The HealthEdge Source Solution Suite

Platform Access

We understand that healthcare payers need control over their payment integrity operations to best serve their members. Platform Access challenges the status quo of claims payment operations by empowering payers with transparency into their own data and the ability to orchestrate their business in a way that makes sense. Our prospective payment integrity solution empowers payers with content and technology designed specifically to address administrative waste and the root cause of payment issues.

Featured in Becker’s Payer Issues: HealthEdge exec's advice to payers on payment integrity reform: Demand more

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“All the data has to be there in one spot to support compliance. This requires reducing the number of vendors, the number of upgrades and system changes. That’s what Source delivers.”
— VP of Operations, Mid-Sized Regional Health Plan

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

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Complete Editing Library With History

Enable reimbursement, clinical and coding edits with access to history, parameters and exceptions

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Custom Edit Builder

Turn specific policies into cost-saving edits

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Embedded Analytics Suite

Provides a real-time view into performance metrics and the value HealthEdge Source™ is providing

Monitor Mode

Production-level modeling provides prospective insight into the impact an edit will have

Advanced Audit Trail

Provides a single place to track and view claim-level edit details

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Delivering content and infrastructure updates automatically once every two weeks

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Payment Integrity Health Check

Gain a deep understanding of problem areas and get the most out of your IP and our library offerings

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Seamlessly Access Third-Party Content

Best-of-breed third-party content libraries natively integrated into the solution

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Gain control of your prospective payment integrity operations.


Why We’re Different

Our Experience

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

Forecast Edits Impacts

Visualize impacts of edits prior to moving them into production with Monitor Mode.

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 Platform Access 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.

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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.