HealthEdge Recognized as a Sample Vendor in 2025 Gartner® Hype Cycle™ for Provider Data Management and AI-Enabled Fraud Detection

HealthEdge®, a leading provider of next-generation core administrative processing systems, payment integrity, and care management solutions, has been recognized as a Sample Vendor in two categories of the 2025 Gartner® Hype Cycle™ for U.S. Healthcare Payers. HealthEdge was included in the Provider Data Management category for its Provider Data Management capabilities and in the AI-Enabled Fraud Detection category for its HealthEdge Source™ solution. HealthEdge views this mention as a reflection of its ongoing commitment to helping health plans tackle modern challenges with integrated technologies, enabling swift adaptation, innovation, and long-term resilience through a unified platform approach.

The Gartner Hype Cycle report is widely referenced by U.S. health plan CIOs for insights into technologies that support modernization, cost management, and improved health outcomes. HealthEdge views that its inclusion in two categories reflects the company’s continued focus on delivering solutions that help health plans maintain operational efficiency and prevent fraud. 

HealthEdge, for its Provider Data Management capabilities, was included in the Provider Data Management category, which the company attributes to its efforts in enhancing provider data accuracy, which is essential for authorizing services, processing claims, and delivering member-centric care efficiently. By leveraging automation and advanced analytics, HealthEdge Provider Data Management supports health plans in adhering to regulatory requirements while improving member satisfaction through accurate provider directories.

HealthEdge was also mentioned as a Sample Vendor in the AI-Enabled Fraud Detection category. HealthEdge Source employs AI technologies to support fraud detection efforts across the healthcare ecosystem. Fraudulent claims harm all stakeholders in the ecosystem, including taxpayers and health plan members, by increasing healthcare costs and reducing the quality of care. HealthEdge’s tools integrate machine learning algorithms to offer unparalleled precision in uncovering complex fraud schemes while supporting compliance initiatives and facilitating proactive cost-saving measures.

“At HealthEdge, we believe this acknowledgement from Gartner aligns with our mission to help health plans overcome mounting industry challenges through seamless technology solutions,” said Anshul Pande, Executive Vice President & General Manager, of HealthEdge HealthRules® Payer. “From ensuring provider data accuracy to addressing the cost of fraud across the healthcare ecosystem, our focus is to empower health plans with unified technology that drives better outcomes for members, providers, and organizations alike.” 

For over twenty years, HealthEdge has been at the forefront of providing solutions for health plans that eliminate inefficiencies and modernize operations. The innovations in AI-Enabled Fraud Detection and Provider Data Management offer additional pathways for health plans to improve operational resilience, save costs, and ultimately enhance service delivery.

To learn more about HealthEdge’s advanced solutions recognized in the Gartner Hype Cycle™, visit healthedge.com.

Gartner, Hype Cycle for U.S. Healthcare Payers, 2025, 16 June 2025

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About HealthEdge® 

HealthEdge® is building a future without limits for health plans, where they can deliver better service and care, make more informed decisions and streamline operations. Through an integrated platform of solutions for core administration (HealthEdge HealthRules® Payer), payment accuracy (HealthEdge Source™), provider network management (HealthEdge Provider Data Management), care management (HealthEdge GuidingCare®) and member experience (HealthEdge Wellframe™), health plans can converge their data and harness automation to drive more informed decisions, improve touchless transaction processing and payment accuracy, foster meaningful collaboration and enhance service and care delivery. HealthEdge is trusted by 116+ health plans, covering more than 110 million lives across 48 states. See what it means to converge without limits at HealthEdge.com and follow us on LinkedIn.