Medicare
Navigate the Competitive Medicare Market
HealthEdge understands the complexities of the Medicare market, where regulatory demands, rising costs, and member expectations create significant challenges. Our purpose-built platform helps Medicare plans confidently address compliance, control costs, and strengthen the member experience. With flexible, scalable technology, we help health plans adapt with ease — meeting today's needs while preparing for what's next.
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.