Discover how our solutions can help your health plan maintain and navigate the complexities of the ever-changing regulatory landscape.
Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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Are you ready to transform compliance into a strategic advantage?
Read the paper!HealthEdge’s 2025 survey of 550 health plan executives reveals a major shift in payer priorities, with regulatory pressures and cost management topping the list. The report highlights strategies like
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Heightened pressures from rising costs, regulatory complexities, AI disruption, and member and provider network expectations indicate a perfect storm is brewing for health plans.
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreOn June 10, 2025, the One Big Beautiful Bill Act (OBBBA), also known as H.R.1, was signed into law, marking the beginning of one of the most sweeping healthcare reforms in recent memory. Given the...
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Sweeping policy changes are nothing new in U.S. healthcare, but the One Big Beautiful Bill Act (OBBBA), also known as H.R. 1, represents a particularly consequential inflection point for health...
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HealthEdge’s GuidingCare® platform is at the forefront of enabling healthcare interoperability. By combining deep technical expertise with a visionary approach, GuidingCare equips health...
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Health plans are under increasing pressure to modernize operations while managing rising costs, regulatory complexity, and evolving member expectations. Many have adopted tech-enabled services to...
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The One Big Beautiful Bill Act (OBBBA) introduces far-reaching, fast-moving regulatory changes that demand adaptability from health plans. Some provisions are already in effect, while additional...
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Strategies for Health Plans Navigating Change, Compliance and Innovation
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Healthcare is at a crossroads. Legacy platforms, endless point solutions, and mounting regulatory pressure are all warning signs on the road to change. The need for transformation is clear, even...
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Health plans serving dual-eligible populations face significant regulatory changes from the Centers for Medicare & Medicaid Services (CMS). The 2027 D-SNP requirements introduce significant...
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What does it take to pay a claim correctly? In healthcare, “editing claims” goes beyond surface-level checks—it’s about ensuring accuracy, compliance, and efficiency. Each claim must align with...
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Navigating healthcare regulations and compliance is an intricate challenge. To optimize the use of healthcare dollars and more effectively address population health, The Office of the National...
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The healthcare industry has long been a primary target for cyberattacks due to the vast amount of sensitive data it handles. The increasing prevalence of cyber incidents, combined with...
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Health plan administrators must adhere to the complex guidelines related to payment integrity, operational efficiency, and regulatory compliance. The claims process is intricate, and the sheer...
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