Case Study: Accelerating Claims Performance and Automation with EDGEcelerate
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Latest Content
Check out our content to gain valuable insights and strategies to leverage digital solutions to achieve your organizational goals.
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White Paper: Beyond the Badge: Why NCQA Certification Matters for Digital Engagement and Population Health
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Services Spotlight: Product Training Is the Missing Link in Core System Implementations
When health plans modernize their core administrative systems, the conversation often centers on technology. Implementation timelines, configuration decisions, and integrations dominate planning...
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Case Study: From Underperformance to a 4+ Star Rating - How HealthEdge Propelled a Health Plan to Quality Excellence and Revenue Growth
Health plans often struggle to achieve performance goals due to limited resources, which can restrict their ability to execute critical quality improvement initiatives.
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Case Study: Health Plan Revitalization - A Strategic Oversight Program for a Leading Health Plan
For health plans, navigating the complexities of modern healthcare technology and operations is critical for sustainable success.
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Case Study: Strategic Stars Turnaround - How a Major Health Plan Stabilized Operations and Secured $1.5B in Revenue
In a dynamic healthcare environment, operational stability and continuous improvement are fundamental for health plans to ensure efficiency, effectiveness, and adaptability.
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White Paper: Turning Gaps into Solutions - Advancing Provider Tools for Quality Care
When measuring success, gaps in care can play an impactful role in HEDIS measure score. Closing gaps in care has a direct impact on HEDIS scores.
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HealthEdge Source™ Ranked Best in KLAS for Pre-Payment Accuracy and Integrity Solutions (Payer)
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White Paper: Getting Risk Adjustment Right - A Guide for Modern Health Plans
In 2024, Americans spent approximately $5.3 trillion on healthcare, about $15,474 per person, and healthcare expenditures accounted for 18.0% of the country’s GDP.
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Executive Discussion: Adopting an Ecosystem Operating Model and Measuring ROI
Part 2 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In the first...
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Executive Discussion: Preparing for the Future of Care Management with an Integrated Operating Model
Part 1 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In this...
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The Transformation Tipping Point: Why Health Plans Are Rethinking Operations
Health plans are heading into 2026 under a level of pressure that feels fundamentally different from just a few years ago. Findings from the HealthEdge® 2026 Healthcare Payer Survey Report, “The...
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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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Case Study: NorthWinds Achieves 90% Auto-Adjudication with HealthEdge
NorthWinds Technology Solutions, a premier technology provider for dentistry organizations, faced significant operational hurdles that yielded low auto-adjudication rates ...
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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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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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eBook: Navigating the New Medicare Advantage Reality - Why Member Engagement and the Right Platform Is Your Competitive Advantage
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Brochure: Dynamic Prospective Risk Adjustment for Advanced Provider Engagement
Empower your provider network with next-generation workflow integration and risk score accuracy
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