Data Sheet: HealthEdge Source™ Product Overview

HealthEdge Source™ is a cloud-based solution engineered to bring together industry data, your own proprietary rules, and a flexible configuration layer to edit and price claims with unparalleled accuracy. It fully adapts your provider contract terms and policy guidelines into the platform as a series of edits and pricers that can be modeled for precise business intelligence and deployed into production with minimal IT lift.

The HealthEdge team consistently keeps edits and pricing rules up-to-date with the latest industry changes from CMS, State Medicaid programs, and other trusted industry sources. With a user-friendly interface and real-time automation, HealthEdge Source improves transparency, reduces IT and operational burdens, and helps health plans achieve significant cost savings.

HealthEdge Source by the Numbers

The platform's performance and scale are demonstrated by key operational metrics.

Core Dimensions of Value for Health Plans

HealthEdge Source delivers value across critical operational areas for health plans, from reimbursement to platform-wide control.

Medicare & Commercial Reimbursement

Optimize your reimbursement processes for both Medicare and commercial lines of business.

• Achieve accurate modeling of complex reimbursement scenarios.
• Simplify provider contract configuration and management.
• Increase payment accuracy with user-friendly tools.
• Enhance automation to reduce manual intervention.
• Lessen the drag on internal IT and operations resources.

Advanced Claim Editing

Gain control over your claim editing rules to reduce dependency on external vendors and address issues at their origin.

• Build, model, and implement custom edits with precision.
• Reduce reliance on third-party vendors for editing content.
• Address root-cause payment issues proactively.
• Decrease the burden on IT and operational teams.

Total Solution Platform Access

Leverage the full power of an integrated platform for a proactive, enterprise-wide approach to payment integrity.

• Unlock root-cause remediation for systemic issues.
• Implement a proactive and preventative payment strategy.
• Drive enterprise-wide alignment on payment policies.
• Increase ownership and control over your payment integrity operations.

Differentiating Technology: The Source Advantage

Our technology is the foundation of our differentiation, providing a unified and efficient solution for modern health plans.

• Single Instance: Connects to all your claims systems and handles all lines of business from one centralized platform.
• Single Transaction: Manages editing, pricing, auditing, and business intelligence in a single, cohesive process.
• Single Configuration Layer: Consolidates your intellectual property, Source content, and third-party rules in one manageable layer.
• Cohesive Workflow: Streamlines interactions between all claims processing functions for maximum efficiency.
• Cloud-Hosted Infrastructure: Delivers automated content delivery and eliminates the need for on-premise hardware management.
• Rapid Update Cycle: A two-week update cycle ensures you always have the most current content and rules.
• Centralized Data: Enables integrated, real-time audit and analytics functionality for immediate business insights.