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 February 15, 2022
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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…
Blog Post February 10, 2022
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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…
Blog Post February 08, 2022
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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 …
Blog Post February 03, 2022
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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…
Blog Post February 01, 2022
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Headlines & Highlights: No Surprises Act
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…
Blog Post January 27, 2022
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AI May Cure The Ills In Healthcare Tech
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…
Blog Post January 24, 2022
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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…
Blog Post January 20, 2022
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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…
Blog Post January 19, 2022
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Good digital experiences demand good data
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…
Blog Post January 14, 2022
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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 …
Blog Post January 11, 2022
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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…
Blog Post January 07, 2022
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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, …