The pace of change in healthcare has accelerated at record speeds in recent years. Many health plan CIOs are struggling to help their businesses adapt quickly due to their dependencies on legacy...
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Care management isn’t new. For decades, care managers have been providing information, support, and guidance to members facing chronic and acute healthcare challenges and complex transitions of...
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The business of the modern Health Plan is highly complex and to be successful, plans often require the assistance and contribution of outside providers for a range of goods and services. Those...
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The KLAS Emerging Solutions Spotlight on Source separates fact from fiction by conducting in-depth interviews with Source customers to understand their use of the platform, expectations and...
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Genetic testing was once only available to individuals with a family history of certain genetic conditions or those who were experiencing symptoms. In recent years however, advances in technology...
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It’s no secret that change is the only constant in today’s business world. As organizations pivot to navigate the ever-evolving needs of their employees, customers, and markets, leaders must be...
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For many Health Plans, 2023 presents unique challenges and opportunities when it comes to addressing strategic initiatives. The healthcare payer ecosystem is becoming increasingly digital, and for...
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Here at HealthEdge, our cybersecurity strategy relies on a defense-in-depth approach, which means we rely on people, processes, and technology to ensure our security controls remain viable and...
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HealthEdge’s Core Administrative Processing Platform Earns #1 Ranking HealthEdge Software, provider of the industry’s leading next-gen integrated solution suite for health insurers, is proud to...
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New York represents one of the country’s largest populations of Medicaid beneficiaries, according to Medicaid.gov. Keeping up with the payment and policy updates that the New York State Department...
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Health insurers increasingly understand that delivering a delightful customer experience to members is critical for success. In a survey of health insurance executives conducted by market research...
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Prior authorization is a challenge for both providers and patients. The new CMS proposed rule on interoperability and electronic prior authorization aims to decrease provider abrasion and enhance...
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The bad news for the American healthcare system: Estimates show up to 18 million Americans will lose their health insurance coverage through Medicaid within 14 months
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Data Protection in All States Data must be protected in all states, when in use, in motion, and at rest. Data in use is data that is actively being accessed, processed, or updated. Data in motion...
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Medical necessity is one of the hardest things for both payers and providers to get right due to the complexity these policies usually require. However, medical necessity serves an important role...
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With the ease of shopping on Amazon and proliferation of curbside, delivery, and pickup options, consumers want options, the best deal, and fastest delivery/pickup. With modern digital...
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Medicare Advantage brings affordable, comprehensive healthcare coverage to nearly 30 million Americans. This program serves diverse American communities, including 3.7 million rural Americans. 40%...
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Cyber Threat Intelligence (intel) is an important component of our security operations strategy. We believe it is critical to gather intel from multiple trusted sources and use it as a force...
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Have you ever gotten a phone call or meeting request where you were told that you were getting a new boss, being moved into a different role, or even that your entire department was going to be...
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As it has been in the last several years, 2023 has significant regulations in play – predominantly revolving around interoperability and transparency, making it strategically critical for health...
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