The Source Solution Suite

Third-Party Integrations

Source delivers an integrated ecosystem that brings accuracy and business intelligence upstream in the payment process. A unique advantage of Source is its extensibility to incorporate third-party solutions and their data into a cohesive workflow where we manage and synchronize all third-party content updates and handle the administrative overhead for you. With our prospective payment integrity third-party integrations, partner solutions operate seamlessly within the Source workflow and completely integrate with our native contract configuration, edits, prices, audit trails, and analytics.

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Working with best-of-breed solutions for more comprehensive adjudication and improved accuracy
Includes third-party data into a cohesive workflow
Extensible to other Program Integrity solutions
Provides interoperability of normally disjointed solutions
Enables complete set of payment guidance to be returned for a claim prospectively

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See how you can improve accuracy through automation.


Third-Party Partnerships


Integration with 3M’s GPCS cloud-based solution for APR-DRGs and EAPGs. Includes state-specific Medicaid grouping and reimbursement.

American Society of Anesthesiologists

Integration with ASA’s Relative Value Guide® (RVG™) data for rate setting. Used as an alternative to CMS and Medicaid guidelines.

Concert Genetics

Proprietary approach to classifying complex claim billings to facilitate more accurate payment. Editing opportunities based on industry-accepted genetic testing reimbursement standards.

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Includes medical necessity, frequency, age and gender edits sourced to CMSs NCDs and LCDs; as well as Part A/B, Home Health, and DME policies. Learn more about MediQuant as part of the Source solution.

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Price and reimburse specialty drug information services. HCPCS or NDC code level edits.


Pre-payment itemized bill review for accurate coding and inappropriate billing. Client-specific flexibility to ensure accuracy.

Additional Solutions

Source also has the unique ability to integrate any existing third-party solution a health plan already uses in its workflow, removing the need to manage and maintain connections with separate point solutions. By taking ownership of these third-party connections, Source reduces IT burden and costs, enables more accurate and efficient results, and ensures better compliance for our partners.

Why We’re Different

Zero IT Lift

We handle the overhead with no IT footprint, integration or maintenance required – removing the need for health plans to establish and maintain additional integrations.

Cohesive Approach

Source brings together all native and third-party editors, prices and workflows to provide complete payment guidance on a single claim.

Improved Automation

Remove manual processes for third-party companies to perform reviews with decision-making configured by you to ensure the correct claims are sent for itemized review.

Efficient & Transparent

Automated repricing and an audit trail of all claim iterations enable accurate, efficient and transparent resolution of claims.


Source includes best-of-breed third-party solutions that provide unique capabilities to enable greater prospective payment integrity. We continuously look for strategic partners who provide best-of-breed data and processes, value being forward-thinking disruptors, and emphasize using technology to improve the healthcare industry.

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Payer-Source Integration

The integration between HealthRules® Payer and 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 Source Solution Suite

Source Medicare Reimbursement

Delivers, manages and maintains CMS pricing data for comprehensive payment accuracy.

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Source Medicaid Reimbursement

Pay Medicaid claims accurately, quickly and comprehensively – the first time.

 Source Commercial Reimbursement

A dynamic solution that simplifies contract configuration and provides accurate modeling.

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Source Editing

Comprehensive support to handle complex policies automatically across all lines of business.

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Source Platform Access

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

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Additional Offerings

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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Source Professional Services

Our 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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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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