Real-Time Data

Current Trends For Payers - From Siloes to Synergy: The Power of a Data Hub

Closing the Gap: Leveraging Hybrid Records to Propel Medicare Advantage Plans to 5 Stars

Achieving a 4.5-Star rating is a major accomplishment for any Medicare Advantage health plan. But moving from 4.5 to 5 Stars is a different challenge altogether. Only a small percentage of plans...

Is Your Health Plan Ready for Touchless Claims Processing?

Is Your Health Plan Ready for Touchless Claims Processing? The pace of change in healthcare continues to accelerate. Don’t let outdated technology keep your organization from seizing new...

RISE National 2026: A Turning Point for Risk Adjustment—and the Work Ahead 

This year marked the 20th anniversary of the RISE National Conference, but the milestone felt less like a retrospective and more like a clear signal of where health plan risk adjustment is heading...

Real-Time Risk Adjustment in 2026: Modernizing Medicare Advantage Programs

Risk adjustment programs are entering a new phase of maturity. Historically, health plans approached Medicare Advantage risk adjustment retroactively, reviewing charts after...

Executive Discussion: Adopting an Ecosystem Operating Model and Measuring ROI 

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...

Preparing for Software Testing: 8 Best Practices for Health Plans 

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...

6 Executive Strategies for Optimizing Care Coordination and Delivery 

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...

7 Payment Integrity Trends Health Plans Can’t Afford to Ignore in 2026 

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...

How AI-Powered Document Processing Transforms Provider Data Management

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...

Unlocking the Future of Healthcare Technology: Interoperability, Transparency, and AI

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....

Setting the Standard for Payment Integrity: HealthEdge Source™ Named Best in KLAS 

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...