As regulatory and quality expectations intensify, the National Committee for Quality Assurance (NCQA) vendor certification offers health plans a trusted signal that their technology partners can...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreAcross the healthcare industry, organizations are making do with a payment integrity process that relies on a complex web of disparate systems, multiple vendors, and manual ticketing processes....
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How integrated HealthEdge® technology helps improve member outcomes, reduces spend, and delivers on the promise of coordinated care. Ask any care manager why they chose their profession, and the...
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At HealthEdge®, we understand that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate provider...
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When state regulations change, health plans must be ready to respond—particularly when those changes impact core Medicaid services. That was the case in 2025 when the State of Texas mandated...
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Implementing new care management technology is about more than just meeting a go-live date. For Medicaid and Long-Term Services and Supports (LTSS) plans navigating evolving state mandates,...
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See what 3,500 consumers say about their healthcare experiences
Read the report!The healthcare payer landscape is undergoing a seismic transformation, as revealed by the 2026 HealthEdge® Annual Payer Report. HealthEdge surveyed more than 550 health plan executives, including...
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As the healthcare industry prepares for the ripple effects of the One Big Beautiful Bill Act (OBBBA), few payer segments face more immediate challenges than health plans focused on Medicaid...
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The HealthEdge® 2026 Annual Payer Report, “The Great Rebalancing: Inside the New Realities Shaping Health Plan Performance,” reveals how health plans are navigating growing financial pressure,...
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As health plans become increasingly reliant on complex software platforms to manage operations, timely access to accurate product information is essential. Yet traditional documentation search...
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Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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AI is reshaping how software gets built—enabling faster delivery, real-time iteration, and deeper collaboration between technical and business teams. At HealthEdge®, we’re exploring how AI-driven...
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In an industry flooded with point solutions, health plans are realizing that using more tools don’t necessarily lead to more value. From member engagement apps and wellness portals to survey...
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Health plan leaders have dozens of digital solutions to choose from—so many that it can feel like real partnership is rare. Too often, vendors deliver software and walk away, leaving health...
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Better outcomes, lower costs: Why health plans are turning to HealthEdge® Wellframe Across the healthcare industry, many health plans grapple with vendor sprawl—a web of disparate systems and...
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By Rob Duffy, CTO, HealthEdge It’s easy to talk about innovation in healthcare technology; it’s harder to build it in a way that scales for health plans and improves real outcomes. At HealthEdge,...
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At HealthEdge, we know that deploying AI tools is just one piece of the puzzle. True transformation happens when people across the organization not only understand what AI can do but also begin to...
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On June 10, 2025, the One Big Beautiful Bill Act (OBBBA), also known as H.R.1, was signed into law, marking the beginning of one of the most sweeping healthcare reforms in recent memory. Given the...
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Sweeping policy changes are nothing new in U.S. healthcare, but the One Big Beautiful Bill Act (OBBBA), also known as H.R. 1, represents a particularly consequential inflection point for health...
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Health plans are under increasing pressure to modernize operations while managing rising costs, regulatory complexity, and evolving member expectations. Many have adopted tech-enabled services to...
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