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.
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Health plan executives are pursuing integrated platform solutions that provide better access to data, leading to better member outcomes.
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Many health plans continue to rely on legacy Core Administrative Processing Systems (CAPS) as the backbone for managing critical operations such as claims processing, benefit configuration, and...
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As the environment for health plans evolves rapidly, now is the time to modernize CAPS to enhance your ability to compete for members, improve effciencies, and maintain compliance.
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In the swiftly evolving landscape of healthcare, staying ahead demands not just understanding the market but redefining the competition. For health plan leaders, navigating these waters involves a...
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HealthEdge had the opportunity to sit down with Presbyterian Health Plan leadership to learn more about why their organization decided to make the switch to HealthRules Payer as it's CAPS partner.
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Experts in managing complex CMS data for over 25 years. Partnering with top payers for 10+ years.
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The Transparency in Coverage Guide (CMS-9915-F) is a pivotal regulation aimed at increasing transparency in healthcare pricing, enabling consumers to access price information before receiving services
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The No Surprises Act (NSA) marks a significant regulatory milestone aimed at protecting consumers from surprise medical bills and enhancing transparency in healthcare.
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Achieving regulatory compliance in the healthcare industry is a complex and evolving challenge, particularly with mandates such as the Transparency in Coverage (TIC) Final Rule and the No Surprises Ac
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In the fast-paced world of healthcare, the management of payment integrity initiatives has emerged as a critical challenge for payers. The increasing complexities of healthcare claims have led to...
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HealthEdge's Configuration as a Service optimizes HealthRules® Payer system configurations, accelerating time-to-value for health plans.
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HealthEdge Source™ is a cloud-based solution designed to enhance payment accuracy and integrity for health plans with home & host capabilities.
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In our work with HealthRules® Payer clients, we have gained first-hand experience, supporting these plans with the technology they need to lead value-based care and healthcare transformation.
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As more contracts and policies shift toward value-based care and billing requirements, evolve, the opportunities for inaccurate payments increase...
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The case study highlights the value of pricing & editing using Source, a comprehensive platform that has streamlined vendor solutions for Medicare Advantage employer groups and commercial claims.
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SummaCare Health Plan, based in Akron, Ohio, is a provider-owned health plan with around 62,000 members.
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HealthRules Payer has been named “Best in KLAS” by KLAS Research for Claims & Administration Platforms for the second year in a row.
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Traditional claims systems are often fragmented and inefficient, leading to significant errors and unnecessary operational costs.
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In today's healthcare landscape, the complexity and inefficiencies of payment systems are a common source of frustration for patients, providers, and payers alike.
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