For health plans, payment errors and discrepancies aren’t just frustrating—they can be costly. Without access to updated pricing information, health plans face payment delays and inaccuracies that can negatively impact provider relationships, regulatory compliance, and administrative processes.
Many payers rely on a patchwork system of point solutions to address individual business needs. While disparate systems may work well for their specific niche, a network of disparate tools can lead to siloed data, cumbersome workflows, and a reliance on manual intervention. An integrated digital ecosystem can empower your health plan to respond faster to market demands and scale your offerings.
HealthEdge Source™ breaks the paradigm of disjointed point solutions by integrating the industry’s leading third-party payment integrity solutions directly into a unified ecosystem. This approach helps payers directly address inefficiencies while providing actionable insights and analytics.
3 Benefits of an Integrated Payment Integrity Solution
A third-party payment integrity ecosystem rewrites how payers approach payments and billing, creating clarity while enhancing operational outcomes. Here’s what the shift to an integrated solution can do for your organization.
1. Reduce Administrative Burdens
Every new vendor a payer adopts comes with its own learning curve—oversight responsibilities, system compatibilities, and manual review processes can take valuable time away from strategic action. It’s not uncommon for payers to find themselves juggling multiple vendor contracts, managing system redundancies, and comparing siloed data from disparate systems.
For example, HealthEdge Source delivers automated updates to help streamline workflows, ensuring your systems stay up to date without requiring manual intervention. The solution also automates fee schedule updates, allowing payers to reclaim critical hours and focus on achieving organizational goals.
Integrating third-party tools can be a game-changer. For one HealthEdge Source customer, the integrated solution led to a 30-40% reduction in resource-intensive contract maintenance processes. By embedding pricing, compliance, and editing solutions directly into the payment integrity ecosystem, payers can reduce their reliance on disconnected systems to streamline workflows and reduce administrative burden.
2. Driving Cost Savings
Efficiency and accuracy can help drive cost savings for healthcare payers. From minimizing vendor contracts to automating updates, the scalability of integrated payment integrity tools enables payers to capture immediate savings—and sustain those reductions over time.
By aligning teams around a unified third-party ecosystem, payers can reduce the hidden costs of operational silos. Whether it’s avoiding duplicated effort, cutting contract negotiation delays, or auto-adjudicating claims with high accuracy, streamlined functionalities create long-term financial advantages for payers.
For one health plan, leveraging the HealthEdge Source solution led to a 500% increase in savings. The integrated pricing and editing functions allowed the payer to achieve these significant saving by streamlining processes and reducing manual intervention.
3. Compliance Confidence
Keeping up with consistent regulatory updates (like the No Surprises Act and updates from the Centers for Medicare and Medicaid Services (CMS) is a never-ending task for health plans. Falling out of compliance isn’t simply an inconvenience—it can damage provider relationships, tarnish payer reputations, and lead to significant penalties.
Compliance with evolving regulations begins and ends with accurate, accessible information. HealthEdge Source helps simplify this process by embedding compliance updates within the ecosystem, ensuring you remain aligned with the latest mandates. For instance, automatic CMS fee schedule uploads every two weeks guarantee health plans operate with current policy information. Additionally, automated features—like real-time claims adjudication—help ensure accuracy.
With these safeguards in place, payers aren’t rushing to adjust systems or scrambling in response to regulatory shifts. Instead, they operate with confidence, delivering value to both providers and members.
Discover the Third-Party Ecosystem Built for Growth
HealthEdge Source transforms its integrated ecosystem into more than just a platform—it’s a strategic partner that evolves with you. By incorporating third-party payment integrity solutions into one centralized system, the solution eliminates unnecessary complexities while enabling smarter decision-making.
Key advantages of the HealthEdge Source solution include:
- One-Stop Access to Top Solutions: Industry-leading libraries like RJ Health and FAIR Health are embedded directly into the solution.
- Automated Updates: Continuous updates to the solution and available data reduce the workload for your team.
- Reduced IT Overhead: HealthEdge Source doesn’t require custom coding or high-maintenance integrations.
- Proactive Cost Savings: Innovations like auto-adjudication and customizable workflows deliver ongoing value.
- Future-Proof Compliance: Easily adapt to new regulations without system overhauls.
From the American Society of Anesthesiologists’ billing data to real-time fraud prevention tools from Codoxo, every element of the HealthEdge ecosystem is designed to enhance accuracy, elevate outcomes, and diminish inefficiencies across the board.
Healthcare leaders know that piecemeal solutions can’t keep pace with modern demands. HealthEdge Source weaves together the industry’s best third-party solutions into a unified ecosystem that’s built to scale and evolve. By integrating editing, pricing, and compliance solutions in one system, payers can achieve unprecedented levels of clarity and precision.
Leave the inefficiencies behind—learn more about how HealthEdge Source can help your health plan leverage integrated third-party payment solutions and make sure you’re prepared for the future of payment integrity.