For many health plans, HEDIS® final submission feels like the finish line. In reality, it’s the moment when months of quality improvement efforts, chart retrieval activities, and data validation...
Read Blog
Key Takeaways For health plans, the implementation period is one of the highest-risk, highest-stakes phases of any technology investment—and AI can significantly reduce that risk. HealthEdge...
Read Blog
This is part 3 of a blog series on Ethical AI. For context on this series and why we’re writing it, see our introduction in part 1, Ethical AI: Privacy and Security. How Can Payers Address Bias in...
Read Blog
Error - something went wrong!
Enjoying the content? Sign up to our weekly blog email recap!
Thank you!
Introduction This is part 2 of a series on Ethical AI. The content was adapted from an internal learning and development session developed by the Machine Learning Engineers at HealthEdge®, focused...
Read Blog
Key Takeaways Post-hybrid review is a critical audit readiness phase: Success depends on strong documentation workflows, accurate validation, and timely support for auditor requests. Centralized...
Read Blog
Healthcare consumers are changing how they seek information, and increasingly, they are turning to artificial intelligence to do it. Tools powered by generative AI, including platforms like...
Read Blog
Key Takeaways HealthEdge centers every product innovation around delivering three core outcomes: lower-risk implementations in less time, higher quality at a lower cost, and continuous innovation...
Read Blog
Key Takeaways For payers, inaction is not a neutral choice—legacy operating models carry compounding costs that erode financial performance, member satisfaction, and competitive positioning over...
Read Blog
Key Takeaways For health plans, managing multiple vendors can create compounding operational inefficiencies that inflate costs and impede decision-making. A single integrated technology...
Read Blog
Efficiencies in claims processing is a direct driver of cost management, member satisfaction, and competitive positioning. NorthWinds Technology Solutions leadership understood this when they made...
Read Blog
Achieving a 4.5-Star rating is a major accomplishment for any Medicare Advantage health plan. But moving from 4.5 to 5 Stars is a different challenge altogether. Only a small percentage of plans...
Read Blog
Is Your Health Plan Ready for Touchless Claims Processing? The pace of change in healthcare continues to accelerate. Don’t let outdated technology keep your organization from seizing new...
Read Blog
Artificial intelligence (AI) is no longer a future consideration for health plans. AI-powered tools are already reshaping how organizations operate, how members seek information, and how leaders...
Read Blog
Shifts in healthcare regulations continually push health plans to adjust their strategies. The Centers for Medicare & Medicaid Services (CMS) introduced sweeping mandates that fundamentally shift...
Read Blog
With the recently released the 2027 Medicare Advantage Final Rule and Rate Announcement, The Centers for Medicare and Medicaid Services (CMS) confirmed it is finalizing payment rates at a...
Read Blog
This year marked the 20th anniversary of the RISE National Conference, but the milestone felt less like a retrospective and more like a clear signal of where health plan risk adjustment is heading...
Read Blog
Health plans with home and host capabilities have set the standard for healthcare excellence since 1929—but mounting industry pressures constantly challenge these market leaders. Decreasing...
Read Blog
Risk adjustment programs are entering a new phase of maturity. Historically, health plans approached Medicare Advantage risk adjustment retroactively, reviewing charts after...
Read Blog
This is part 1 of a blog series on Ethical AI. This content was adapted from an internal learning and development session developed by HealthEdge’s AI team, focused on educating our organization...
Read Blog
When health plans modernize their core administrative systems, the conversation often centers on technology. Implementation timelines, configuration decisions, and integrations dominate planning...
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.
