The HealthEdge Source Solution Suite

Commercial Reimbursement

HealthEdge Source™ is a prospective commercial reimbursement solution designed specifically to enable payers to pay claims accurately, quickly and comprehensively – the first time. Our transformative solution sets a new standard for reimbursement across your organization, equipping you with up-to-date regulatory data, claims pricing and editing in a single pass, flexible contract configuration, and accurate modeling capabilities – all within a single IT ecosystem. Our Commercial Reimbursement solution radically reduces contract maintenance by up to 90%, minimizing strain while optimizing results for your organization.

Learn More

“Anytime you have a manual process, you have inconsistency … We found that Source really does limit the rework – the provider abrasion and member abrasion.” — VP of Operations, Mid-Sized Regional Health Plan

"With this conversion to Source, we really take advantage of all the bells and whistles and get away from as much manual as we can." VP of Operations, Mid-Sized Regional Health Plan

“When it comes to building and managing claims, I never want to go back to anything else.” — Director of Payment Policy & Editing, Large Southeast Payer


Frame (12)

As a cloud-based solution, HealthEdge Source was designed to automatically deliver IT infrastructure and content updates every two weeks – reducing IT lift organization-wide.

Frame (16)
Customized Pricing

User-driven customization allows users to freeze rates, establish unlimited payment carveouts, and accommodate complex scenarios.

Frame (18)
Enterprise Benchmarking

Reprice every production claim at any frequency in a post-return analytics queue and create a 100% Medicare baseline result grouped by dozens of categories in multi-dimensional reports.

Production Metrics

Real-time production metrics include data on claims volume and financial impact of edits, among other items, to give you an up-to-date snapshot of your claims operations.

Frame (19)
Financial Impact Analysis

Evaluate financial performance of configurations against various standards, including impact of edits in production for enhanced automation.

Frame (20)
Workflow Capabilities

Natively manage interoperability between claims editing, pricing and business intelligence reporting.

Frame (21)
Audit Support

Our Advanced Audit Trail tracks all edits and prices and provides supporting documentation including date-time stamped rules for comprehensive assistance with provider, security and compliance inquiries.

Request a Demo

Discover what a more dynamic reimbursement solution can do for you.


Why We’re Different

Our Experience

We have 25+ years’ experience providing technology solutions addressing healthcare claims payment inefficiencies.

Accurate Modeling

With centralized data, we deliver benchmarking and modeling within the solution to improve time to market for finalized provider agreements.

Simplified Contract Configuration

Manage synchronization of rules for multiple lines of business, provider types and platforms in one location – reducing internal contract maintenance efforts.

Increased Accuracy With Ease

We manage and maintain all regulatory updates and platform infrastructure with a once-every-two-week update cycle to reduce the need to manually update data sets, improving speed and accuracy.

Enhanced Automation

Eliminate government rate research and maintenance with content libraries that include reimbursement rates and payment policies for all provider types, researched and maintained by our subject matter experts to provide lift to your organization.

Reduced IT & Operations Drag

By consolidating reimbursement workflows across claims platforms and lines of business, our solution helps payers achieve increased efficiencies.

Dynamic Business Rules Flexibility

Our user-friendly interface empowers payer teams to build and manage their provider contracts by line of business or any other common group that fits organizational needs.

Rectangle 22 (3)

Payer-Source Integration

The integration between HealthRules® Payer and HealthEdge Source creates a new level of operational efficiency and accuracy in claims pricing and editing. With the continuous management of payment integrity and core administrative processes between platforms, the Payer-Source integration enables:

  • A single source of truth
  • Increased accuracy
  • Organization-wide IT lift
  • Improved payment integrity
  • Streamlined support model

The increased transparency gained from the Payer-Source integration improves payer-provider relations and member satisfaction.

Learn More

The HealthEdge Source Solution Suite

HealthEdge Source Medicare Reimbursement

Delivers, manages and maintains CMS pricing data for comprehensive payment accuracy.

HealthEdge Source Medicaid Reimbursement

Pay Medicaid claims accurately, quickly and comprehensively – the first time.

HealthEdge Source Commercial Reimbursement

A dynamic solution that simplifies contract configuration and provides accurate modeling.

HealthEdge Source Editing

Comprehensive support to handle complex policies automatically across all lines of business.

Learn More
HealthEdge Source Platform Access

Enabling payers to gain control of their IT ecosystem through radical transparency.

Learn More

Additional Offerings

HealthEdge Source Analytics

Our Business Intelligence capabilities enable enterprise-wide decision support for setting medical policy, renegotiating provider contracts, and identifying and remediating billing and utilization trends within your provider network.

HealthEdge Source Professional Services

Our Source experts are stewards of our solution, with a mission to equip your internal teams with the knowledge and support required to optimize your business.

HealthEdge Source Third-Party Integrations

Incorporate third-party solutions and their data into a cohesive workflow for true interoperability of normally disjointed solutions.