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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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....
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
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...
Read More
Loading More...
