HealthEdge Source™: Unlocking the Advantages of Data Research Module

Unlocking the Advantages of the Data Reference Module for Health Plans

Health plan organizations often face significant challenges due to fragmented data sources, inconsistent information, and inefficient processes. These issues can lead to inaccuracies, compliance risks, and operational inefficiencies.

HealthEdge Source™ Data Reference Module addresses these problems by providing a centralized, accurate, and comprehensive data source. This module aims to streamline data management, enhance payment integrity, and improve operational efficiency. Ultimately, the solution supports better decision-making and strategic planning.

Key takeaways from the video:

Comprehensive Integration:

• The Source platform simplifies claims management by integrating multiple technologies and systems into a single, cloud-hosted environment.
• It combines contract terms, editing, and pricing functionalities into one unified system.

Centralized Data Management:

• The Data Reference Module centralizes all data sources, including health plan data, medical association data, and Medicare and Medicaid data.
• This ensures that all solutions within the platform can leverage accurate, up-to-date data.

Enhanced Data Accuracy:

• Automatic bi-weekly updates eliminate the need for manual updates, reducing errors and ensuring compliance.
• In 2023 alone, our team delivered over 1,500 data updates and 350 policy updates, ensuring your data remains current and reliable.

Full Audit Support:

• The module provides comprehensive visibility into all data points used in claim pricing and editing.
• It facilitates effortless auditing and provider inquiries by offering detailed insights into data usage at both the claim and overall levels.

Powerful Analytics and Modeling:

• Use analytics to gain insights from pricing and editing data, enabling informed decision-making.
• Leverage production data for modeling and benchmarking against industry standards, enhancing strategic planning.

Scalable and Modular Design:

• The system is flexible enough to be used as a whole or in parts, allowing you to integrate only the features you need, such as editing, analytics, or contract terms.

The Data Reference Module is designed to be user-friendly and easy to implement for health plans. With its zero-lift implementation for existing HealthEdge Source customers, the module seamlessly integrates into current systems without extensive setup or training. The automatic bi-weekly updates ensure the data remains current without manual intervention, reducing the workload for health plan administrators. Additionally, the centralized data management and intuitive interface make it straightforward to access and utilize the comprehensive data and analytics features, enabling health plans to efficiently manage claims, ensure compliance, and make informed decisions.