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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Rising costs. Relentless regulation. For health plans, the question isn’t whether these pressures are intensifying. It’s how to respond. According to new research from HealthEdge®, these twin...
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The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower...
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As regulatory and quality expectations intensify, the National Committee for Quality Assurance (NCQA) vendor certification offers health plans a trusted signal that their technology partners can...
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When state regulations change, health plans must be ready to respond—particularly when those changes impact core Medicaid services. That was the case in 2025 when the State of Texas mandated...
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HealthEdge’s GuidingCare® platform is at the forefront of enabling healthcare interoperability. By combining deep technical expertise with a visionary approach, GuidingCare equips health...
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In today’s evolving healthcare landscape, understanding what members want and need is more important than ever. To uncover those insights, HealthEdge conducted its 2025 Healthcare Consumer Study,...
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Health plans serving dual-eligible populations face significant regulatory changes from the Centers for Medicare & Medicaid Services (CMS). The 2027 D-SNP requirements introduce significant...
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The Centers for Medicare & Medicaid Services (CMS) has raised performance benchmarks for Medicare Advantage (MA) and Part D plans, raising the bar for achieving high Star Ratings. By excluding the...
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HealthEdge Source™ is a cloud-based platform for healthcare claims management. It combines claims pricing, editing, and analytics in one system for Medicare, Medicaid, and Commercial claims. All prici
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A strategy to comply with the final rule issued by the U.S. Centers for Medicare & Medicaid Services suggests that payers should unify systems around their core claims and care management platforms...
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Motivating Medicare members to take action to improve their health is a high priority for health plans. Empowering behavior change improves health outcomes among members, builds trust and loyalty, and
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HealthEdge’s Regulatory Compliance Manager Maggie Brown and VP of Sales Solutions Diane Pascot recently addressed a large audience of AHIP members on an AHIP webinar that focused specifically on...
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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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Navigating the complexities of Medicare claims is increasingly challenging due to constantly evolving reimbursement policies and fee schedules.
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The Medicare Benchmarking tool in HealthEdge Source™ Analytics offers health plans a robust way to compare their lines of business against Medicare benchmarks.
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