Serving the approximately 20% of the U.S. population enrolled in Medicaid is a challenge for any health plan. Many Medicaid members face communication, mobility, or complex health needs, and each state sets its own requirements and systems — adding complexity and fragmenting engagement. As a result, health plans serving Medicaid members need advanced Medicaid health plan software to deliver high-quality care, control costs, and stay compliant with evolving state regulations.
Medicaid
Navigate the Competitive Medicaid Market
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.