HealthEdge Source Solution Suite
Medicare Reimbursement
HealthEdge Source™ Medicare Reimbursement makes claim payments easier for your health plan by delivering accurate, up-to-date CMS pricing data. It brings together policy edits, pricing rules, and rate schedules in one place, so your team can handle claims quickly and accurately. Our depth of content includes all provider types and settings, eliminating the need to piece together multiple data sources. This means you can pay claims quickly and correctly the first time.
Learn More“I have found the HealthEdge Source system to be very robust and flexible with regards to all of the different types of CMS and non-CMS based pricing methodologies that it offers.”
– Health Plan Reimbursement Initiatives Manager
“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
Recognized by Gartner for six consecutive years in the Gartner Hype Cycle report as a Sample Vendor for Prospective Payment Integrity
Features
Medicare Content
Our subject matter experts research, develop, and maintain content libraries that include payment policies across a wide range of facility and provider types, removing the need for multiple vendor solutions.
Cloud-Based
As a secure cloud-based solution, Healthedge Source safeguards your claims data while reducing IT workload and allowing real-time access from anywhere.
Parallel Processing
HealthEdge Source accelerates claims processing by seamlessly integrating policy edits, pricing algorithms, and rate schedules across all Medicare markets, enabling complete reimbursement processing with a single API call.
Audit Support
Our Audit Trail tracks every edit, price, and supporting document with precise timestamps, providing full transparency and simplifying security and compliance inquiries.
CMS Reference Tool
Our CMS data reference tool provides a source of truth for all payment policies and edits with comprehensive policy explanation.
Automatic Updates
We provide bi-weekly content updates to keep health plans up to date with the latest policy changes, minimizing manual intervention.
Request a Demo
Request a demo of HealthEdge Source Medicare Reimbursement today and discover how our centralized solution ensures accurate payments with every claim.
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Why We’re Different
Our Expertise
With 28 years of experience, we specialize in delivering technology solutions that tackle inefficiencies in healthcare claims payments.
Comprehensive, Accurate, and Up-to-Date Content
Our Medicare content provides comprehensive reimbursement rates and payment policies for all provider types.
Full-Service Delivery
We manage all CMS regulatory updates and maintain the platform with bi-weekly updates, reducing workload for your IT team and improving speed and accuracy.
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.
Continuous Innovation
HealthEdge Source has always been at the forefront of innovation, from launching the first cloud-based solution to introducing agentic AI for payment integrity. We're committed to improving our platform to deliver the most innovative tools and features for your health plan.
Payer-Source Integration
Payer-Source is an integration between HealthRules® Payer and HealthEdge Source™ that enables continuous management of payment integrity and core administrative processes.
The solution improves efficiency and accuracy by seamlessly connecting data and workflows. This helps health plans adapt quickly, reduce payment errors, and provide greater value to their members.
HealthEdge Source Solution Suite
HealthEdge Source Medicare Reimbursement
Delivers, manages and maintains CMS pricing data for comprehensive payment accuracy
Learn MoreHealthEdge Source Medicaid Reimbursement
Pay Medicaid claims accurately, quickly and comprehensively – the first time
LEARN MOREHealthEdge Source Commercial Reimbursement
A dynamic solution that simplifies contract configuration and provides accurate modeling
LEARN MOREHealthEdge Source Editing
Advanced editing tools with history-based capabilities and custom configurations to enhance payment accuracy
LEARN MOREHealthEdge Source Platform Access
Enabling payers to gain control of the payment ecosystem through radical transparency
LEARN MOREAdditional Offerings
HealthEdge Source Analytics
Real-time analytics, comprehensive financial impact insights, and advanced modeling tools delivered through intuitive dashboards and detailed reports to empower strategic decision-making and drive smarter business intelligence
Learn MoreHealthEdge Source Professional Services
Expert guidance and support to help your team effectively and efficiently achieve organizational goals
Learn MoreHealthEdge Source Third-Party Ecosystem
Seamless integration of industry-leading third-party solutions enhances payment accuracy and reduces administrative burdens
Learn More