Data Sheet: HealthEdge Source™ Product Overview
HealthEdge Source™ (Source) is a cloud-based solution designed to revolutionize payment accuracy and integrity in the healthcare industry.
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Real-Time Data
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See how over 450 health plan leaders are preparing for 2025!
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Data Sheet: Optimize Efficiencies with Integrated HealthRules Payer Solutions
HealthRules® Payer is a next-generation core administrative processing system (CAPS) designed to revolutionize the operations of health plans of all sizes and types.
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Data Sheet: Wellframe Care Programs Overview
Our unparalleled portfolio of adaptable, mobile-optimized care programs are designed to support the whole person, uncover member insights, and trigger real-time alerts for the care team.
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Video: Care-Payer
HealthEdge's HealthRules® Payer and GuidingCare® Solutions are industry-leading standalone products in core claims administration and care management, respectively.
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Data Sheet: GuidingCare SDOH Integrations
Social Determinants of Health (SDOH) shape an estimated 40 percent of a person’s overall health.
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Video: Interoperability Must Haves - Part 1
To remain competitive, modern care management systems must efficiently access and share data across the entire healthcare IT ecosystem.
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Data Sheet: Configuration as a Service Expedites Time-to-Value for Health Plans
HealthEdge's Configuration as a Service optimizes HealthRules® Payer system configurations, accelerating time-to-value for health plans.
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Data Sheet: Member Travel Card & HealthRules Payer
Travel Card members enjoy peace of mind, knowing their healthcare is covered whether they are visiting their primary care doctor in their home neighborhood, traveling across the U.S. for business...
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Data Sheet: HealthRules Payer for Plans with Home & Host Capabilities
Health plans with home and host capabilities have been leading the healthcare industry since 1929 and continue to hold strong with top industry rankings today.
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Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report (PDF)
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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Data Sheet: GuidingCare Business Intelligence
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Data Sheet: What Sets Us Apart - Configure the Business
Implementation and maintenance of a new core administrative processing system (CAPS) traditionally requires highly skilled, well-trained Information Technology resources to interpret..
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Data Sheet: HealthRules Payer Best in KLAS Report
HealthRules Payer has been named “Best in KLAS” by KLAS Research for claims administrative processing system (CAPS). The designation is awarded by KLAS based on in-depth interviews with payers...
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Collaboration in a Competitive Marketplace
Is it possible? Can competitors also collaborate? Do they already? When is it acceptable? When does it push reasonable boundaries and when does it cross the line? This post will cover those...
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Stop Recurring Post-Payment Issues with an Open Book Approach to Payment Integrity
At HealthEdge, disrupting the status quo is part of who we are. When it comes to redefining payment integrity, we often think about it in terms of shifting from a black box to an open book...
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Gartner Reports Next-Gen CAPS Technology Will Be Standard By 2024
Unlike legacy systems, Next-Gen CAPS like those offered by HealthEdge integrate seamlessly with third-party applications, offering more interoperable data and workflows across payer or third-party...
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Why Prospective Payment Integrity Solutions Are Must-Have Tech for Health Plans
What are Prospective Payment Integrity (PPI) solutions anyway? PPI solutions enable health plans to proactively avoid paying claims improperly. They include features like: Claims editing Data...
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Advancing Care Management Through Digital Transformation
Stuart Myer, Chief Information Officer, VillageCare, a community-based, not-for-profit organization in New York, recently joined HealthEdge leaders Christine Davis, Vice President, Product...
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Contract Modeling: The Key to Fostering a Positive Health Plan-Provider Relationship
The ‘pay and chase’ model of reimbursement is prevalent in the health care industry. This means many health plans know and accept the fact that payments to providers are simply incorrect and will...
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Optimize Payment Accuracy with History-Based Editing
40-cents per professional claim. That’s the average savings payers generate after turning on a single feature in Source, HealthEdge’s payment integrity solution. How is that possible? The process...
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