Data Sheet: HealthEdge Source - Medicare Reimbursement
Getting Medicare Reimbursement Right with HealthEdge Source™
Medicare reimbursements can be complex and often inaccurate, with Gartner® reporting that 3-7% of all healthcare claims are paid inaccurately. HealthEdge's prospective payment integrity solution, HealthEdge Source (Source), automates compliance with Medicare reimbursement pricing and payment policies, ensuring claims are priced accurately from the start.
Key Features of HealthEdge Source:
- Single Solution Integration: Source consolidates policy edits, pricing algorithms, and rate schedules from various sources into one comprehensive solution.
- Comprehensive Coverage: It covers all Medicare provider types, including inpatient, professional, outpatient, and post-acute care.
- Advanced Medicare Groupers & Pricers: Includes MS-DRG Groupers, APC Groupers, and critical access among others.
- Medicare Policy Edits: Incorporates edits for Medicare NCCI PTP, Outpatient Code Editor (OCE), and other payment policies to ensure compliance and accuracy.
Benefits of Using HealthEdge Source:
- Automated Claim Processing: Real-time triage and reconciliation of claims editing and pricing results.
- Efficiency and Cost Savings: Reduces internal costs by eliminating the need for manual workflow connection points and managing multiple updates.
- Advanced Audit Capabilities: Captures comprehensive records of each edit and pricing methodology, improving transparency and support for member and provider inquiries.
- Cloud-Hosted Security: HealthEdge Source ensures continuous updates every two weeks and uses HITRUST-certified hosting for enhanced data security.
Why HealthEdge Source Stands Out:
- True Payment Accountability: Recognized by KLAS in the Emerging Solutions Spotlight 2023 for its bi-weekly updates, visibility into results, and client satisfaction.
- Interoperability: Natively supports interoperability between all claims editing, pricing, and business intelligence reporting systems.
HealthEdge Source is designed to handle all lines of business and seamlessly connect to all core administrative processing systems, making it a crucial tool for ensuring efficiency, data management, and competitive advantage in the healthcare industry.
