HealthEdge Blog

Top 5 Tips to Compete & Grow in the Medicare Advantage Space

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%...

Cyber Intelligence Alerts: How to Keep Your Network Safe

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...

3 Quick Tips to Mastering Change in a Remote Environment

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...

2023 Regulatory Compliance: What health plans need to know

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...

How health plans can leverage technology to enhance engagement with senior members

Technology use among seniors saw significant gains over the last several years, fueled in part by a desire to stay connected during the COVID pandemic. A research study performed by AARP showed...

3 Critical Care Management Market Drivers

At HealthEdge, we keep a close eye on the market and the drivers that are influencing healthcare. Our team looks to the experts at Gartner and KLAS, surveys our clients to understand what they’re...

Can Moving from Postpay to Prepay Address Payment Integrity Challenges?

Payer organizations today face significant obstacles as they navigate a new era of member and provider “relationship management.” Members and customers have increased expectations and payers are...

7 Key Trends in Payer Payment Integrity

Lately, payers have been making some interesting shifts to better meet their organizational goals such as executing transactions more quickly and identifying root causes of incorrect payments. As...

The Rise of Digital Healthcare post COVID-19

On March 11, 2020, COVID-19 was declared a global pandemic by the World Health Organization. The accessibility of portable, electronic communication technologies had already begun to change our...

Effective Care Management for D-SNPs

In today’s world, health plans are challenged with improving care, reducing costs, and remaining compliant with ever-changing regulations. This is especially true when it comes to providing care...

7 Most Common Medicaid MCO Claims Management Risks

Health Plan Payers: Are you prepared for internet attack threats?

The 2022 Verizon Data Breach Investigations Report (DBIR) found Internet-facing applications, such as web applications and mail servers, were among the most common methods for attackers to slip...

Beyond Dashboards: How to get the Most out of Your Reimbursement Analytics

At health plans today, reports are often found in the form of spreadsheets – which offer a flat and siloed view of reimbursement insights. Analytics can be more informative when they have accurate...

Uncovering Opportunities: 4 Top Tips when Upgrading Payer Software

Upgrading existing software can be a daunting task to undertake, one that requires planning and freeing of resources to be successful. It’s one of the reasons health plans might put off keeping...

How small & medium health plans can control rising Rx Costs

Healthcare Spending in the US In 2020, U.S. health care spending increased 9.7 percent to reach $4.1 trillion – a much faster rate than the 4.3% increase experienced in 2019. Of this, $359 billion...

CMS Regulations – Top 4 Tips to Stay Compliant

CMS regulations are constantly evolving – and the risks of non-compliance are steep. As the backbone of numerous health plan payers, HealthEdge is responsible for adhering to CMS’s constantly...

6 Ways Technology can lighten your Medicaid MCO team’s workload

Healthcare Cybersecurity: Top Threats and Industry Trends

Industry Trend Comparison The Department of Health and Human Services (HHS) has reported an 84% increase in the number of data breaches against health care organizations from 2018-2021. Data...

California Advancing & Innovation Medi-Cal Enhanced Care Management: Everything You Need to Know

CalAIM Introduction California Advancing and Innovating Medi-Cal, also known as CalAIM, is a multi-year plan to transform California’s Medi-Cal program and make it integrate more seamlessly with...