eBook: Rural Health Clinic Reimbursement - The Hidden Cost in Claims Operations
Why manual RHC processing drives cost, complexity, and compliance risk - and how automation helps health plans regain control
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Regulatory & Compliance
Discover how our solutions can help your health plan maintain and navigate the complexities of the ever-changing regulatory landscape.
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HEDIS Final Submission: How Health Plans Can Ensure Accuracy, Compliance, and Confidence
For many health plans, HEDIS® final submission feels like the finish line. In reality, it’s the moment when months of quality improvement efforts, chart retrieval activities, and data validation...
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Safeguarding HEDIS Compliance: 5 Strategies for Post-Hybrid Review Documentation and Audit Support
Key Takeaways Post-hybrid review is a critical audit readiness phase: Success depends on strong documentation workflows, accurate validation, and timely support for auditor requests. Centralized...
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Combat the Hidden Costs of Vendor Sprawl with Performance Management
Key Takeaways For health plans, managing multiple vendors can create compounding operational inefficiencies that inflate costs and impede decision-making. A single integrated technology...
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Closing the Gap: Leveraging Hybrid Records to Propel Medicare Advantage Plans to 5 Stars
Achieving a 4.5-Star rating is a major accomplishment for any Medicare Advantage health plan. But moving from 4.5 to 5 Stars is a different challenge altogether. Only a small percentage of plans...
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AI in Healthcare: Why Regulatory Momentum Is a Wake-Up Call for Health Plans
Artificial intelligence (AI) is no longer a future consideration for health plans. AI-powered tools are already reshaping how organizations operate, how members seek information, and how leaders...
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Mastering CMS Compliance: Bridging X12 and FHIR
Shifts in healthcare regulations continually push health plans to adjust their strategies. The Centers for Medicare & Medicaid Services (CMS) introduced sweeping mandates that fundamentally shift...
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CY 2027 Medicare Advantage Final Rule & Rate Announcement: 5 Updates Payers Need to Know
With the recently released the 2027 Medicare Advantage Final Rule and Rate Announcement, The Centers for Medicare and Medicaid Services (CMS) confirmed it is finalizing payment rates at a...
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RISE National 2026: A Turning Point for Risk Adjustment—and the Work Ahead
This year marked the 20th anniversary of the RISE National Conference, but the milestone felt less like a retrospective and more like a clear signal of where health plan risk adjustment is heading...
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Are you ready to transform compliance into a strategic advantage?
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Cut Administrative Costs Up to 40% With an Integrated Operating Model
For the second consecutive year, 52% of health plan executives named “managing rising costs” as the top challenge, according to the 2026 HealthEdge® Annual Payer Report. In the same survey, 85% of...
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eBook: Navigating the New Medicare Advantage Reality - Why Member Engagement and the Right Platform Is Your Competitive Advantage
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Brochure: Optimize Health Plan Performance with Stars Consulting Solutions
Achieving Excellence in a Complex Regulatory Landscape.
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Is Your Legacy Care Management System Holding You Back? 5 Signs to Make the Switch
In today’s rapidly evolving healthcare landscape, standing still isn’t an option. Health plans relying on legacy care management platforms, whether vendor-supported, homegrown, or heavily...
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Infographic: How an Integrated Ecosystem and Technology Modernization Answer the Call for Health Plans
Health plans are under increasing pressure: cost, compliance, member experience, and legacy system challenges all converging.
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HealthEdge Achieves HITRUST Risk-based, 2-year Certification to Manage Risk, Improve Security Posture, and Meet Compliance Requirements
HealthEdge today announced that it has achieved HITRUST r2 certification for demonstrating the highest level of cybersecurity and information assurance.
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eBook: Care Management Implementation Best Practices for Regulatory Compliance Agility
Discover how Nascentia Health partnered with HealthEdge to modernize care management, achieve regulatory compliance agility, and drive measurable operational improvements.
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Elevate Care Management with the Integrated Power of HealthEdge GuidingCare®
Industry pressures like regulatory complexity and the shift toward value-based care demand that health plans take an integrated, strategic approach to care management. Whether payers are...
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New Research: How Rising Costs and Regulatory Pressures Are Reshaping Health Plan Priorities
Rising costs. Relentless regulation. For health plans, the question isn’t whether these pressures are intensifying. It’s how to respond. According to new research from HealthEdge®, these twin...
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From Petabytes to Practicality: Navigating the New CMS Transparency Rule
The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower...
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How BPaaS and Technology Modernization Answer the Call for Health Plans in 2026
As health plans face mounting cost pressures and an increasingly complex regulatory landscape, one thing has become clear: incremental change is no longer enough. Today’s health plan environment...
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