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Government

Government

Government-sponsored healthcare programs now dominate U.S. healthcare spending, offering significant opportunities for growth. Health plans offering Government lines of business must overcome challenges such as delivering high-quality care, managing costs, maintaining strict regulatory compliance, and transitioning to value-based care models.

HealthEdge® provides purpose-built solutions designed for government lines of business. Our advanced solutions equip health plans with the tools to meet these demands head-on. From improving care quality and operational efficiency to enhancing regulatory adherence and supporting value-based care, HealthEdge enables you to thrive in this complex and dynamic sector.

Picture shows male and female healthcare professionals in a discussion about government-sponsored healthcare programs
Medicare

In the competitive Medicare market, HealthEdge solutions help ensure quality, ease the shift to value-based care, support compliance and lower costs.

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Medicaid

Overcome the complexity and fragmented engagement of Medicaid care with HealthEdge solutions that support care, compliance and help control costs.

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Dual-Eligibles

Our dual-eligibles solution suite enhances claims processing with prospective payment integrity and feeds data to an end-to-end care management solution. Together, they enhance compliance, lower costs, and deliver improved outcomes.

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How HealthEdge
Can Help

HealthRules® Payer

Gain the ability to expand into new markets and quickly stand up and grow all lines of business. Our next-generation core administrative platform provides industry-leading flexibility for contract configurations so you can reduce IT and administrative overhead and improve operational efficiencies.

EXPLORE HEALTHRULES PAYER
HealthEdge SourceTM

Transform your business with the market-leading prospective payment accuracy and integrity solution designed specifically to enable health plans to pay claims accurately, quickly and comprehensively the first time.

EXPLORE SOURCE
GuidingCare®

Turn to the nation's largest and most widely adopted solution for care management and population health to address care coordination, medical management workflow, and regulatory compliance to serve all members.

EXPLORE GUIDINGCARE
WellframeTM

Gain insights between clinical encounters and provide more consistent support. Wellframe Digital Care Management extends the reach of your staff to engage more fully with high-risk members.

EXPLORE WELLFRAME
Provider Data Management

Streamline data ingestion and enrichment using a Generitive AI-powered framework that enables real-time accurate provider data to flow across the HealthEdge solution suite and the broader heath plan ecosystem.

Explore Provider Data Management
HealthEdge SourceTM

Transform your business with the market-leading prospective payment accuracy and integrity solution designed specifically to enable health plans to pay claims accurately, quickly and comprehensively the first time.

EXPLORE SOURCE
GuidingCare®

Turn to the nation's largest and most widely adopted solution for care management and population health to address care coordination, medical management workflow, and regulatory compliance to serve all members.

EXPLORE GUIDINGCARE
WellframeTM

Gain insights between clinical encounters and provide more consistent support. Wellframe Digital Care Management extends the reach of your staff to engage more fully with high-risk members.

EXPLORE WELLFRAME
Provider Data Management

Streamline data ingestion and enrichment using a Generitive AI-powered framework that enables real-time accurate provider data to flow across the HealthEdge solution suite and the broader heath plan ecosystem.

Explore Provider Data Management
HealthRules® Payer

Gain the ability to expand into new markets and quickly stand up and grow all lines of business. Our next-generation core administrative platform provides industry-leading flexibility for contract configurations so you can reduce IT and administrative overhead and improve operational efficiencies.

EXPLORE HEALTHRULES PAYER