Skip to main content
logo Contact us

Data Sheet: Expanding Payment Integrity Through Seamless Integrations

Published Date

HealthEdge Source’s comprehensive ecosystem unites the industry’s best third-party solutions.

Download PDF

Health plans today face increasing pressure to manage costs, ensure regulatory compliance, and improve payment accuracy. To meet these challenges, HealthEdge Source™ offers a comprehensive digital ecosystem that integrates industry-leading third-party solutions directly into its payment integrity platform. By unifying pricing, editing, and compliance tools into a single workflow, HealthEdge Source empowers payers to streamline operations and reduce administrative burdens without the need to manage multiple vendors.

Seamless Integration for Enhanced Accuracy

HealthEdge Source™ eliminates the inefficiencies of disconnected systems by embedding specialized third-party content directly into the claims process. This integrated approach ensures precision and compliance across critical healthcare domains:

  • Precision in Anesthesia Billing (ASA): Automates billing with ASA’s RVG™ standards, reducing disputes and ensuring compliance.
  • AI-Powered Fraud Prevention (Codoxo): Uses AI to detect fraud and waste before claims are paid, shifting to proactive prevention.
  • Smarter Genetic Test Reimbursement (Concert Genetics): Automates policy enforcement for genetic test billing, reducing complexity and denials.
  • Accurate Market-Based Pricing (FAIR Health): Provides region-specific benchmarks to resolve disputes and meet No Surprises Act requirements.
  • Medical Necessity Compliance (MediQuant®): Validates claims against CMS coverage rules, reducing rework and ensuring compliance.
  • High-Cost Drug Pricing (RJ Health): Offers real-time drug pricing and algorithms to prevent overpayments on specialty drugs.
  • State-Specific Medicaid Pricing (3M/Solventum): Keeps Medicaid pricing compliant with automated updates for state policies.

Strategic Benefits for Health Plans

Implementing the HealthEdge Source™ third-party ecosystem delivers immediate and long-term value:

  1. No Extra Vendor Management: HealthEdge Source maintains the relationships, updates, and pricing.
  2. Immediate Impact: Turn on edits instantly, without additional IT effort.
  3. Future-Proof Complaince: Stay ahead of regulatory changes automatically.

By adopting this integrated payment integrity solution, health plans can achieve superior payment accuracy, operational efficiency, and significant cost savings, positioning themselves to adapt nimbly to the evolving healthcare landscape.