Commercial
The commercial health plan market is marked by high member turnover, with nearly 20% disenrolling each year. This creates intense pressure for health plans to minimize churn, invest in new enrollment strategies, and balance affordability with business growth in an increasingly competitive environment.
HealthEdge® offers an AI-powered platform built specifically for commercial health plans. Designed for scalability and flexibility, our platform helps you adapt quickly to changing market conditions. With HealthEdge, you can launch innovative products, reduce administrative costs, and improve operational efficiency. Most importantly, our platform helps you deliver exceptional value and a stronger member experience, protecting enrollment and driving sustainable growth.
How HealthEdge
Can Help
HealthRules® Edge
HealthRules® Edge, formerly HealthRules® Payer, is our core claims engine: a cloud-native solution that powers accurate, efficient claims administration, delivers industry-leading auto-adjudication rates, and enables stronger financial and operational performance.
Payment Accuracy Edge
Payment Accuracy Edge, formerly HealthEdge Source™, is our prospective payment integrity solution that powers accurate payments for continuous cost containment through end-to-end systems.
Clinical Edge
Clinical Edge, formerly HealthEdge GuidingCare®, is an integrated care management platform that helps improve care quality outcomes and cost management by streamlining care team workflows.
Revenue Align Edge
Revenue Align Edge, formerly HealthEdge Risk Adjustment, enables proactive management and stronger compliance across the payer enterprise by giving health plans a clear, data driven picture of risk.
Provider Atlas Edge
Provider Atlas Edge, formerly HealthEdge Provider Data Management, helps reduce operational friction, compliance risk, and administrative risk through a single, reliable source of truth across the payer data ecosystem.
Payment Accuracy Edge
Payment Accuracy Edge, formerly HealthEdge Source™, is our prospective payment integrity solution that powers accurate payments for continuous cost containment through end-to-end systems.
Clinical Edge
Clinical Edge, formerly HealthEdge GuidingCare®, is an integrated care management platform that helps improve care quality outcomes and cost management by streamlining care team workflows.
Revenue Align Edge
Revenue Align Edge, formerly HealthEdge Risk Adjustment, enables proactive management and stronger compliance across the payer enterprise by giving health plans a clear, data driven picture of risk.
Provider Atlas Edge
Provider Atlas Edge, formerly HealthEdge Provider Data Management, helps reduce operational friction, compliance risk, and administrative risk through a single, reliable source of truth across the payer data ecosystem.
HealthRules® Edge
HealthRules® Edge, formerly HealthRules® Payer, is our core claims engine: a cloud-native solution that powers accurate, efficient claims administration, delivers industry-leading auto-adjudication rates, and enables stronger financial and operational performance.