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Artificial Intelligence (AI) is transforming payment integrity in the health insurance industry, particularly in detecting and preventing fraudulent payments and waste. As fraudulent claims become...
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See how over 450 health plan leaders are preparing for 2025!
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"All of our pricing and editing is a one stop shop"
- Melissa Rusk, VP of Operations, SummaCare
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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Healthcare regulations continue to evolve, reshaping how health plans operate and do business in a competitive market. Amid rising costs and regulatory pressures, healthcare fraud prevention is...
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HealthEdge Source™ (Source) is a cloud-based solution designed to revolutionize payment accuracy and integrity in the healthcare industry.
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A prospective payment integrity solution that manages accurate and compliant pricing data, so health plans don’t have to.
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The traditional post-pay model has long been the standard in healthcare claims adjudication. However, it can result in significant administrative burdens and increased costs for healthcare payers....
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Introducing Advanced Custom Edits from HealthEdge Source™, a new feature designed to expedite and streamline the claims editing process.
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HealthEdge Source™ (Source) recently hosted a training webinar focusing on the latest enhancements to the Custom Edit tool.
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Maximize efficiency and accuracy in claims processing by utilizing historical data to create custom edits.
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HealthEdge Source Advanced Custom Editing lets you build and manage custom claim edits, apply edit history, and control user access. Easily configure complex edit rules and apply them to your claims.
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Healthcare payer claims operations teams often face additional work and processing when working with multiple claims or data systems. Scattered processes and data lead to waste, inaccuracies, and...
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We’re obsessed with getting claims paid correctly the first time, which is why we’ve taken our Retroactive Change Manager and made it even better. Now, in addition to tracking regulatory updates, Retr
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Healthcare payers are turning to innovative digital solutions to maintain payment integrity. But ever-shifting guidelines can make it challenging to pay claims accurately the first time—costing...
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Experts in managing complex CMS data for over 25 years. Partnering with top payers for 10+ years.
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Data Reference, which can be accessed through your instance of Source, provides insight into any current or historical fee schedules, rates, payment policies, and provider-level data.
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Gain insights from a survey of health plan leaders on how to solve payment integrity challenges and achieve enterprise alignment.
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