The 'Edge Report

Get the latest perspectives on healthcare issues from a panel of contributors from both inside and outside HealthEdge. Visit often or subscribe to stay up to date.

Blog Post May 19, 2022
‘Gold Card’ Approach to Prior Authorization No Hurdle for HealthEdge
States have been passing legislation in recent years to address the complaints of providers that they are subject to too many prior authorization requirements …
Blog Post May 17, 2022
7 Critical Risks to Successful Implementation
A successful implementation of our products begins with a strong foundational relationship between our health plan customers and HealthEdge. Our goal is for cu…
Blog Post May 12, 2022
Trends of 2022: Business Process as a Service (BpaaS)
An Intro to Business Process as a Service (BpaaS) BpaaS is the delivery of business process outsourcing (BPO) services as a cloud-based subscription service…
Blog Post May 10, 2022
Impacts of COVID-19 on Care Management in the Dual-Eligible Population
COVID-19 has highlighted weaknesses in our healthcare system and shone a spotlight on fault lines, especially for the most clinically and socially vulnerable l…
Blog Post May 03, 2022
State of the D-SNP Market
Within Medicare Advantage (MA), there are Special Needs Plans (SNP) with specialty cohorts that provide coverage for members who qualify for both Medicare and …
Blog Post May 02, 2022
Why Using Modern Technology is Critical to Serving the D-SNP Population
As the dual eligible population grows, Dual Eligible Special Needs Plans (D-SNPs) are also experiencing tremendous growth across the country. CMS reports that …
Blog Post April 28, 2022
Public Health Emergency Clock Ticks Forward to July
As expected, the Biden administration extended the mid-April expiration of the Public Health Emergency (PHE) another 90 days, so the countdown again restarts f…
Blog Post April 26, 2022
CMS Opens Portal for IDR Under No Surprises Act
In the ongoing struggle to achieve clarity around how Surprise Billing regulations will work, the Centers for Medicare and Medicaid (CMS) opened a Federal IDR …
Blog Post April 21, 2022
Healthcare Rules and Regulations are Constantly Changing, But Your Payment Accuracy Doesn’t Have To
Healthcare is unique in so many ways – services are customized to each person, experience is impacted heavily by the provider, and quality of care is affected …
Blog Post April 19, 2022
Top 5 Challenges of Payment Accuracy
Health plan payers receive hundreds of millions of claims each year. With such an inundation, it’s easy to understand how complicated and challenging payment p…
Blog Post April 14, 2022
Taming the Mess of Medicaid Payments Through Technology
Bad data is estimated to cost the healthcare industry $314 billion annually and negatively impact an organization’s revenue by 10-25%. The claims payment struc…
Blog Post April 12, 2022
The Many Dimensions of Value-Based Care
Value-based care aims to improve the quality and outcome for patients by linking provider reimbursement to the quality of care provided. Under this system, pro…