HealthEdge Blog

Building a More Intelligent Payment Integrity Process: AI Enhancements in HealthEdge Source

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...

Comprehensive AI Glossary: Key Terms for Payers Explained

Dive into our AI glossary tailored for health plans and payers. Learn essential terms like Machine Learning, Generative AI, and NLP to understand their impact on healthcare operations and payer...

HealthEdge® CTO Update: Key Areas of Investment for 2025

In our December IMPACT customer event, we introduced a few key areas of investment at the platform level, and I have some exciting updates to share with you on customer experience, integrations...

How the HealthEdge® AI Summarizer Empowers Teams to Deliver Personalized Care at Scale

Care managers are responsible for far more than delivering care. They coordinate member communication, update health records, navigate program changes, and play a crucial role in ensuring...

Scaling Smartly: How Curative Health Plan Leveraged HealthEdge® to Power Growth and Achieve Operational Efficiencies

Advancing Health Equity: Strategies for Health Plans Navigating Change, Compliance, and Innovation

As regulatory guidelines evolve and the emphasis on improving healthcare access and outcomes intensifies, health plans that serve Medicaid and D-SNP populations face an urgent mandate to improve...

Navigating CMS 2027 D-SNP Requirements: Preparing Your Health Plan for HIDE and FIDE SNP Compliance

Health plans serving dual-eligible populations face significant regulatory changes from the Centers for Medicare & Medicaid Services (CMS). The 2027 D-SNP requirements introduce significant...

Creating a Culture of Innovation to Accelerate AI Adoption

Artificial Intelligence (AI) is transforming healthcare by helping payers streamline operations, reduce costs, and enhance experiences for staff, members, and providers. However, health plans must...

Pursuing NCQA Accreditation: How Wellframe™ Is Enabling Health Plans to Address SDOH

Now more than ever before, health plans are recognizing the importance of holistic care delivery to improve outcomes and reduce costs. Social determinants of health (SDOH) such as food security,...

The Health Plan’s Guide to Payment Integrity Solutions

Payment integrity solutions are becoming an increasingly essential part of payers’ digital ecosystems. An integrated payment integrity platform can work with a health plan’s existing technology...

How Health Plans Can Improve Outcomes and Reduce Costs with Automated Prior Authorizations

Prior authorizations remain one of the most complex and time-consuming administrative processes in the healthcare industry. Inefficient processes can aggravate provider abrasion and delay patient...

How Health Plans Can Succeed in 1115 Medicaid Waiver Programs

Medicaid is a lifeline for millions of vulnerable citizens, providing essential healthcare services. However, traditional Medicaid programs often require innovation and flexibility to meet the...

8 Ways GuidingCare® Helps Health Plans Support Communities with Diverse and Complex Care Needs

Health plans today face multifaceted challenges, particularly when managing care for individuals navigating significant barriers to health equity. These populations, including dual-eligible...

Why Advanced Care Management is Crucial for Better Member Engagement and Outcomes

Modernizing technology solutions and adjusting digital strategies are key priorities for health plan executives. Advancements in integrated care management solutions are enabling payers to...

5 Common Barriers to Efficient Claims Management for Health Plans

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...

Want to Enhance Your Health Plan Technology Systems? Start with an Optimization Assessment

Optimizing healthcare technology solutions is no longer just a nice-to-have—it’s a strategic move that can drive significant improvements in efficiency and cost saving. From reducing operational...

How Advanced Provider Data Management Solutions Drive Efficiency and Growth for Healthcare Payers

Provider data is the backbone of operational efficiency for health plans. From ensuring accurate claims processing to improving member satisfaction, maintaining an up-to-date and reliable provider...

Elevate the Member Experience Through Digital Solutions: Insights from the HealthEdge® Leadership Forum

At the 2024 HealthEdge® Leadership Forum, health plan leaders shared their insights on leveraging digital solutions to elevate the member experience, improve engagement, and increase operational...

How to Use Digital Engagement to Improve Care Management Utilization

Effective care management begins with getting members onboarded. For health plans, the onboarding process sets the tone for the member’s experience while also building the foundation for long-term...