The HealthEdge Source Solution Suite

HealthEdge Medicare Reimbursement

HealthEdge Source™ Medicare Reimbursement makes accuracy easy by delivering, managing and maintaining accurate and compliant CMS pricing data so health plans don’t have to. Our solution is uniquely designed to integrate policy edits, pricing algorithms, and rate schedules and process them in parallel to improve accuracy and automation. Our depth of content includes all provider types and settings, eliminating the need to piece together multiple data sources so you can pay claims accurately, quickly and comprehensively – the first time.

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“The Gospel … Our determination if we are going to pay or not” — Director of Healthcare Economics and Government Programs Finance, Mid-Sized Regional Payer

“When I think about and contrast and compare Source’s every two weeks update schedule … to doing this manually and understand the requirements and the implications, there's no way a small health plan would be able to stay anywhere near as current. There's just no way to match this.” — VP of Operations, Mid-Sized Regional Health Plan

We provide over 25 years of experience in managing complex CMS data and were first to market with a cloud-enabled solution with once-every-two-week Medicare updates in production.

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

Gartner sample vendor


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Medicare Content

HealthEdge Source subject matter experts research, develop and maintain content libraries that include payment policies across a wide range of facility and provider types to remove the need for multiple vendor solutions.

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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.

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Parallel Processing

HealthEdge Source offers integrated claims processing in parallel with policy edits, pricing algorithms, and rate schedules covering all Medicare markets in the United States for comprehensive reimbursement - enabling faster processing of claims with a single API call.

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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.

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CMS Reference Tool

Our CMS data reference tool provides a source of truth for all payment policies and edits with comprehensive policy explanation.

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Discover what we can do for your Medicare line of business.


Why We’re Different

Our Experience

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

The Most Comprehensive, Accurate, Up-to-Date Content

Our Medicare content includes full Medicare reimbursement rates and payment policies for all provider types, researched and maintained by our subject matter experts to provide lift to your organization.

Full-Service Delivery

We manage and maintain all CMS 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.

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Transparency & Control

Built from the ground up, HealthEdge Source combines next-generation technology with a unique depth of content to provide unparalleled transparency and enhanced control for payers.

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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.

HealthEdge Source Platform Access

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


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.

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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.

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HealthEdge Source Third-Party Integrations

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

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