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What does it take to pay a claim correctly? In healthcare, “editing claims” goes beyond surface-level checks—it’s about ensuring accuracy, compliance, and efficiency. Each claim must align with...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreIn our "Path to Payment Integrity" webinar, we discussed the biggest challenges in claims payment accuracy, including complex regulations, reliance on recovery vendors, high administrative costs, and
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"All of our pricing and editing is a one stop shop"
- Melissa Rusk, VP of Operations, SummaCare
Join us to get up to speed on key release features and give your input on new and ongoing product updates.
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For health plans, payment errors and discrepancies aren’t just frustrating—they can be costly. Without access to updated pricing information, health plans face payment delays and inaccuracies that...
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To stay ahead of complex payment models and billing guidelines, healthcare payers are turning to integrated digital solutions that can help streamline operations to achieve key business goals....
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Health plans face a variety of challenges when it comes to contract modeling, negotiations, and reviews. A reliance on manual processes and disparate tools can make it difficult to accurately...
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Health plan executives are pursuing integrated platform solutions that provide better access to data, leading to better member outcomes.
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Learn about SummaCare's journey to streamlined operations, improved payment accuracy, and enhanced provider transparency.
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Discover how one health plan enhanced efficiency, accuracy, and transparency through with HealthEdge Source.
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The healthcare industry has long been a primary target for cyberattacks due to the vast amount of sensitive data it handles. The increasing prevalence of cyber incidents, combined with...
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Health plans often face challenges during contract negotiations due to disparate data sources, complex configurations, and manual processes. The reliance on estimates rather than precise data can lead
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Explore key priorities, investments, and challenges facing health plan executives in the coming year.
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Artificial Intelligence (AI) is transforming payment integrity in the health insurance industry, particularly in detecting and preventing fraudulent payments and waste. As fraudulent claims become...
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Health plan administrators must adhere to the complex guidelines related to payment integrity, operational efficiency, and regulatory compliance. The claims process is intricate, and the sheer...
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Healthcare regulations continue to evolve, reshaping how health plans operate and do business in a competitive market. Amid rising costs and regulatory pressures, healthcare fraud prevention is...
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HealthEdge Source™ (Source) is a cloud-based solution designed to revolutionize payment accuracy and integrity in the healthcare industry.
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