Risk adjustment programs are entering a new phase of maturity. Historically, health plans approached Medicare Advantage risk adjustment retroactively, reviewing charts after...
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Health plans often struggle to achieve performance goals due to limited resources, which can restrict their ability to execute critical quality improvement initiatives.
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Part 2 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In the first...
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When a health plan undertakes a major technology change, whether implementing a new platform, modernizing a legacy system, or rolling out new functionality, the promise is compelling: streamlined...
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At a recent roundtable, the HealthEdge® Chief Medical Officer led executives from three leading health plans in a discussion centered around optimizing care delivery and...
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Payment integrity has always played a critical role in payer operations, but in 2026, it has become a strategic imperative. According to the HealthEdge® 2026 Annual Payer Survey, health plan...
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At HealthEdge®, our team understands that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate...
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At a recent executive roundtable, HealthEdge® brought together health plan leaders from across the U.S. to share their experiences and see how other organizations are addressing key challenges....
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Discover how HealthEdge Care Solutions leverages advanced AI to streamline workflows, enhance care management, and deliver measurable outcomes for health plans and their members.
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A connected ecosystem powered by consolidated data offers a transformative solution for health plans looking to streamline operations, reduce costs, and improve member experience.
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HealthEdge Source™ earned the 2026 Best in KLAS Awards: Software and Services as the leader in “Pre-Payment Accuracy & Integrity Solutions (Payer)”—with an overall score 8% higher than its...
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Industry pressures like regulatory complexity and the shift toward value-based care demand that health plans take an integrated, strategic approach to care management. Whether payers are...
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Care teams, product managers, and operations leaders across healthcare live inside documents: contracts, benefit summaries, clinical policies, internal runbooks, and email threads. These artifacts...
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The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower...
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Sutter Health Partners with HealthEdge to Centralize Provider Data, Enhance Data Quality, and Build a Scalable Foundation for Future Growth
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At HealthEdge®, we understand that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate provider...
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Positioning Health Plans for the Future: Elevate Prior Authorization Efficiency, Accuracy, and Compliance with HealthEdge GuidingCare
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Expert Guidance to Solve Operational Challenges, Optimize Performance, and Move Your Business Forward
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Provider data management systems of record are being evolved by healthcare payers that want to automate workflow, solidify data, & enable flexibility in their back office to reduce operational costs.
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Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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