Dual Eligibles
Although beneficiaries who qualify for both Medicare and Medicaid benefits make up a small percentage of your health plan's member base, they account for a disproportionately high share of program costs — and coordinating payments between the two programs can be a challenge.
HealthEdge® provides an AI-powered platform for dual-eligible members that helps your health plan deliver high-quality care at every stage and drive better health outcomes while keeping costs low. Our integrated approach strengthens claims processing with payment integrity, then feeds that data into an end-to-end care management platform. Together, these capabilities support regulatory compliance, lower administrative costs, and improve care quality and patient outcomes.
How HealthEdge
Can Help
HealthRules® Edge
HealthRules® Edge, formerly HealthRules® Payer, is our core claims engine: a cloud-native solution that powers accurate, efficient claims administration, delivers industry-leading auto-adjudication rates, and enables stronger financial and operational performance.
Payment Accuracy Edge
Payment Accuracy Edge, formerly HealthEdge Source™, is our prospective payment integrity solution that powers accurate payments for continuous cost containment through end-to-end systems.
Clinical Edge
Clinical Edge, formerly HealthEdge GuidingCare®, is an integrated care management platform that helps improve care quality outcomes and cost management by streamlining care team workflows.
Revenue Align Edge
Revenue Align Edge, formerly HealthEdge Risk Adjustment, enables proactive management and stronger compliance across the payer enterprise by giving health plans a clear, data driven picture of risk.
Provider Atlas Edge
Provider Atlas Edge, formerly HealthEdge Provider Data Management, helps reduce operational friction, compliance risk, and administrative risk through a single, reliable source of truth across the payer data ecosystem.
Payment Accuracy Edge
Payment Accuracy Edge, formerly HealthEdge Source™, is our prospective payment integrity solution that powers accurate payments for continuous cost containment through end-to-end systems.
Clinical Edge
Clinical Edge, formerly HealthEdge GuidingCare®, is an integrated care management platform that helps improve care quality outcomes and cost management by streamlining care team workflows.
Revenue Align Edge
Revenue Align Edge, formerly HealthEdge Risk Adjustment, enables proactive management and stronger compliance across the payer enterprise by giving health plans a clear, data driven picture of risk.
Provider Atlas Edge
Provider Atlas Edge, formerly HealthEdge Provider Data Management, helps reduce operational friction, compliance risk, and administrative risk through a single, reliable source of truth across the payer data ecosystem.
HealthRules® Edge
HealthRules® Edge, formerly HealthRules® Payer, is our core claims engine: a cloud-native solution that powers accurate, efficient claims administration, delivers industry-leading auto-adjudication rates, and enables stronger financial and operational performance.