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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Navigating the complexities of Medicare claims is increasingly challenging due to constantly evolving reimbursement policies and fee schedules.
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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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HealthEdge Source™ is a cloud-based solution designed to enhance payment accuracy and integrity for health plans with home & host capabilities.
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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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Health plans must quickly and effectively react to the latest regulatory shifts, competitive pressures, opportunities for expansion, large-scale public health...
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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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SummaCare has embarked on a significant digital transformation to improve operations and enhance customer engagement.
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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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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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Traditional claims systems are often fragmented and inefficient, leading to significant errors and unnecessary operational costs.
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