Case Study: Highmark Wholecare, Delaware Health Options, West Virginia Health Options
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How HealthEdge Supports California Health Plans
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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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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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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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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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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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A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
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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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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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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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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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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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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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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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