HealthEdge Source™ Horizons: How Payment Integrity Innovation Helps Expand New Business Opportunities

Healthcare payers are adopting flexible, scalable digital solutions to meet market demands and grow membership. HealthEdge Source™ is designed to help health plans win new business opportunities through payment integrity innovation.

Our five-part blog series, HealthEdge Source™ Horizons, highlights how our payment integrity solution helps healthcare payers achieve their organizational goals.

Read the entire series at the links below: 

• Improve Payment Accuracy and Efficiency with Advanced Automation
• Ensure Regulatory Compliance & Cost Transparency
• How Payment Integrity Innovation Helps Expand New Business Opportunities 
• Simplifying Value-Based Care Contracts & Reimbursements
• Increase Member Engagement & Build Trust with Cost Transparency

Stay Ahead of Industry Changes with a Flexible Payment Solution

The healthcare landscape is in constant flux, with new regulations, shifting reimbursement models, and technological breakthroughs. To stay competitive, health plans need to be adaptable. A flexible payment solution can help you adapt to new regulations, seamlessly integrate systems, and scale into new markets —all while providing valuable data for continuous improvement.

HealthEdge Source offers a platform that gives your organization control of claims payment workflows to reduce dependency on third-party vendors. The solution also delivers unified data that allows for real-time business decisions, enhancing efficiency and improving transparency. This integrated digital solution helps prevent inaccurate payments and resource wastage by ensuring claims are paid correctly the first time.

Support All Claims Systems and Provider Types with a Single API

Payer IT ecosystems can be a patchwork of different systems and providers. This kind of internal fragmentation can make it challenging for payers to properly scale their solutions and expand into new markets. HealthEdge Source simplifies this process with a single application programming interface (API) that can connect with any claims systems and support all provider types:

• Unified Access: One gateway for pricing, editing, and analytics. No more interface juggling – it’s all here.
• Cloud-Based Efficiency: Our solution was built to support cloud-based delivery—unlike many of our competitors—keeping you up-to-date on compliance and improving accuracy.
• Seamless Integration: Connect to your claims systems through a single instance, streamlining your workflow and eliminating integration headaches.
• Automated Third-Party Connections: Gain access to the latest industry edits through automated connections.

Easily Create and Customize Contract Configurations with Rules Management Synchronization

Complex contract configurations are often bottlenecks to health plan growth. Different lines of business (LOBs) often have unique contract needs, resulting in numerous configurations that demand time and resources. HealthEdge Source cuts through the clutter with a user-friendly solution that simplifies and streamlines configuration management to facilitate your market expansion journey.

Effortless Configuration, Exceptional Results:

• Easy Setup: Remove redundancy with one configuration layer for edits and pricing, freeing you to focus on growth.
• Consistent Results: Shared business rules ensure consistency and compliance, with customization options for specific needs.
• User-Friendly Customization: Create and adjust contract settings easily with an accessible interface.
• Pre-Production Powerhouse: Model new contracts in a test environment before launch, guaranteeing a smooth transition.

HealthEdge Source goes beyond basic configuration. It’s a comprehensive solution that optimizes your claims processes through an emphasis on payment integrity innovation.

Scale Your Organization’s Growth, Agility, and Transformation

HealthEdge Source isn’t just built for today’s needs—it anticipates tomorrow’s challenges. Whether your organization is focusing on the commercial sector, government programs, or niche markets, the payment integrity solution can adapt to support your growth.

• Simplified Workflow: One solution handles pricing, editing, and contract configuration to help your health plan quickly resolve payment integrity issues.
• Reduced Maintenance, Increased Efficiency: Bi-weekly updates ensure minimal maintenance when contract terms evolve.
• Enhanced Analytics: Get valuable insights from a unified source. Model and analyze data to conduct “what-if” scenarios on contract changes to negotiate better contracts and confidently enter new markets.
• Compliance Confidence: Transparency and a single workflow lead to improved compliance through enhanced detection and resolution of issues. Focus on delivering exceptional care, knowing your payment integrity is in good hands.

Your organization doesn’t have to turn to disruptive “rip-and-replace” solutions. HealthEdge Source offers a platform access approach that seamlessly integrates with your existing workflow, empowering you with a smooth onboarding process and the ability to scale up as your needs evolve. Our approach ensures your solution grows with you, meeting your needs today and well into the future. With HealthEdge Source, you can embrace a future-proof solution that empowers your confident growth in any market.

Access Comprehensive Support for Medicaid Reimbursement 

Medicaid is a significant segment of the healthcare landscape, and HealthEdge Source can support your reimbursement needs across 19 states (and counting). We go beyond typical inpatient and outpatient Medicaid pricing and payment policies to deliver content that is automatically updated on time to ensure adherence and accuracy.

Investing in HealthEdge Source for Medicaid unlocks several benefits for your health plan:

• Boost Efficiency: No more manual tasks like research and vendor management. HealthEdge Source streamlines your processes so you can focus on what matters.
• Ensure Accuracy: Our thorough Medicaid edits and contract configurations mean fewer mistakes.
• Speedy Payments: 12% of claims are stuck in accounts receivable for longer than 120 days. With Source real-time editing and pricing, claims get processed faster, keeping your members and providers happy.
• Audit Confidence: Stay audit-ready with frequent updates and a robust audit trail. With HealthEdge Source, you’re prepared for anything.

Your Launchpad for Growth in Healthcare

HealthEdge Source empowers you to conquer new markets, seamlessly configure for diverse needs, and navigate change with agility. Our dedication to payment integrity innovation empowers health plans like yours to streamline workflows, optimize efficiency, and reduce administrative burdens – all while delivering exceptional care.

HealthEdge Source isn’t just a payment integrity solution; we’re your trusted partner in driving digital transformation, streamlining automation, and delivering real-time insights. Let’s unlock the potential of your organization – together.

Want to learn more about how your health plan can access valuable analytics and increase transparency? Read our blog, “The Shift to Payment Accountability®: An Enterprise Approach to Healthcare Payment Integrity.”