eBook: Path to Payment Integrity: A Story of Innovation and Impact

HealthEdge Source helps health plans ditch outdated payment recovery methods and switch to a smarter, data-driven approach, fostering long-term operational efficiency, cost savings, and improved relationships with stakeholders. While the story within the eBook is fictional, it reflects the very real challenges health plans face and demonstrates how innovative solutions can drive transformative change.

Key Challenges Faced by Health Plans

Health plans often struggle with fragmented vendor systems, rising recovery costs, excessive manual rework, inefficient processes, and strained provider partnerships. These common pain points lead to high error rates, financial leakage, and decreasing member satisfaction.

Transforming Payment Integrity with Proactive Solutions

The story illustrates the pivotal shift from “pay-and-chase” methodologies to a prospective approach. HealthEdge Source uses a unified, cloud-based platform that integrates claims editing, pricing, and analytics in real time. This innovative solution eliminates redundancies, ensures accuracy, and sets the stage for smarter, more efficient claims management.

Proven Outcomes

The fictional health plan’s story highlights the outcomes achievable with HealthEdge Source:

• Significant cost savings, reduced administrative overhead, and decreased dependence on third-party recovery vendors.
• Improved claims accuracy, streamlined workflows, and faster issue resolution.
• Strengthened provider trust with fewer retroactive adjustments and transparent processes.
• Elevated Star ratings and better service experiences for members.

While the story illustrates potential results, HealthEdge Source provides real-world solutions designed to help today’s health plans not only tackle existing inefficiencies, but also adapt proactively to the evolving landscape of the healthcare industry. Discover how HealthEdge Source can support your health plan.