In the ever-evolving landscape of healthcare, one of the most challenging aspects for healthcare payers is keeping up with the constant changes in fee and policy schedules set by the Centers for...
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The volume of changes CMS makes to its policies and pricing schedules every year is staggering, with over 600 retroactive changes anticipated for 2023 alone, making it challenging for payers who...
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For all the talk about value-based care models, few payers have actually discovered the secret to successfully deploying these types of arrangements with a significant portion of their provider...
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With hundreds of health plans depending on HealthEdge’s HealthRules® Payer core administrative processing system (CAPS) every day, members of the Customer Operations team have their work cut out...
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As the U.S. healthcare system is undergoing rapid transformation, many health plans are looking to modernize their core administrative processing systems (CAPS). In fact, according to the 2023...
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The healthcare landscape is in a constant state of evolution, with technology innovations serving as a guiding force for payers striving for efficiency, accuracy, and enhanced operations. In this...
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In the ever-evolving landscape of health insurance, claims editors play a pivotal role as the first line of defense against inaccurate claim submissions. These editors are vital for the success of...
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Health plans want to know – what can I do to improve member satisfaction? A recent AHIP webinar, co-hosted by HealthEdge, featured the results of an independent, nationwide study of more than...
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In the fast-paced landscape of the healthcare industry, adaptation and innovation are key to success. At HealthEdge® Professional Services, this philosophy is not just a motto but a driving force...
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In the fast-paced world of healthcare, the management of payment integrity initiatives has emerged as a critical challenge for payers. The increasing complexities of healthcare claims have led to...
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In the dynamic world of healthcare, consumer expectations are rapidly evolving. The rise of retail experiences has empowered healthcare consumers with higher expectations, prompting health plans...
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In the ever-evolving landscape of healthcare technology, HealthEdge has emerged as an integral player in providing innovative solutions to streamline healthcare processes and enhance patient care....
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As a trusted partner in the ever-evolving healthcare landscape, HealthEdge understands the importance of transparency in healthcare pricing for health plans and their members. The recent...
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Over the past several years, health plans have been hit by a tsunami of regulatory changes, and two primary themes have emerged: transparency and interoperability. From the Transparency in...
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In today’s rapidly evolving healthcare landscape, health plans face increasing challenges to provide quality care while identifying new efficiencies. As a result, more health plans are turning to...
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Earlier this year, a select group of clinical leaders from across the country gathered with HealthEdge and Wellframe at the Clinical Leadership Forum, an event that provided a unique opportunity...
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In an era where healthcare costs continue to rise, the concept of value-based care has emerged as a game-changer in the health insurance industry. Value-based care focuses on achieving better...
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Star ratings have long been a cornerstone of assessing the quality and performance of health insurance plans from the Centers for Medicare & Medicaid Services (CMS). These ratings play a crucial...
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