Case Study: Large Regional Health Plan Achieves Scalable Success with HealthEdge Source™ Services
The HealthEdge Source Professional Services team supported a large regional health plan with their claims process and scaled their operations to meet growing demands.
A large regional health plan worked with HealthEdge Source™ Professional Services to address roadblocks in claims processing, regulatory compliance, and contract management.
Key challenges
- High-volume claims: The plan managed a growing number of claims, causing backlogs and payment delays.
- Regulatory compliance: Keeping up with frequent regulations and avoiding penalties for a large volume was difficult.
- Contract management: Updating and maintaining many provider contracts was time-consuming.
Support from HealthEdge Source
HealthEdge Soure provided tailored support to this health plan by:
- Seamlessly transitioned the system to HealthEdge Source, ensuring contract information stayed current.
- Provided detailed training and documentation to help users adopt the new system quickly.
- Assigned subject-matter-expert to support ongoing regulatory updates and day-to-day questions.
- Regularly updated the team with bi-weekly releases relevant to the plan, listing priorities and next steps.
Results
With the support of HealthEdge, they efficiently manage day-to-day operations and adapt to increasing transaction volumes. This approach allows the team to streamline workflows and scale their processes without sacrificing accuracy or responsiveness.
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