The HealthEdge Source Solution Suite
Professional Services
We understand that containing costs is the biggest challenge payers face today. Implementing new technologies, processes and other cost-containment strategies takes time and resources – something most payers do not have enough of.
That’s where HealthEdge Source™ Professional Services can help. Our HealthEdge Source experts are stewards of our solution, with a mission to equip your internal teams with the knowledge and support to strategize, operationalize and realize cost containment measures that impact your bottom line.
Features
Contract Configuration
Our subject matter experts partner with your team to configure contracts within HealthEdge Source, including configuration of default rates, custom carve-outs, fee schedules and other complex terms.
Contract Maintenance
Evaluate existing contract configurations used by your team and identify areas for optimization to reduce maintenance and improve workflow.
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.
Data Studies
Gain insight into your business and make informed business decisions based on actual modeling scenarios. Customized for existing clients and prospective clients.
Product Education
Go beyond standard implementation training and gain a deeper understanding of specific product components, including configuration design, edit creation, training on new features and more.
Content Education
Learn more about all aspects of policy and payment methodologies, including provider type methodologies, policy-specific aspects, and CMS updates and revisions.
Agile Services
A unique service offering to accommodate your business needs. Focus may include combining multiple Professional Services offerings, exploration of workflow challenges, specialized enhancements, integration and data mapping, and more.
Edit Creation
Optimize your edits with our team of experts for the design and development of net new edits in Source.
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Gain the power to perform enterprise-wide decision support for setting medical policy, contract renegotiations, and analyzing billing and utilization trends.
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Why We’re Different
Experience in Design and Automation
Inefficient design and manual processes typically result in an additional $5-$10 per claim. Our Professional Services team provides years of experience maximizing pricing and editing automation with a high degree of provider contract terms accuracy to drive down costs.
Improved Effectiveness
While internal or other third parties requiring multiple FTEs can drive up costs, our fully trained and scalable workforce has the ability to flex to our client’s needs.
Increased Time to Value (TTV)
Our dedication to achieving rollout deadlines requires no ramp-up period to train internal resources or other third parties and enables us to meet rolling go-live dates.
Efficient Maintenance Plan
Our maintenance plan promotes smart sharing of similar contract terms to help streamline changes and promote accuracy – removing the need for health plans to rely on internal FTE resources.
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.
The 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.
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A dynamic solution that simplifies contract configuration and provides accurate modeling.
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Comprehensive support to handle complex policies automatically across all lines of business.
LEARN MOREHealthEdge Source Platform Access
Enabling payers to gain control of their IT ecosystem through radical transparency.
Learn MoreAdditional 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.
LEARN MOREHealthEdge 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.
LEARN MOREHealthEdge 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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