Boost Efficiency, Accuracy, and Flexibility with Advanced Custom Edits

Managing complex healthcare claims requires a flexible editing system that adapts to the unique needs of your health plan. Traditional claims editing tools often fall short, leaving you vulnerable to errors and inefficiencies. That’s why HealthEdge Source™ (Source) developed Advanced Custom Edits (ACE), a new feature that allows users to create and manage custom edits directly within the Source interface.

Our solution goes beyond pre-defined edits by analyzing the member’s claim history, allowing you to identify potential irregularities with a high level of accuracy. This opens doors to a whole new level of control and adaptability you can access in-house. With ACE, you can tailor editing rules to address specific scenarios and business needs with ease.

Building on the foundation of our existing custom editing feature, Advanced Custom Edits empower your health plan to take editing a step further. You will have complete control over defining the edit itself, including name, ID, disposition, message, and provider type. In addition, it introduces a powerful new capability: evaluating data from historical member claims.

Think of it as adding a magnifying glass to your claims editing process. By incorporating claim history data (identified by beneficiary ID), ACE significantly expands the reach of your editing rules. This allows your team to analyze a broader range of claims data, resulting in more precise and comprehensive claim evaluation.