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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Good privacy practices have become a valuable business asset that produces a myriad of benefits. Processing data and protecting data are fundamental components of today’s digital economy,...
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A robust and thriving employee experience boasts happy and loyal customers, high performing teams, and a work environment that exudes flexibility and purpose. A well curated employee experience...
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