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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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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Becoming a Digital Payer: Enabling Business Transparency
HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery...
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Becoming a Digital Payer: Constantly Striving for Higher Quality
HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery...
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Top 5 Challenges of Medicaid Healthcare Payers
The growth in our country’s Medicaid population has reached an all-time high in this post-pandemic society. Years of Medicaid expansion under the Affordable Care Act and increasing job losses due...
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Source Launches Retroactive Change Manager
The first tool to automate repricing of claims, variance reports for over and under payments and monitoring of retroactive changes. Today, payers looking to reconcile inaccurate payments rely on...
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How to Achieve Claims Automation for Health Plans
Step 1: Objectively Measure Impact of “Stacking” vs Prospective Payment Integrity With complementary access to Gartner® research, Adopt Prospective Payment Integrity to Thwart Healthcare Fraud and...
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“Stacking” Editing Solutions vs Prospective Payment Integrity
Improper claims payment and fraud contribute more than $200 billion to the annual cost of U.S. healthcare.1 Summary In order to generate cost savings, most U.S. healthcare payers: Focus on...
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5 Requirements for Health Plan Vendors to Achieve Payment Integrity
Standard Manual Processes and Disjointed Tech Stacks Combat Payment Integrity Traditionally, payer’s internal IT and business operations have implemented government updates and/or third-party...
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Why Automation Technology Will Disrupt Claims Processing
Summary Automated claims technologies are uniquely positioned to increase accuracy of claims because: Most claims paid by health insurers are based on predetermined rates Medicare and Medicaid...
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500 Shoppable Services' - The Next Trend in Healthcare Price Transparency
The healthcare ecosystem is rolling slowly toward greater pricing transparency, but there are many challenges. Among them is predicting consumer behavior in the fog of new health information that...
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Why Using Modern Technology is Critical to Serving the D-SNP Population
As the dual eligible population grows, Dual Eligible Special Needs Plans (D-SNPs) are also experiencing tremendous growth across the country. CMS reports that as of February 2022, D-SNPs are...
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State of the D-SNP Market
Within Medicare Advantage (MA), there are Special Needs Plans (SNP) with specialty cohorts that provide coverage for members who qualify for both Medicare and Medicaid. The membership for these...
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Top 5 Challenges of Payment Accuracy
Health plan payers receive hundreds of millions of claims each year. With such an inundation, it’s easy to understand how complicated and challenging payment processing can be. And when the...
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