Data Sheet: HealthEdge Source™ Medicaid - Arizona
A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
Navigating the complexities of state-specific reimbursement requires a sophisticated, data-driven approach. HealthEdge Source provides a premier Arizona Medicaid payment integrity solution designed to manage accurate and compliant pricing data so health plans don't have to. By automating the maintenance of fee schedules and payment policies, Source empowers payers to streamline operations, ensure regulatory excellence, and achieve strategic cost management.
Arizona-Specific Expertise and Innovation
Source leverages a cloud-supported infrastructure and a single API to improve time-to-value, delivering a comprehensive suite of tools tailored specifically for the Arizona Health Care Cost Containment System (AHCCCS).
- 10+ years of experience providing specialized Medicaid support to Arizona clients.
- Comprehensive content delivery covering state-specific fee schedules and payment policies across a wide range of facility and professional provider types.
- Automated policy updates delivered every two weeks by Source Subject Matter Experts (SMEs), removing the need for internal IT maintenance.
- Advanced customization for complex payment arrangements, including the unique Differential Adjusted Payment (DAP), which Source can apply before or after "lesser of" calculations based on business needs.
Proven Operational Impact
With CMS estimating $132 billion in annual improper payments—over 60% of which stem from Medicaid programs—Source enables health plans to pay claims accurately and quickly. Our solution drives measurable ROI and operational efficiency:
- 40% reduction in claims needing to be re-keyed due to improved workflow.
- 5-8% of total claims identified with inaccuracies are corrected.
- 25% time savings over previous legacy processes.
- $5 in savings per identified claim resulting from improved accuracy.
Comprehensive Service Coverage
Source serves as a single source of truth for fee schedules and pricing formulas, covering a broad spectrum of Arizona Medicaid facilities and services, including:
- Ambulance and Ambulatory Surgery Center (ASC)
- Inpatient, Outpatient, and Professional Services
- Nursing Facility (NF), Hospice, and Home Health
- Medicaid fee-for-service pricing formulas and National Medicaid NCCI edits
By integrating this prospective Arizona Medicaid payment integrity solution, health plans can eliminate transparency barriers for audit and provider relations while securing a competitive advantage in a complex regulatory environment.
