The One Big Beautiful Bill Act (OBBBA) is reshaping healthcare, especially for Medicaid and Medicare plans. With tighter budgets, closer oversight, and an emphasis on population health in rural...
Read Blog
See how over 450 health plan leaders are preparing for 2025!
Learn MoreHealthcare payers are under increasing pressure to integrate and unify digital solutions so they can streamline workflows and improve operational efficiency. With the passing of the...
Read Blog
Increasing rates of claims denials cause operational bottlenecks and financial consequences across the healthcare system. In 2024, the initial claims denial rate rose to nearly 12%. Denied claims...
Read Blog
Error - something went wrong!
Enjoying the content? Sign up to our weekly blog email recap!
Thank you!
Health plans are grappling with the challenge of reducing operating costs without sacrificing clinical outcomes. At the heart of this challenge lies the core administrative processing system...
Read Blog
As artificial intelligence (AI) rapidly transforms healthcare, many leaders are asking what it really means to go all in. For HealthEdge®, it means embedding practical, responsible, and...
Read Blog
Maintaining efficient claims processing workflows can become an overwhelming task for many health plans. Claims teams have to process every claim accurately and on time, keep up with changing...
Read Blog
See what 3,500 consumers say about their healthcare experiences
Read the report!For many payers, maintaining accurate provider information is complicated. Managing disparate data sources, analyzing information, and reviewing existing records can feel like trying to solve a...
Read Blog
In today’s evolving healthcare landscape, understanding what members want and need is more important than ever. To uncover those insights, HealthEdge conducted its 2025 Healthcare Consumer Study,...
Read Blog
Discover how the HealthEdge® Customer Operations team makes it easier for HealthRules® Payer customers to meet their business goals. Health plans across the U.S. depend on the HealthEdge...
Read Blog
Care managers enter the healthcare field to support patients—not drown in paperwork. Yet for many, that’s the daily reality: hours spent sorting through handwritten notes, summarizing past...
Read Blog
Healthcare consumers are raising the bar for what they expect from their health plans. Members want experiences that are personalized, convenient, and responsive. Meeting these expectations across...
Read Blog
AI is changing business operations across industries. See how HealthEdge® is integrating AI to automate workflows & improve business outcomes. Artificial intelligence (AI) is reshaping how...
Read Blog
The healthcare industry is at an intersection of technology, artificial intelligence (AI), and operational efficiency. For payers, ensuring provider data integrity is fundamental to scaling...
Read Blog
Three months ago, I posed a question to our engineering leadership team: “What if we could use AI tools eliminate the mundane and amplify human creativity in every phase of software development?”...
Read Blog
Claims inaccuracy has long been a pain point in the healthcare industry. Processing inefficiencies lead to challenges like payment delays, retroactive changes, damaged member and provider...
Read Blog
Healthcare consumers are increasingly demanding choice and control, and health plans are under growing pressure to adapt. In the 2025 HealthEdge® Healthcare Consumer Study, 60% of individuals with...
Read Blog
Artificial intelligence (AI) is moving beyond the experimental phase, and its applications are certainly no longer reserved for very large enterprises. In healthcare, applying AI to improve...
Read Blog
Accurate and reliable data is the backbone of efficient healthcare operations, facilitating key operations—from claims processing to enhanced member engagement. Yet, for many health plans,...
Read Blog
HealthEdge® recently released its fifth annual Healthcare Consumer Study, one of the most comprehensive consumer surveys in the health insurance industry. This year, more than 4,500 healthcare...
Read Blog
The growth in our country’s Medicaid population has reached an all-time high in this post-pandemic society. Years of Medicaid expansion under the Affordable Care Act and increasing job losses due...
Read Blog
Loading More...
HealthEdge Software, Inc. | HealthEdge®, HealthRules®, The HealthRules Language™, GuidingCare®, and the Wellframe logo are registered trademarks of HealthEdge Software, Inc. All Rights Reserved.
