Lines of Business

eBooks: Challenging Reimbursement in Healthcare Claims Payments With Source

When it comes to handling reimbursement, dealing with incorrect payments caused by inaccessible pricing data and disjointed payment solutions can be a significant issue.

Data Sheet: Source Claims Modeling

HealthEdge Source™ (Source) contract modeling solution empowers health plans to leverage modeling of historical claims data.

Data Sheet: GuidingCare Medication Therapy Management

The Importance of Medication Therapy Management

Data Sheet: GuidingCare Utilization Management

Data Sheet: HealthRules Payer + Source Integration

Case Study: AmeriHealth Administrators

With market dynamics impacting health plans dramatically, the one-size-fits-all-approach no longer works.

Data Sheet: GuidingCare Appeals & Grievances

Meet Regulatory demands and ensure compliance with GuidingCare Appeals & Grievance.

White Paper: Secondary Editing Platform

eBooks: 5 Steps to a Successful CAPS Implementation

Implementing a Core Administrative Processing System (CAPS) can revolutionize a health plan's ability to adapt to emerging payment models, design new benefit plans, and compete effectively...

Infographic: HealthRules Payer Implementation

Implementing HealthRules® Payer software necessitates a meticulously planned and efficiently executed program.

Data Sheet: Source Editing

Improving accuracy, transparency, and consistency drives extreme efficiencies

Case Study: McLaren Health Plan

For McLaren Health Plan, outdated 30-year-old technology was resulting in a zero percent claims auto-adjudication rate, after switching to HealthRules Payer they are now exceeding 90 percent.

White Paper: Payment Integrity Medicaid

The intricacies and variability of state-by-state Medicaid regulations are presenting significant challenges for health plan executives, who must continually adapt to the latest Medicaid payment...

Brochure: Prospective Payment Integrity

Case Study: Medicaid & Duals

A top-15 insurance company with over 5 million members aimed to expand its government business, streamline operations, and explore new models.

Case Study: Large, National Health Insurer

A leading national health insurer, already ranked among the top 15 insurance companies with over 6 million members, set out on an ambitious growth plan.

Case Study: Independent Health

Paying for value continues to gain momentum in the industry. This presents significant challenges, and interesting opportunities, for health plans.