When health plans modernize their core administrative systems, the conversation often centers on technology. Implementation timelines, configuration decisions, and integrations dominate planning...
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Part 2 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In the first...
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Part 1 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In this...
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Health plans are heading into 2026 under a level of pressure that feels fundamentally different from just a few years ago. Findings from the HealthEdge® 2026 Healthcare Payer Survey Report, “The...
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Large language models (LLMs) are inherently probabilistic, meaning the same input can produce different outputs. That variability makes traditional unit tests, which verify exact results,...
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For the second consecutive year, 52% of health plan executives named “managing rising costs” as the top challenge, according to the 2026 HealthEdge® Annual Payer Report. In the same survey, 85% of...
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When a health plan undertakes a major technology change, whether implementing a new platform, modernizing a legacy system, or rolling out new functionality, the promise is compelling: streamlined...
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Artificial intelligence (AI) is fundamentally changing how healthcare software is built. From automated test case generation to intelligent documentation and decision support, large language...
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Payment integrity has always played a critical role in payer operations, but in 2026, it has become a strategic imperative. According to the HealthEdge® 2026 Annual Payer Survey, health plan...
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At a recent roundtable, the HealthEdge® Chief Medical Officer led executives from three leading health plans in a discussion centered around optimizing care delivery and...
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At HealthEdge®, we strive to understand the key challenges health plans face so we can help anticipate and address new market opportunities. Recently, HealthEdge Chief Strategy Officer, Raj...
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When health plans implement new software, upgrade existing platforms, or roll out new features, one factor is key to achieving success is effective testing.` While testing may not always...
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Recently, the HealthEdge® Chief Solutions Officer hosted a discussion with four health plan executives to discuss how they’re using advanced, integrated technology solutions to enhance claims...
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Health plans are racing ahead with artificial intelligence (AI). Members are moving more cautiously. In 2026, the question is no longer whether AI will shape healthcare. It’s whether payers and...
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In today’s rapidly evolving healthcare landscape, standing still isn’t an option. Health plans relying on legacy care management platforms, whether vendor-supported, homegrown, or heavily...
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At HealthEdge®, our team understands that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate...
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At a recent executive roundtable, HealthEdge® brought together health plan leaders from across the U.S. to share their experiences and see how other organizations are addressing key challenges....
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Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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HealthEdge Source™ earned the 2026 Best in KLAS Awards: Software and Services as the leader in “Pre-Payment Accuracy & Integrity Solutions (Payer)”—with an overall score 8% higher than its...
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Industry pressures like regulatory complexity and the shift toward value-based care demand that health plans take an integrated, strategic approach to care management. Whether payers are...
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