HealthEdge Platform
Breaking down barriers.
Building smarter health plans.
Outdated technology and fragmented systems have held health plans back for too long. At HealthEdge, we’re transforming the way plans operate with a single, integrated platform that brings clinical and administrative data together in one place. The result? Smarter decisions, faster payments, more meaningful collaboration and better service and care for every member.
Contact UsA unified platform to power your plan
Core administrative systems built for what's next
The core of your operations should be agile, accurate and adaptable. Our suite of core solutions delivers powerful administrative capabilities, precise provider data and real-time payment precision, helping your plan stay ahead of change.
Connecting care and member experience
Better outcomes start with better connections. Our care solutions bridge the gap between plans and the people they serve, enhancing care management, supporting clinical engagement and driving proactive member outreach.
GuidingCare®
Care Management
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Wellframe™
Member Engagement
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Seamless connections.
Smarter outcomes.
With hundreds of integrations across the healthcare ecosystem, HealthEdge brings together clinical, financial and administrative data to create real-time, actionable intelligence. Featured integrations include:
Provider Data Management - Payer
Supports accurate, consistent provider data across all systems to streamline workflows
learn moreCare-Wellframe
Combines clinical data with real-time insights to meet members where they are
learn moreServices that support every step of your journey
From implementation to optimization, HealthEdge Professional Services are here to help you get the most from your solutions. Our experts work alongside your team to accelerate ROI, reduce disruption and unlock new capabilities at scale.
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Trust Center Security
Safeguard your members’ data and protect your business. Our Trust Center prioritizes transparency, offering clear insight into our security, privacy and compliance practices and access to key documentation.
Infrastructure & Cloud Center of Excellence
Support a smarter, faster future. By migrating to AWS, our system delivers stronger performance, reliability, and scalability. Plus, our Cloud Center of Excellence helps streamline DevOps, AI innovation, and application management.
Touchless transaction processing
Boost efficiency across your plan. With intelligent automation, you can process claims and transactions accurately and instantly reduce manual work, freeing your team to focus on higher-impact tasks.
Prospective payment accuracy
Avoid the cost of getting it wrong. Our prospective payment capabilities help ensure accuracy upfront, reducing provider abrasion and minimizing errors, appeals and recovery cycles.
Care integrity
Deliver better care – more efficiently. Our platform supports timely, appropriate and coordinated care, helping you improve outcomes while reducing administrative burden.
AI-based business intelligence
Turn insights into action. Our AI-native platform, developed with AWS and Loka, delivers real-time intelligence that powers faster decisions, optimizes performance and drives continuous improvement.
Converge without limits
Health plans need more than incremental change. They need to bring all their data together, apply automation and drive smarter, faster decisions at every level.
HealthEdge makes that possible. Our integrated platform breaks down silos and enables health plans to:
- Use automation to improve care delivery, compliance and operational efficiency
- Accelerate payments with increased accuracy and transparency
- Elevate member experiences with timely, relevant engagement
- Gain insights that lead to better, more affordable care
Purpose-built for every segment of healthcare
HealthEdge supports health plans across a broad range of markets, bringing integrated technology and tailored support to:
- Commercial Plans
- Government Programs (Medicare, Medicaid, and Dual-Eligibles
- Plans with Home and Host Capability
- Dental Plans
- Consultants and Strategic Advisors
Get a first look at smarter claims, care and member experience
Meet with a HealthEdge expert to see how our integrated platform helps streamline claims, enhance care coordination and elevate member engagement. Let’s work together to build a more efficient, connected and forward-looking health plan.
Schedule A Consultation