Data Sheet: Redefining Payment Integrity with HealthEdge Source™ Platform Access

HealthEdge Source™ Platform Access is designed to address the critical pain points health plans face in claims processing and payment accuracy. Traditional systems often rely on fragmented, siloed processes involving primary editors, secondary editors, and post-pay audits. This setup leads to inefficiencies, inflated operating costs, and strained provider relationships. HealthEdge Source simplifies and unifies these processes, allowing health plans to reimagine their payment integrity strategy through a smart, cohesive approach.

Key Benefits for Health Plans

Proactive Payment Accuracy

Unlike legacy systems focused on post-payment recovery, HealthEdge Source moves edits and validations upstream, offering pre-adjudication and pre-payment capabilities. This means errors are caught before claims are paid significantly reducing the need for recoupment efforts.

Integrated and Reliable Functionality

By consolidating primary and secondary editing with pricing processes, the platform ensures consistent configuration across all claims. This eliminates errors caused by misaligned systems and keeps updates synchronized across the board.

Cost Efficiency Through Automation

The solution eliminates unnecessary manual reviews and reduces vendor dependency. The result? Dramatic reductions in administrative costs, often by hundreds of thousands annually, and improved resource allocation for strategic initiatives.

Customizable Tools for Flexibility

Health plans can easily implement custom rules through Advanced Custom Editing to address specific challenges, such as contract-related nuances or recurring inefficiencies. This level of personalization ensures the platform adapts to the unique needs of each organization.

Improved Provider Relationships

Fewer errors and reduced manual rework foster trust, improve collaboration, and strengthen long-term partnerships with providers.

Real-Time Analytics for Better Decision-Making

With robust, real-time reporting and historical data insights, users can monitor performance and model payment configurations before activation. This transparency drives operational improvement without disrupting workflows.

By adopting HealthEdge Source™ Platform Access, your health plan will not only resolve current inefficiencies, but also gain a competitive edge in an evolving healthcare landscape. Take control of your payment processes today and experience lasting improvements in accuracy, efficiency, and collaboration.