Preparing for CMS Updates & Retroactive Changes with HealthEdge Source Retroactive Change Manager

Health plans often struggle with retroactive changes from CMS and state Medicaid programs. These changes, like fee schedule updates or policy adjustments, are frequently backdated, forcing plans to revisit and correct previously processed claims. This process is time-consuming, increases the risk of payment errors, and can lead to compliance issues during audits. For plans operating across multiple states, the complexity grows as each state has its own update process. HealthEdge Source™ Retroactive Change Manager simplifies this by automatically identifying claims affected by retroactive changes. It analyzes the impact, showing exactly which claims were overpaid or underpaid, and by how much. This reduces manual work, helps avoid provider disputes, and ensures compliance, making it easier for health plans to manage these updates efficiently. To learn more, check out our resources: https://learn.healthedge.com/learn-more-about-retroactive-change-manager