Case Study:Transforming Payment Accuracy and Operational Efficiency at a Large National Health Plan
Discover how one health plan enhanced efficiency, accuracy, and transparency through with HealthEdge Source.
Faced with operational inefficiencies and a pressing need for greater transparency, a health plan tackled challenges in payment processes, contract management, and provider relationships. By adopting HealthEdge Source™, seamlessly integrated with HealthRules® Payer, the organization streamlined workflows, improved payment accuracy, and strengthened provider trust.
Challenges at a Glance
The health plan struggled with several operational hurdles:
- Cumbersome payment processes: Downloading and maintaining Medicare fee schedules was a manual, time-consuming task prone to errors.
- Inefficient contract maintenance: Prolonged negotiations and delays in payments placed a significant strain on resources.
- Lack of transparency: Limited visibility created friction and trust issues with providers.
Why HealthEdge Source?
The health plan decided to transition to Source due to its long-standing partnership with HealthEdge and the integration with HealthEdge’s claims processing system, HealthRules® Payer. The integration promised enhanced efficiency and smoother implementation
Key Benefits and Results
- Simplified Contract Management: Source made managing complex contracts more straightforward, with flexible tools to configure and customize edits for various groups—all within a unified platform.
- Streamlined Operations: Automation significantly reduced resource demands. Contract maintenance required 30-40% less effort, and negotiations were completed faster, easing administrative burdens.
- Enhanced Payment Accuracy and Trust: With Monitor Mode, users could assess edit impacts in real time. This transparency minimized disputes and fostered stronger provider relationships.
Looking Ahead: Building on Success
The health plan is committed to expanding its use of Source, transitioning more operations to the platform. By staying aligned with industry changes and leveraging regular updates, they aim to ensure sustained efficiency and long-term growth.
