In today’s healthcare environment, care managers are at the heart of improving outcomes for members with complex needs. Yet, the growing volume of documentation, assessments, and free-text notes...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreFax-based communication and the manual work required to process physical documents remain daily challenges for health plan care teams. Communications related to authorizations, appeals,...
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Operating within the U.S. healthcare industry can be challenging. Decades of layered regulations, siloed processes, and a sprawling network of stakeholders have created an environment where...
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In our first blog, we explored how HealthEdge’s AI-powered optical character recognition (OCR) platform is transforming prior authorization and other document-heavy workflows. Now, we’re taking...
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The One Big Beautiful Bill Act (OBBBA) introduces far-reaching, fast-moving regulatory changes that demand adaptability from health plans. Some provisions are already in effect, while additional...
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The healthcare industry is in constant motion. Regulations change and care models evolve, while competitive pressures and member expectations grow more complex every year. For health plans, this...
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See what 3,500 consumers say about their healthcare experiences
Read the report!Artificial intelligence (AI) is quickly becoming foundational to the future of healthcare. From automating claims reviews to powering proactive care management, AI has the potential to help health...
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I recently had the opportunity to sit down with the HealthEdge Marketing team to understand how they’ve been adopting AI and how that evolution reflects the broader organizational shift toward...
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By Ethan Zhu + Justin Wolkowicz From Burden to Breakthrough: Tackling Document Chaos with AI At HealthEdge, our AI-first approach isn’t about abstract promises. It’s about solving real, persistent...
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At HealthEdge, our AI Team was created with a clear mission: to accelerate the innovation and adoption of AI technologies that deliver real value for both our customers and our internal teams....
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Extensive 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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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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