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.
Redefining Payment Integrity: From Black Box to Open Book
“How much should a healthcare provider be reimbursed for the services they provided our member?”
While a seemingly straightforward question, the answer, un…
Some Payers Scramble to Meet COVID Test Rules; Others Pivot Quickly
New federal rules set early in the year mandate that private payers cover eight free FDA-approved COVID tests per member per month as of Jan. 15. The intent is…
HealthEdge’s HealthRules Payor® Ranked #1 in CAPS and named ‘Best in KLAS’
HealthEdge Software, provider of the industry’s leading next-gen integrated solution suite for health insurers, said today its HealthRules Payor® solution has …
Improving member health with predictive risk modeling
Smokers, on average, die 10 years younger than nonsmokers. But that’s just one data point. What happens when you consider all the data that composes the fabric…
The Balance Billing Protections of the No Surprises Act, passed in late 2021, went into effect on January 1, 2022. This law provides federal protection to cons…
As our healthcare system struggles toward a model in which consumers are at the center of the equation, technology is playing a rapidly increasing role in smoo…
Innovation at HealthEdge: Making Waves in Healthcare Payer Technology
The journey of transforming healthcare starts with innovation. We recently sat down with Sanjeev Sawai, Chief Innovation Officer at HealthEdge, to understand h…
Care management for D-SNP populations: The key to compliance and member satisfaction
Dual Eligible Special Needs Plans (D-SNP) are a special kind of Medicare Advantage Plan for people who qualify for both Medicare and Medicaid. This program tak…
As consumers of digital services in our daily lives, our expectations of personalized self-service experience have been set by the likes of Amazon, Netflix and…
What are the top features of optimal Medicaid payment technology?
Medicaid MCO claims management is complex and dynamic. The traditional approach to Medicaid payment policies and fee schedules is challenged by the increasing …
6 Ways Technology Can Lighten Your Medicaid MCO Team’s Workload
According to the Kaiser Family Foundation, there are over 280 Medicaid Managed Care Organizations (MCOs) that provide comprehensive managed care for over 55 mi…
7 Most Common Medicaid MCO Claims Management Risks
“Variability in Medicaid is the rule rather than the exception. States establish their own eligibility standards, benefit packages, provider payment policies, …
Skip to main content
