Product Demonstration: HealthEdge Source™ - Medicaid Reimbursement

Medicaid Reimbursement with HealthEdge Source

The HealthEdge Source™ platform is designed to streamline Medicaid reimbursement processes, ensuring accuracy and efficiency in claims management. Traditional approaches to payment integrity often involve multiple claims editors, leading to inefficiencies and errors.

HealthEdge Source addresses these challenges by providing a comprehensive solution that integrates automated updates and flexible options for Medicaid reimbursement.

Key features include:

• Automated Reimbursement: Supports various Medicaid states and includes provider types such as ambulance services, ESRD, inpatient, outpatient, and professional providers.
• Accurate & Up-to-Date: Content is updated bi-weekly by the HealthEdge team and automatically integrated into the system, ensuring the most current Medicaid pricing and policy information.

Flexible Pricing & Policies:

• Offers the option to price at 100% of the State Medicaid rate or adjust to a percentage of the fee schedule.
• Provides payment policies in the form of edits, including National Medicaid NCCI and MU edits, as well as state-specific policies like modifier adjustments, physician specialty adjustments, and surgery reductions.
• All edits can be customized to meet your organization’s specific needs.

By leveraging these capabilities, your health plan can improve payment integrity, reduce administrative costs, and enhance overall efficiency. The focus is on getting claims paid correctly the first time.