Building Trust in AI: A Guide to LLM Evaluations
Large language models (LLMs) are inherently probabilistic, meaning the same input can produce different outputs. That variability makes traditional unit tests, which verify exact results,...
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Cut Administrative Costs Up to 40% With an Integrated Operating Model
For the second consecutive year, 52% of health plan executives named “managing rising costs” as the top challenge, according to the 2026 HealthEdge® Annual Payer Report. In the same survey, 85% of...
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Preparing for Software Testing: 8 Best Practices for Health Plans
When a health plan undertakes a major technology change, whether implementing a new platform, modernizing a legacy system, or rolling out new functionality, the promise is compelling: streamlined...
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Building Trust in LLM Solutions: A Practical Guide to Evaluation Planning
Artificial intelligence (AI) is fundamentally changing how healthcare software is built. From automated test case generation to intelligent documentation and decision support, large language...
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7 Payment Integrity Trends Health Plans Can’t Afford to Ignore in 2026
Payment integrity has always played a critical role in payer operations, but in 2026, it has become a strategic imperative. According to the HealthEdge® 2026 Annual Payer Survey, health plan...
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6 Executive Strategies for Optimizing Care Coordination and Delivery
At a recent roundtable, the HealthEdge® Chief Medical Officer led executives from three leading health plans in a discussion centered around optimizing care delivery and...
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Executive Strategies for Balancing Costs and Quality for Health Plans
At HealthEdge®, we strive to understand the key challenges health plans face so we can help anticipate and address new market opportunities. Recently, HealthEdge Chief Strategy Officer, Raj...
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Software Testing Essentials: Why It Matters for Health Plans and How HealthEdge® Makes It Easier
When health plans implement new software, upgrade existing platforms, or roll out new features, one factor is key to achieving success is effective testing.` While testing may not always...
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Core System Modernization: Innovative Solutions for Cost Management and Member Health
Recently, the HealthEdge® Chief Solutions Officer hosted a discussion with four health plan executives to discuss how they’re using advanced, integrated technology solutions to enhance claims...
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AI in 2026: Are Health Plans and Members Aligned on the Future?
Health plans are racing ahead with artificial intelligence (AI). Members are moving more cautiously. In 2026, the question is no longer whether AI will shape healthcare. It’s whether payers and...
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Is Your Legacy Care Management System Holding You Back? 5 Signs to Make the Switch
In today’s rapidly evolving healthcare landscape, standing still isn’t an option. Health plans relying on legacy care management platforms, whether vendor-supported, homegrown, or heavily...
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How AI-Powered Document Processing Transforms Provider Data Management
At HealthEdge®, our team understands that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate...
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Unlocking the Future of Healthcare Technology: Interoperability, Transparency, and AI
At a recent executive roundtable, HealthEdge® brought together health plan leaders from across the U.S. to share their experiences and see how other organizations are addressing key challenges....
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From Guessing Game to Proactive Process: Simplify Edits with HealthEdge Source™
Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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Setting the Standard for Payment Integrity: HealthEdge Source™ Named Best in KLAS
HealthEdge Source™ earned the 2026 Best in KLAS Awards: Software and Services as the leader in “Pre-Payment Accuracy & Integrity Solutions (Payer)”—with an overall score 8% higher than its...
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Elevate Care Management with the Integrated Power of HealthEdge GuidingCare®
Industry pressures like regulatory complexity and the shift toward value-based care demand that health plans take an integrated, strategic approach to care management. Whether payers are...
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Turning Unstructured Healthcare Data into Answers with Retrieval Augmented Generation
Care teams, product managers, and operations leaders across healthcare live inside documents: contracts, benefit summaries, clinical policies, internal runbooks, and email threads. These artifacts...
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New Research: How Rising Costs and Regulatory Pressures Are Reshaping Health Plan Priorities
Rising costs. Relentless regulation. For health plans, the question isn’t whether these pressures are intensifying. It’s how to respond. According to new research from HealthEdge®, these twin...
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From Petabytes to Practicality: Navigating the New CMS Transparency Rule
The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower...
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How BPaaS and Technology Modernization Answer the Call for Health Plans in 2026
As health plans face mounting cost pressures and an increasingly complex regulatory landscape, one thing has become clear: incremental change is no longer enough. Today’s health plan environment...
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