Key Takeaways For health plans, managing multiple vendors can create compounding operational inefficiencies that inflate costs and impede decision-making. A single integrated technology...
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Every premium dollar a health plan collects must be carefully divided between medical care, administrative operations, and margin.
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Efficiencies in claims processing is a direct driver of cost management, member satisfaction, and competitive positioning. NorthWinds Technology Solutions leadership understood this when they made...
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Achieving a 4.5-Star rating is a major accomplishment for any Medicare Advantage health plan. But moving from 4.5 to 5 Stars is a different challenge altogether. Only a small percentage of plans...
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Is Your Health Plan Ready for Touchless Claims Processing? The pace of change in healthcare continues to accelerate. Don’t let outdated technology keep your organization from seizing new...
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HealthEdge Source™ Ranked Best in KLAS for Pre-Payment Accuracy and Integrity Solutions (Payer)
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Artificial intelligence (AI) is no longer a future consideration for health plans. AI-powered tools are already reshaping how organizations operate, how members seek information, and how leaders...
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Shifts in healthcare regulations continually push health plans to adjust their strategies. The Centers for Medicare & Medicaid Services (CMS) introduced sweeping mandates that fundamentally shift...
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With the recently released the 2027 Medicare Advantage Final Rule and Rate Announcement, The Centers for Medicare and Medicaid Services (CMS) confirmed it is finalizing payment rates at a...
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This year marked the 20th anniversary of the RISE National Conference, but the milestone felt less like a retrospective and more like a clear signal of where health plan risk adjustment is heading...
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Health plans with home and host capabilities have set the standard for healthcare excellence since 1929—but mounting industry pressures constantly challenge these market leaders. Decreasing...
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Risk adjustment programs are entering a new phase of maturity. Historically, health plans approached Medicare Advantage risk adjustment retroactively, reviewing charts after...
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This is part 1 of a blog series on Ethical AI. This content was adapted from an internal learning and development session developed by HealthEdge’s AI team, focused on educating our organization...
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