Case Study: Highmark Wholecare, Delaware Health Options, West Virginia Health Options
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California
How HealthEdge Supports California Health Plans
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Data Sheet: Provider Data Management Frequently Asked Questions
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Data Sheet: Provider Data Management - Commitment to Security and Data Protection
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Data Sheet: Provider Data Management Integrates Seamlessly for Powerful Workflow and Accuracy
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Data Sheet: Stay Ahead of a Shifting Regulatory Landscape with Provider Data Management
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Data Sheet: Drive Data Integrity and Reliability with Provider Data Management
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The Hidden Costs of Legacy Core Administrative Processing Systems (CAPS)
Many health plans continue to rely on legacy Core Administrative Processing Systems (CAPS) as the backbone for managing critical operations such as claims processing, benefit configuration, and...
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How HealthEdge HealthRules® Payer Helped Medica Transform Claims Operations through Strategic Automation
Faced with growing administrative and medical cost pressures, Medica needed a solution to streamline its claims processing and improve efficiency across its operations.
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Infographic: Legacy vs. Next-Generation Core Administrative Processing Systems (CAPS)
As the environment for health plans evolves rapidly, now is the time to modernize CAPS to enhance your ability to compete for members, improve effciencies, and maintain compliance.
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HealthEdge® Survey Reveals Top Health Plan Priorities for 2025
Nearly 500 health plan leaders consider security, modern technology, and product expansions as the most important. BURLINGTON, Mass.–(BUSINESS WIRE)–HealthEdge®, a leader in healthcare technology...
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Data Sheet: Optimize Efficiencies with Integrated HealthRules Payer Solutions
HealthRules® Payer is a next-generation core administrative processing system (CAPS) designed to revolutionize the operations of health plans of all sizes and types.
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Data Sheet: HealthEdge Source™ - Medi-Cal Reimbursement
A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
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Navigating Capitation in California: A Digital Health Plan Imperative
In the dynamic California landscape of health care, capitation is gaining popularity as a reimbursement model. Capitation is the practice of paying care providers a fixed amount for each patient....
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How to Navigate Complex Healthcare Regulations in California and Beyond
Navigating the labyrinth of healthcare regulations is no small feat. This is especially true for health plans operating in California. The state has the largest population in the U.S., with varied...
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Webinar: Proactively Addressing Regulatory Complexities in California and Beyond
Payers continue to invest time and energy into keeping up to date and remaining flexible amidst the constantly evolving regulatory landscape.
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California Duals: Curating Competitive D-SNP Offerings with GuidingCare Care Management Software
The healthcare landscape in California is undergoing a significant transformation as part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative. A pivotal change involves the...
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HealthRules Payer Case Study with Presbyterian
HealthEdge had the opportunity to sit down with Presbyterian Health Plan leadership to learn more about why their organization decided to make the switch to HealthRules Payer as it's CAPS partner.
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Video: Next Generation Core Administration Processing
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CalAIM ECM: Everything You Need to Know
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...
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Is your care management platform compliant with CalAIM?
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...
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