Data Sheet: HealthEdge Source™ - Medi-Cal Reimbursement
A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
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A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
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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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Experts in managing complex CMS data for over 25 years. Partnering with top payers for 10+ years.
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The Transparency in Coverage Guide (CMS-9915-F) is a pivotal regulation aimed at increasing transparency in healthcare pricing, enabling consumers to access price information before receiving services
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Data Reference, which can be accessed through your instance of Source, provides insight into any current or historical fee schedules, rates, payment policies, and provider-level data.
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The No Surprises Act (NSA) marks a significant regulatory milestone aimed at protecting consumers from surprise medical bills and enhancing transparency in healthcare.
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In the fast-paced world of healthcare, the management of payment integrity initiatives has emerged as a critical challenge for payers. The increasing complexities of healthcare claims have led to...
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HealthEdge's Configuration as a Service optimizes HealthRules® Payer system configurations, accelerating time-to-value for health plans.
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In our work with HealthRules® Payer clients, we have gained first-hand experience, supporting these plans with the technology they need to lead value-based care and healthcare transformation.
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Health plans with home and host capabilities have been leading the healthcare industry since 1929 and continue to hold strong with top industry rankings today.
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Managing members’ utilization of benefits is a complex and time-consuming, yet necessary task that often requires extensive human resources.
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Source deliveries in-depth MI Medicaid content that includes state-specific fee schedules and payment policies across a wide range of facility and professional provider types.
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As more contracts and policies shift toward value-based care and billing requirements, evolve, the opportunities for inaccurate payments increase...
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GuidingCare® delivers more than just software. The GuidingCare team brings unmatched clinical expertise to ensure your care management platform and programs truly advance clinical..
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New York represents one of the country’s largest populations of Medicaid beneficiaries, according to Medicaid.gov. Keeping up with the payment and policy updates that the New York State Department...
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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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