HealthEdge Source

HealthEdge and Gynisus Bring AI-Powered Clinical Precision to Payment Integrity

Proven Agentic AI Model Powered by Gynisus Adds Speed and Accuracy to Adjudicating Claims for Coding Errors, Clinical Integrity and Medical Necessity

See how over 450 health plan leaders are preparing for 2025!

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White Paper: Position Your Health Plan for Long-Term Success with Payment Integrity

"All of our pricing and editing is a one stop shop"

- Melissa Rusk, VP of Operations, SummaCare

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5 Common Barriers to Efficient Claims Management for Health Plans

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...

Webinar: Path to Payment Integrity - Enhance Payment Accuracy with HealthEdge Source™ Editing

In 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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Expanding Payment Integrity Through Seamless Integrations | HealthEdge Source™ Third-Party Ecosystem

Improve Visibility and Control Over Claims Processes with Platform Access from HealthEdge Source™

If you’re responsible for managing a health plan, you’ve probably felt the strain of payment processes that don’t work as they should. Payment errors pile up, outdated systems slow you down, and...

3 Benefits of a Third-Party Payment Integrity Ecosystem

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...

Set the Bar for Payment Integrity with Enterprise Payment Accountability

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....

Streamline Healthcare Contract Negotiations and Reviews with HealthEdge Source™ What-If Modeling

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...

Case Study: How One Regional Health Plan Created a Member-Centric Digital Ecosystem

Health plan executives are pursuing integrated platform solutions that provide better access to data, leading to better member outcomes.

Case Study: SummaCare's Secret to Payment Integrity Success

Learn about SummaCare's journey to streamlined operations, improved payment accuracy, and enhanced provider transparency.

Case Study:Transforming Payment Accuracy and Operational Efficiency at a Large National Health Plan

Discover how one health plan enhanced efficiency, accuracy, and transparency through with HealthEdge Source.

Infographic: Top 5 Payment Integrity Trends

Improve Data Security & Compliance with a Prospective Payment Integrity System

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...

Webinar: Transform Contract Negotiations with Data-Driven Insights

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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Infographic: HealthEdge Annual Planning Report 2025

Explore key priorities, investments, and challenges facing health plan executives in the coming year.

Top 6 AI Trends in Payment Integrity for Detecting and Preventing Fraudulent and Inaccurate Claims Payments

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...