is to accelerate AI-powered innovation in healthcare, ushering in a future that improves cost and care outcomes while enabling members to live their best lives.

We have been investing in agentic platforms, partnered with a third party for their expertise, and have working proofs of concept for how the agentic workflow is going to help us ingest data, move it through the AI-powered workflow, and provide rules or configurations at the other end. Our focus areas include:

• Intelligent Claims Operations
• Automate every aspect of claims adjudication with AI, including contract management, adjudication, fraud detection, and improved financial accuracy
• Proactive & Integrated Care
• Improving care and cost outcomes while driving care team quality and efficiency through predictive insights, automation and tailored care support
• Elevated Member & Provider Experience
• Enabling personalized experiences at scale to meet member and provider needs across intelligent content, workflows and data

Early Access to 3 Professional Services Offerings in 2025

Want to meet with us and work on this together? We’re looking for partners in the following areas to work with our Global Professional Services team:

1. Reporting Data Lake

If you’re a HealthEdge customer and you’re thinking about your data strategy and how you’re going to get reporting and business intelligence across products, we would love to partner with you. Come spend half a day with us to run a design sprint so that we can understand your data landscape and how we might design our data lake to mirror that. It includes:

• Multiple new and existing report options across HealthRules Payer, HealthEdge Source, HealthEdge Provider Data Management, GuidingCare, and Wellframe
• Customized report options
• Consultation on report options
• Best practice recommendations
• Run a Design Sprint—half-day to one-day workshop to understand current, necessary, and recommended reporting requirements

2. Test Automation as a Service

Client-side testing is essential for us to ensure the success of our implementations. The current method is inefficient and costly. But there’s a better way – with HealthEdge’s new test automation platform, which leads to better speed, efficiency, quality, and value. By working together, we can substantially and meaningfully improve the amount of automation and testing we have within your environments, and we can do it on our platform with our knowledge and expertise. It includes:

• User Acceptance Testing and integration from domain experts
• Faster, reduced risk, and added capacity for other org priorities
• IP that can be capitalized
• Run like Design Sprint—half-day to one-day workshop to understand what your team is doing now, current team size, types of testing, and testing of current processes
• Proposal with testing automation experts and quality assurance

3. Agentic AI Services

Agentic AI is the next generation of robotic process automation. We’d like to work with you to figure out how we can design a system that closes that gap in automation. For example, with a HealthRules Payer claim, when it goes pending, there are a bunch of steps a human must do (open documents, read information, and gather data from multiple systems). We’d like to create an AI-based agentic workflow system that automates those manual tasks based on the information that’s available to it and build it into the product so that your users can do less manual work.

We’re looking for:

• 10 customers for Q2 visits
• Robotic optimization on top of HealthRules Payer, GuidingCare, or total health plan
• Manual tasks that you want to automate
• Turn these into a platform with agents
• Currently looking for design partners

These are three exciting offers we have. We’re bringing them to you early because we think they’re meaningful and because we’d like to design them with you to better understand how you can get leverage from them.

Contact your Customer Success Executive to learn more and join us in one of these early access opportunities.