Infographic: Optimize Your Workflow and Maximize Savings with Integrated Secondary Editing for HealthRules® Payer

Optimize Claims Accuracy with Integrated Secondary Editing

In the current healthcare landscape, payers face significant challenges in ensuring payment integrity due to fragmented systems, manual workflows, and data silos. The HealthEdge Payer-Source solution addresses these inefficiencies by integrating HealthEdge Source™ advanced secondary editing directly into the HealthRules® Payer platform. This seamless API data exchange empowers health plans to automate decisions, reduce overpayments, and achieve substantial cost savings.

Key Benefits of Payer-Source Secondary Editing:

• Enhance claims accuracy and quality with comprehensive edits.
• Simplify maintenance and cut costs for rules updates.
• Minimize overpayments via seamless, up-to-date workflows.
• Strengthen provider relations with clear audit trails.
• Detect fraud, waste, and abuse more effectively.
• Leverage analytics and centralized data for smarter insights.
• Automate decisions to pay, pend, or deny claims.

Business Impact by the Numbers:

• National Health Plan: 1.1% in incremental savings, or $8.7M in opportunity on 51M Claims.
• Regional Medicaid Plan: savings, or $9.1 M in opportunity on 2.1M claims.
• Regional Medicare Advantage Plan: 1.6% in incremental savings, or $11.1 M in opportunity on 1.7M claims.

Strategic Value Proposition:

By placing HealthEdge Source as a real-time secondary editor within the payment workflow, organizations create a single source of truth for pricing and editing. This approach not only enhances payment integrity through history-enabled editing but also strengthens provider relations via clear audit trails.