Payment Accuracy Edge: Reimbursement Transformation
Payment Accuracy Edge (formerly HealthEdge Source) 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.
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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 Datamart
- Retroactive Change Manager
Platform Configuration & Workflow
Allows a health plan to set up its own pricing methods like flat daily rates or per-case pricing and applies them automatically, with built-in checks to catch exceptions.
- Commercial Pricing Methodology
- Rules Engine
- Data Warehouse
- Configuration
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 Enterprise Transformation
Accurate Payments in Real-Time. Ensuring accurate payments for continuous cost containment through transformative payment integrity solutions.
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.