Payment Accuracy Edge: Enterprise Transformation
Payment Accuracy Edge (formerly HealthEdge Source) provides accurate payments in real-time. Ensuring accurate payments for continuous cost containment through transformative integrity solutions.
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Key Capabilities
Reimbursement Libraries
Built-in tools that help calculate the right price for a claim using government pricing rules, state-specific requirements and a health plan's own custom pricing agreements
- Covers all provider types
- Groups claims automatically
- Applies Medicare/Medicaid pricing
- Lets plans set custom commercial pricing deals
Source Insights
Helps health plans see the full picture on pricing, testing what-if scenarios, comparing performance to benchmarks and keeping an audit-ready claims history.
- Production Impacts
- Monitor Mode
- Batch/Benchmarking
- Modeling
- HealthEdge Datasmart
Payment Integrity Libraries
Access a complete library of claim edits, plus the ability to build custom edits on top.
- Medicare/Medicaid
- Validation
- Billing & Coding Guidelines
- Clinical
- Cost Containment
Platform Configuration & Workflow
Set custom pricing rates, decide which rules take priority when they conflict, and manage billing codes, fee schedules and exceptions all in one place.
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Commercial Pricing Methodology
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Rules Engine
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Custom Edit Creation
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Data Warehouse
Post-payment audit
Recover leakage that slips through with retrospective analysis and automated recovery workflows across vendors and providers.
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Retrospective claims analysis
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Recovery workflow automation
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Vendor & provider reconciliation
Payment Accuracy Edge Solution Suite
Payment Accuracy Edge Platform Access
Gives health plans more transparency and control — a complete editing library, custom edit creation, and embedded analytics in one platform.
Payment Accuracy Edge Reimbursement Transformation
Unites Medicare, Medicaid and commercial pricing with editing in one configurable engine, giving health plans the power to model, monitor and correct payment impact, not just calculate it.
Delivery Services
Expert contract configuration, maintenance, and data studies that extend your team.
Transparency and Control Over Payments
Payment Accuracy Edge gives health plans full visibility and control over payment editing.