Medicare Advantage

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.

Infographic: The History of HealthEdge Source™ The Payment Accountability® Platform

Experts in managing complex CMS data for over 25 years. Partnering with top payers for 10+ years.

eBook: CMS Transparency in Coverage Rule

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

Data Sheet: HealthEdge Source — Data Reference Module

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.

Data Sheet: Navigating the No Surprises Act - The Right Tools for Health Plan Success

The No Surprises Act (NSA) marks a significant regulatory milestone aimed at protecting consumers from surprise medical bills and enhancing transparency in healthcare.

Data Sheet: Configuration as a Service Expedites Time-to-Value for Health Plans

HealthEdge's Configuration as a Service optimizes HealthRules® Payer system configurations, accelerating time-to-value for health plans.

Data Sheet: HealthEdge Source - Software for Health Plans With Home & Host Capabilities

HealthEdge Source™ is a cloud-based solution designed to enhance payment accuracy and integrity for health plans with home & host capabilities.

Brochure: Value-Based Care - Health Plans With Home & Host Capabilities Are Market Leaders

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.

Data Sheet: HealthRules Payer for Plans with Home & Host Capabilities

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.

Data Sheet: Platform Access Delivers a Transformative Approach to Payment Integrity

Data Sheet: Optimize Payment Accuracy with History-Based Editing

As more contracts and policies shift toward value-based care and billing requirements, evolve, the opportunities for inaccurate payments increase...

Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report (PDF)

HealthRules Payer has been named “Best in KLAS” by KLAS Research for Claims & Administration Platforms for the second year in a row.

Data Sheet: Point-of-Service Payment System Success - Integrated Ecosystems (PDF)

Traditional claims systems are often fragmented and inefficient, leading to significant errors and unnecessary operational costs.

Data Sheet: Cloud-Based Data Delivery in Healthcare — Point-of-Service Payment Success Path

In today's healthcare landscape, the complexity and inefficiencies of payment systems are a common source of frustration for patients, providers, and payers alike.