Improve Visibility and Control Over Claims Processes with Platform Access from HealthEdge Source™

If you’re responsible for managing a health plan, you’ve probably felt the strain of payment processes that don’t work as they should. Payment errors pile up, outdated systems slow you down, and fragmented data blocks you from seeing the full picture. Worst of all, these inefficiencies cost you time and money—and they cost your members, too.

With HealthEdge Source™ Platform Access, we’re making your operations easier to manage, helping you eliminate waste and save on costs. Here’s how Platform Access helps tackle the big issues holding health plans back.

Top 4 Challenges in Payment Integrity

If you’ve been dealing with payment integrity challenges, the following challenges probably sound familiar. Incorrect payments, vendor management, siloed information, and inefficient workflows can slow your processes and damage your reputation with providers—in addition to the financial costs.

1. Frequent Payment Errors

One-third of medical claims in the U.S. are paid incorrectly each year, leading to in waste from duplicate charges, coding issues, and other billing problems. These inefficiencies aren’t just a nuisance—they unnecessarily consume vital resources from your health plan and your members.

2. Too Many Vendors, Too Little Control

use two or more payment integrity vendors to manage their processes. While this piecemeal approach might seem comprehensive, it often creates inconsistent workflows, higher costs, and limited visibility into your operations.

3. Siloed Data Chaos

When your billing, claims, and clinical data are spread across separate systems, how do you connect the dots? Data silos cause delays, incorrect billing, compliance risks, and missed opportunities to improve care, making them a major pain point for many health plans.

4. Clunky, Outdated Workflows

Legacy IT systems slow down claim processing and leave your teams stuck in endless administrative loops. This creates bottlenecks, drains resources, and forces your organization to over-rely on manual processes that can’t keep up with today’s fast-paced healthcare demands.

These challenges eat up time and resources, making it harder for your teams to focus on what really matters—taking care of your members and building trust with providers.

Platform Access as a Comprehensive Solution

Platform Access from HealthEdge Source tackles these challenges with a fresh approach, giving health plans more control by improving visibility into their payment integrity processes. This offering simplifies claims processing by gathering your payment workflows into one easy-to-manage system, cutting out the need for multiple vendors and disparate systems.

By addressing payment errors at the source, you can stop payment mistakes before they snowball into bigger problems. Your health plans can get real-time insights into your workflows, so you can catch issues early, work more efficiently, and focus on delivering better care while keeping costs under control.

Root-Cause Detection

The Platform Access solution dives deep into your claims data to find and fix the root cause of errors. It stops mistakes, like coding and policy misalignments, before they require a large-scale, expensive fix. Claims rework, currently an issue for

Custom Editing Tools for Faster Adjustments

Advanced editing tools allow your health plan to create custom rules, implement changes on your timeline, and reduce dependence on external vendors. Advanced Custom Edits from HealthEdge Source uses current claim conditions, historical claim conditions, and relational criteria to create custom edits that maximize efficiency and improve payment accuracy.

One System, Full Visibility

Managing fragmented solutions from disparate vendors is inefficient. The HealthEdge Source solution brings payment data and processing together into one system, giving your health plan real-time oversight of your workflows. This centralization makes compliance, reporting, and root-cause analysis easier, while fostering transparency between payers and providers.

Analytics That Guide Savings

don’t just solve today’s problems—they help you prepare for tomorrow’s, too. Predictive tools like these can identify potential risks and help your health plan optimize contracts, reduce unnecessary spending, and flag issues before they impact your bottom line.

Break Down Silos

Platform Access tackles the challenges of siloed data by connecting information from billing, electronic health record (EHR) systems, and financial systems into one integrated platform. Instead of chasing fragmented data, you’ll make decisions based on full, unified insights.

Achieve Key Operational Goals with Platform Access

When you streamline inefficiencies with Platform Access, the results speak for themselves. Improving your Medical Loss Ratio (MLR) becomes achievable by reducing payment errors and unnecessary vendor fees, freeing up more of your budget for patient care instead of administrative costs.

Lower administrative expenses are another win for payers. By eliminating waste and connecting workflows, you can reinvest those savings into other strategic goals. Providers also feel the impact, as accurate and timely payments build trust and reduce disputes, creating smoother collaborations. Ultimately, these improvements position your health plan to offer more competitive pricing without compromising the personalized service your members value.

The healthcare industry is changing, and health plans that don’t adapt risk falling behind. HealthEdge Source Platform Access offers a comprehensive solution to tackle the major challenges of payment integrity, providing your health plan with more control, visibility, and efficiency. By fixing payment errors at their root, consolidating vendors, and breaking down data silos, you save money, streamline workflows, and, most importantly, deliver better care to your members.

At HealthEdge Source, we aim to be more than another payment integrity solution. Our mission is to be the solution to payment integrity, supporting your health plan and solving these challenges together—because real change takes a true partner.

Discover how Platform Access from HealthEdge Source can help transform your payment integrity workflows and improve efficiency. Learn more.