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...
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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...
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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...
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California Advancing & Innovation Medi-Cal Enhanced Care Management (CalAIM) is designed to improve the level of whole person care that is given to the population. This is especially true for...
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Healthcare Payers: True Digital Transformation Healthcare organizations and leaders are thinking about how to provide the experiences that patients and consumers have come to expect from the...
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We are nearing the 1/1/23 requirement for health plans to provide online shopping/price comparison on health plan member portals for around 500 services. This is part of the Transparency in...
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Have you ever tried to find an in-network doctor on your health plan member portal, found one, and called them – only to find out that they’re not actually in network? Or worse, gone to a doctor...
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Cybersecurity is a constantly evolving threat with the potential for massive risk and impact. HealthEdge is always on guard against cyber threats with a security blueprint and technology stack....
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Is it possible? Can competitors also collaborate? Do they already? When is it acceptable? When does it push reasonable boundaries and when does it cross the line? This post will cover those...
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Long term technology success hinges on the last step of HealthEdge’s Transform Methodology, Execution Transform Methodology’s Last Step: Execution Traditionally technology implementations involved...
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Transform Methodology: Change Management Framework Transform methodology is the insurance industry’s cutting-edge approach to change management during internal project launches. Its principles can...
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At HealthEdge, disrupting the status quo is part of who we are. When it comes to redefining payment integrity, we often think about it in terms of shifting from a black box to an open book...
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Enrollment Trend Drivers 2023 Key drivers for open enrollment trends 2022-2023 include: The COVID-19 Pandemic Labor shortages Popularity of hybrid and remote work Focus on emotional well-being...
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Unlike legacy systems, Next-Gen CAPS like those offered by HealthEdge integrate seamlessly with third-party applications, offering more interoperable data and workflows across payer or third-party...
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What are Prospective Payment Integrity (PPI) solutions anyway? PPI solutions enable health plans to proactively avoid paying claims improperly. They include features like: Claims editing Data...
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Stuart Myer, Chief Information Officer, VillageCare, a community-based, not-for-profit organization in New York, recently joined HealthEdge leaders Christine Davis, Vice President, Product...
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Leveraging his experiences as the Chief Information Officer at VillageCare, Stuart Myer discusses successfully attaining executive board buy-in for long-term technology investments. Issues...
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In 2022, HealthEdge once again commissioned an independent survey of health insurance executives to capture and monitor perspectives regarding current challenges and priorities. There were over...
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The ‘pay and chase’ model of reimbursement is prevalent in the health care industry. This means many health plans know and accept the fact that payments to providers are simply incorrect and will...
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We all get the emails – mid-year check-in, annual reviews. These performance reviews are designed to help us continuously grow and develop throughout our career. Your manager and/or mentor can...
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