Brochure: HealthEdge AI-Powered Operational Infrastructure - Unlock the Full Value of HealthRules® Payer
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Legacy Systems
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Combat the Hidden Costs of Vendor Sprawl with Performance Management
Key Takeaways For health plans, managing multiple vendors can create compounding operational inefficiencies that inflate costs and impede decision-making. A single integrated technology...
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4 Ways Home and Host Plans Stay Ahead with Next-Generation CAPS
Health plans with home and host capabilities have set the standard for healthcare excellence since 1929—but mounting industry pressures constantly challenge these market leaders. Decreasing...
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Services Spotlight: Product Training is the Missing Link in Core System Implementations
When health plans modernize their core administrative systems, the conversation often centers on technology. Implementation timelines, configuration decisions, and integrations dominate planning...
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Executive Discussion: Adopting an Ecosystem Operating Model and Measuring ROI
Part 2 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In the first...
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Executive Discussion: Preparing for the Future of Care Management with an Integrated Operating Model
Part 1 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In this...
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Cut Administrative Costs Up to 40% With an Integrated Operating Model
For the second consecutive year, 52% of health plan executives named “managing rising costs” as the top challenge, according to the 2026 HealthEdge® Annual Payer Report. In the same survey, 85% of...
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Preparing for Software Testing: 8 Best Practices for Health Plans
When a health plan undertakes a major technology change, whether implementing a new platform, modernizing a legacy system, or rolling out new functionality, the promise is compelling: streamlined...
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Executive Strategies for Balancing Costs and Quality for Health Plans
At HealthEdge®, we strive to understand the key challenges health plans face so we can help anticipate and address new market opportunities. Recently, HealthEdge Chief Strategy Officer, Raj...
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Is Your Legacy Care Management System Holding You Back? 5 Signs to Make the Switch
In today’s rapidly evolving healthcare landscape, standing still isn’t an option. Health plans relying on legacy care management platforms, whether vendor-supported, homegrown, or heavily...
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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....
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Brochure: Five Signs You've Outgrown Your Legacy Admin Platform
Five signs your legacy platform is no longer serving you, and why a cloud-based solution might be exactly what you need.
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Case Study: Small Changes Lead to Big Impacts — A HealthEdge Case Study of BPaaS in Action
Choosing the right transformation partner is critical for health plans striving to achieve efficiency and excellence. The wrong vendor decision can lead to serious challenges.
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Setting the Standard for Payment Integrity: HealthEdge Source™ Named Best in KLAS
HealthEdge Source™ earned the 2026 Best in KLAS Awards: Software and Services as the leader in “Pre-Payment Accuracy & Integrity Solutions (Payer)”—with an overall score 8% higher than its...
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How BPaaS and Technology Modernization Answer the Call for Health Plans in 2026
As health plans face mounting cost pressures and an increasingly complex regulatory landscape, one thing has become clear: incremental change is no longer enough. Today’s health plan environment...
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From Guessing Game to Proactive Process: Simplify Edits with HealthEdge Source™
Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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Case Study: HealthRules Payer Case Study with Presbyterian
HealthEdge had the opportunity to sit down with Presbyterian Health Plan leadership to learn more about why their organization decided to make the switch to HealthRules Payer as it's CAPS partner.
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Data Sheet: Achieving Transparency Compliance Through HealthRules Payer
Achieving regulatory compliance in the healthcare industry is a complex and evolving challenge, particularly with mandates such as the Transparency in Coverage (TIC) Final Rule and the No Surprises Ac
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Infographic: Traditional Claims Editing Software vs. HealthEdge Source
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Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report
HealthRules Payer has been named “Best in KLAS” by KLAS Research for Claims & Administration Platforms for the second year in a row.
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