The HealthEdge Source Solution Suite


HealthEdge Source™ Editing is payment integrity editing software that combines revolutionary technology with best-of-breed content and is uniquely flexible to fit anywhere within a payer’s workflow for a customized, agile approach. HealthEdge Source Editing is designed to deliver accurate, transparent, comprehensive claims payments upstream in the adjudication process and enable payment integrity transformation for your business.

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“If there’s an edit conflict, Source is the source of truth.”
— VP of Operations, Mid-Sized Regional Health Plan

Recognized by Gartner for three consecutive years in the Gartner Hype Cycle report as a Sample Vendor for Prospective Payment Integrity

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Gartner sample vendor


Editing builder
Editing Content

Our content libraries include support for government, clinical, billing and validation edits to handle complex policies automatically across all LOBs.

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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.


Our history-enabled editing capability enables comprehensive and reliable adjudication of claims.

Audit support
Business Rules Flexibility

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

Edit Exceptions

Easily override or make exceptions to existing edits to readily fit your business needs.

Audit support
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.

Third party
Integrated Third-Party Edit Libraries

Complement our native content with additional third-party libraries – all within a single interface for increased speed and accuracy.

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Integrated Advanced Analytics

Enhanced transparency into business operations for improved business intelligence and informed decision-making.

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See how HealthEdge Source Editing can transform your business.


Why We’re Different

Our Experience

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

Diminish Contingency Payments

Move edits from post-payment to pre-payment with full visibility into content performance.

Address Root-Cause Issues

Move from a black box to an open-book approach – empowering your payment integrity team with better intelligence for improved decision-making.

Reduce IT & Operations Drag

With improved data control and the flexibility to implement and own your own IP, Platform Access increases the efficiency of edit creation through comprehensive edit life cycle management.

A Single Instance, A Single Source

HealthEdge Source Editing provides a source of truth for your payment integrity teams, using a single call for fee schedules and payment policies with customization capabilities to meet complex payment arrangements, and a single instance to connect with all claims systems.

Empowering Payer Teams Through Unparalleled Partnership

With a focus on prioritizing payment issues and transitioning from retrospective to prepayment editing to reducing provider/member abrasion, we empower payer operational stakeholders to customize, manage and maintain their editing libraries and content to suit their business needs without having to rely on outsourced engineering teams.

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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.

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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.

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HealthEdge Source Platform Access

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

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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 HealthEdge 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.