How U.S. Healthcare Payer CIOs Can Future-Proof Claims Editing

HealthEdge Source, a payment integrity platform uniquely offering claims reimbursement, payment policy management, and analytics, was recently mentioned as a Representative Vendor in the 2023 Gartner® How U.S. Healthcare Payer CIOs Can Future-Proof Claims Editing report .​

According to Gartner, “U.S. healthcare payers need flexible and durable IT systems to work toward real-time administration. To foster integration into a real-time claims-processing environment, CIOs should assess current and future capabilities, hold vendors accountable and include the claim staff in technology decisions”.1​

As a disruptor in the claims editing market, HealthEdge Source understands this. That’s why Source was specifically designed to deliver pricing and editing in a single call to enable more comprehensive, accurate results, and help payers fix issues upstream.​

“With HealthEdge Source, we are helping health plans become more agile by enabling them with technology that increases accuracy, reduces contingency spending, and shifts the focus back to what matters most: taking care of their members and providers,” said Ryan Mooney, General Manager and Executive Vice President of HealthEdge Source.​

To read more Gartner recommendations on future-proofing your claims editing, click here for complimentary access to this report.

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About HealthEdge Source​

HealthEdge Source offers the ability for clients to unlock transformation at the reimbursement, payment integrity, and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for Commercial and Government lines of business. Payment Integrity Transformation includes rich editing libraries with history-based capabilities, easy development of customized edits, and improved transparency to reduce vendor dependency and increase control. As a complete solution, clients can achieve Enterprise Transformation, where root-cause issues are identified and addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence.

About HealthEdge

HealthEdge® is the health insurance industry’s first digital nervous system to provide automation and seamless connectivity between all parts of a payer’s administrative and clinical systems. HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. In 2020, funds managed by Blackstone became the majority owner. HealthEdge and its portfolio of mission-critical technology assets for payers, including HealthRules® Payer, Source, GuidingCare®, and Wellframe are collectively driving a digital transformation in healthcare. Follow HealthEdge on Twitter or LinkedIn.

1 Source: Gartner, How U.S. Healthcare Payer CIOs Can Future-Proof Claims Editing. Austynn Eubank, 20 April 2023.​

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