HealthEdge AI

How NorthWinds Technology Solutions Reached 90% Auto-Adjudication with HealthRules® Payer AI 

Efficiencies in claims processing is a direct driver of cost management, member satisfaction, and competitive positioning. NorthWinds Technology Solutions leadership understood this when they made...

Podcast: Current Trends for Payers - Call Centers in the Age of AI

AI in Healthcare: Why Regulatory Momentum Is a Wake-Up Call for Health Plans 

Artificial intelligence (AI) is no longer a future consideration for health plans. AI-powered tools are already reshaping how organizations operate, how members seek information, and how leaders...

HealthEdge® Partners with Ellipsis Health to Scale Care Management Through AI-Powered Virtual Nursing

Partnership brings autonomous, voice-based member outreach to health plans, to improve efficiency, member engagement and population health outcomes

Ethical AI: Privacy and Security

This is part 1 of a blog series on Ethical AI. This content was adapted from an internal learning and development session developed by HealthEdge’s AI team, focused on educating our organization...

Building Trust in AI: A Guide to LLM Evaluations 

Large language models (LLMs) are inherently probabilistic, meaning the same input can produce different outputs. That variability makes traditional unit tests, which verify exact results,...

Building Trust in LLM Solutions: A Practical Guide to Evaluation Planning 

Artificial intelligence (AI) is fundamentally changing how healthcare software is built. From automated test case generation to intelligent documentation and decision support, large language...

AI in 2026: Are Health Plans and Members Aligned on the Future? 

Health plans are racing ahead with artificial intelligence (AI). Members are moving more cautiously. In 2026, the question is no longer whether AI will shape healthcare. It’s whether payers and...

HealthEdge GuidingCare Launches Decision Intelligence Ecosystem with Anterior, Latitude Health and Case Health AI

Integrations with leading clinical AI solutions give health plans access to best-in-class decision-making capabilities to transform utilization management

How AI-Powered Document Processing Transforms Provider Data Management

At HealthEdge®, our team understands that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate...

Unlocking the Future of Healthcare Technology: Interoperability, Transparency, and AI

At a recent executive roundtable, HealthEdge® brought together health plan leaders from across the U.S. to share their experiences and see how other organizations are addressing key challenges....

Turning Unstructured Healthcare Data into Answers with Retrieval Augmented Generation

Care teams, product managers, and operations leaders across healthcare live inside documents: contracts, benefit summaries, clinical policies, internal runbooks, and email threads. These artifacts...

HealthEdge® and Suki Introduce Ambient Clinical Intelligence for Care Management

HealthEdge®, the technology and services company powering health plans’ most important value streams, and Suki, a leading provider of artificial intelligence (AI) technology for healthcare, today anno

From Simple Tools to Smart Orchestration: How AI Agents Are Transforming Work 

Imagine this scenario: A critical exception fires in your company’s observability tool. Someone needs to check the logs, categorize the severity, and create a defect in the systems’ project...

The Manual Entry Bottleneck: How AI-Powered Document Processing Transforms Provider Data Management

At HealthEdge®, we understand that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate provider...