For many health plans, it’s easy to get stuck in a costly cycle of rework: pay a claim, spot an error months later, hire a recovery vendor, then repeat. This reactive approach uses unnecessary...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreExtensive legislative reform is shifting the healthcare landscape. The One Big Beautiful Bill Act (OBBBA) introduces significant changes to eligibility requirements across Medicaid, Medicare, and...
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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...
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Healthcare 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...
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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...
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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...
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See what 3,500 consumers say about their healthcare experiences
Read the report!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...
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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...
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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...
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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,...
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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...
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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...
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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...
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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...
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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...
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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?”...
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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...
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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...
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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...
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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,...
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