Operating within the U.S. healthcare industry can be challenging. Decades of layered regulations, siloed processes, and a sprawling network of stakeholders have created an environment where...
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Increasing rates of claims denials cause operational bottlenecks and financial consequences across the healthcare system. In 2024, the initial claims denial rate rose to nearly 12%. Denied claims...
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Regulations are getting tougher, value-based care is expanding, and members now expect fast, seamless experiences. In this demanding landscape, achieving payment accuracy is more than just...
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Maintaining efficient claims processing workflows can become an overwhelming task for many health plans. Claims teams have to process every claim accurately and on time, keep up with changing...
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Claims inaccuracy has long been a pain point in the healthcare industry. Processing inefficiencies lead to challenges like payment delays, retroactive changes, damaged member and provider...
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In a recent webinar, two HealthEdge Source™ product leaders demonstrated how our teams are integrating artificial intelligence (AI) into our solutions to enhance experiences and outcomes for...
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What does it take to pay a claim correctly? In healthcare, “editing claims” goes beyond surface-level checks—it’s about ensuring accuracy, compliance, and efficiency. Each claim must align with...
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If you’re responsible for managing a health plan, you’ve probably felt the strain of payment processes that don’t work as they should. Payment errors pile up, outdated systems slow you down, and...
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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...
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To stay ahead of complex payment models and billing guidelines, healthcare payers are turning to integrated digital solutions that can help streamline operations to achieve key business goals....
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Health plans face a variety of challenges when it comes to contract modeling, negotiations, and reviews. A reliance on manual processes and disparate tools can make it difficult to accurately...
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Section Guide: Key investments for member engagement Overcoming barriers to member satisfaction 7 Key strategies for boosting member engagement Impacts of transforming member engagement Key...
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Effective provider engagement is fundamental to reducing administrative costs and improving member outcomes. However, as operational complexities persist and healthcare demands increase, the need...
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Health plans face continual pressures to modernize their services and provide personalized offerings to broader member populations—without breaking the budget. For 36% of health plan leaders,...
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For healthcare payers, complying with shifting regulations can be a challenge. Increasingly, state and federal guidelines focus on improving cost transparency while improving patient data safety....
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As we approach 2025, health plan executives are facing new challenges and opportunities. The HealthEdge® Annual Payer Market Planning Report 2025 outlines the top priorities, investments, and...
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Healthcare regulations continue to evolve, reshaping how health plans operate and do business in a competitive market. Amid rising costs and regulatory pressures, healthcare fraud prevention is...
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Latest Release: 2024 Gartner® Hype Cycle™ for U.S. Healthcare Payers Gartner has published its highly anticipated Hype Cycle for U.S. Healthcare Payers. HealthEdge® was recognized as a Sample...
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