Data Sheet: Better Decisions in Healthcare Claims Processing Through Source Software Insights

Healthcare Claims Modeling with Source Analytics

Predicting the financial and operational impact of pricing edits and configuration changes in healthcare claims has been a long-standing challenge. HealthEdge’s payment integrity platform, HealthEdge Source (Source), offers a breakthrough solution through its Analytics module. This advanced business intelligence tool empowers health plans to eliminate guesswork, ensuring more accurate and efficient claims operations.

Key Features and Benefits

• Financial Impact Assessment: Source Analytics provides real-time insights into how edits affect the bottom line, enabling payers to review detailed financial impact reports.
• Monitor Mode: This feature allows for "what-if" scenarios by flagging standard or custom edits for monitoring without affecting actual production.
• Enterprise Benchmarking: By repricing every production claim against Medicare and Medicaid baselines, it offers comprehensive multi-dimensional reports.
• Live Production Metrics: Users gain a real-time, holistic view of claims operations, including claims volume and financial impacts, all accessible via a single dashboard.
• Batch Modeling: This feature allows historical claims data comparison, supporting provider network decision-making through system batch-imports from various sources.

Why Choose Source Analytics?

• Transparency and Optimization: Leaders can accurately assess the impact of changes before implementation, avoiding unnecessary overpayments and improving provider relations.
• Compliance and Efficiency: The platform reduces internal effort needed to manage and review results, proactively adapting to policy and rate changes.
• Comprehensive Data Integration: It utilizes the most accurate, complete, and up-to-date data, integrating both native and third-party claims data for optimal performance.

By leveraging HealthEdge’s Source Analytics, health plan leaders can make informed, strategic decisions, positioning their claims operations for enhanced efficiency and compliance. Discover how Source Analytics can transform your healthcare claims modeling today.