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 June 21, 2022
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Guide to RFP Evaluation: Payment Integrity Vendors for Health Plans
Step 2: Evaluating Vendor RFPs “Improper claims payment and fraud contribute more than $200 billion to the annual cost of U.S. healthcare…”.1 Here’s what he…
Blog Post June 16, 2022
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How to Achieve Claims Automation for Health Plans
Step 1: Objectively Measure Impact of “Stacking” vs Prospective Payment Integrity With complementary access to Gartner® research, Adopt Prospective Payment …
Blog Post June 14, 2022
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Providers Struggle with Realities of Transparency
Providers Grapple with Regulatory Realities Providers appear to be grappling with the regulatory realities of value-based care, especially when it comes to …
Blog Post June 09, 2022
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"Stacking" Editing Solutions vs Prospective Payment Integrity
With complementary access to Gartner research, Adopt Prospective Payment Integrity to Thwart Healthcare Fraud and Improper Claims Payment. Improper claims p…
Blog Post June 07, 2022
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6 Leadership Skills for Building a Resilient Workforce
How health plan leaders can maximize productivity without burnout. Why Resilience Matters  Think about the last time your health plan faced a large …
Blog Post June 02, 2022
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5 Requirements for Health Plan Vendors to Achieve Payment Integrity
Standard Manual Processes and Disjointed Tech Stacks Combat Payment Integrity Traditionally, payer’s internal IT and business operations have implemented g…
Blog Post May 31, 2022
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Why Automation Technology Will Disrupt Claims Processing
Summary Automated claims technologies are uniquely positioned to increase accuracy of claims because: Most claims paid by health insurers are based on…
Blog Post May 26, 2022
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‘500 Shoppable Services’ Could Be the Next Healthcare Buzzwords
  The healthcare ecosystem is rolling slowly toward greater transparency, but there are many challenges. Among them is predicting consumer behavior in …
Blog Post May 24, 2022
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Why Isn't the Payment Error Rate Closer to 0% for Health Plans?
Claims Payment Accuracy Hasn’t Significantly Improved in Recent Years Today the overall claims error rate is at 6.26%. In the past decade this error rate ha…
Blog Post May 19, 2022
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‘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
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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
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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…