Provider Data Management Readiness Assessment
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Transparency
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The HealthEdge® Commitment: Three Outcomes We Guarantee
Key Takeaways HealthEdge centers every product innovation around delivering three core outcomes: lower-risk implementations in less time, higher quality at a lower cost, and continuous innovation...
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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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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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6 Executive Strategies for Optimizing Care Coordination and Delivery
At a recent roundtable, the HealthEdge® Chief Medical Officer led executives from three leading health plans in a discussion centered around optimizing care delivery and...
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Unlocking the Future of Healthcare Technology: Interoperability, Transparency, and AI
At a recent executive roundtable, HealthEdge® brought together health plan leaders from across the U.S. to share their experiences and see how other organizations are addressing key challenges....
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Setting the Standard for Payment Integrity: HealthEdge Source™ Named Best in KLAS
HealthEdge Source™ earned the 2026 Best in KLAS Awards: Software and Services as the leader in “Pre-Payment Accuracy & Integrity Solutions (Payer)”—with an overall score 8% higher than its...
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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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From Guessing Game to Proactive Process: Simplify Edits with HealthEdge Source™
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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How Advanced Payment Integrity Strengthens Transparency and Collaboration Across the Healthcare Ecosystem
Increasing rates of claims denials cause operational bottlenecks and financial consequences across the healthcare system. In 2024, the initial claims denial rate rose to nearly 12%. Denied claims...
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Case Study: HealthRules Payer Case Study with Presbyterian
HealthEdge had the opportunity to sit down with Presbyterian Health Plan leadership to learn more about why their organization decided to make the switch to HealthRules Payer as it's CAPS partner.
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Data Sheet: Navigating the No Surprises Act - The Right Tools for Health Plan Success
The No Surprises Act (NSA) marks a significant regulatory milestone aimed at protecting consumers from surprise medical bills and enhancing transparency in healthcare.
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Data Sheet: Achieving Transparency Compliance Through HealthRules Payer
Achieving regulatory compliance in the healthcare industry is a complex and evolving challenge, particularly with mandates such as the Transparency in Coverage (TIC) Final Rule and the No Surprises Ac
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Infographic: Traditional Claims Editing Software vs. HealthEdge Source
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Data Sheet: HealthRules Payer - Resiliency to Change
Health plans must quickly and effectively react to the latest regulatory shifts, competitive pressures, opportunities for expansion, large-scale public health...
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Case Study: SummaCare - How do you see Source helping you long term
As a long-term partner with HealthEdge Source, SummaCare was asked how they envision Source supporting their team over the next five years.
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Data Sheet: Point-of-Service Payment System Success - Integrated Ecosystems (PDF)
Traditional claims systems are often fragmented and inefficient, leading to significant errors and unnecessary operational costs.
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Data Sheet: Cloud-Based Data Delivery in Healthcare — Point-of-Service Payment Success Path
In today's healthcare landscape, the complexity and inefficiencies of payment systems are a common source of frustration for patients, providers, and payers alike.
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Data Sheet: Point-of-Service (POS) Payment Success in Healthcare - Process Automation & Intelligent Workflows
What if we could develop a smart and efficient workflow that ensures payment accuracy from the start?
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White Paper: Prospective Payment Integrity Moving from Pay and Chase to Predictive
This Spotlight examines payer payment integrity platforms and how payers can aggressively apply analytics and coordinate workflows to move "left" from reactive postpay to proactive, predictive prepay.
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