Articles from HealthEdge

HealthEdge®, a leading provider of next-generation core administrative processing systems (CAPS) and care management solutions, today announced that it is migrating its operations to AWS (Amazon Web Services) and integrating generative artificial intelligence (AI) and agentic systems into the core of its operations, products, and infrastructure. Loka, AWS partner of the year in 2024, will use Amazon Bedrock to build and scale generative AI applications that help transform HealthEdge into an AI native enterprise and deliver new efficiencies for its business, products and customers.

HealthEdge®, a leading provider of next-generation core administrative processing systems (CAPS) and care management solutions for healthcare payers, today announced the integration of the Gynisus advanced artificial intelligence (AI) platform into the leading payment integrity solution, HealthEdge Source™. This enhancement makes agentic AI fully accessible through HealthEdge Source, bringing seamless deployment, high configurability, and payer-centric automation under one roof.

HealthEdge®, a leading provider of next-generation core administrative processing systems, payment integrity, and care management solutions, unveiled its HealthEdge Provider Data Management platform that empowers health payers to automate the tedious, yet critical task of maintaining accurate and updated information on healthcare providers. The company also announced the first deployment of HealthEdge Provider Data Management with PEHP Health & Benefits, a division of the Utah Retirement Systems that provides medical, dental, life, and long-term disability insurance plans to public employees.

HealthEdge®, a leading provider of next-generation core administrative processing systems (CAPS) and care management solutions, and Unite Us, the nation’s leading technology partner for social care transformation, are partnering to empower health plans with the tools to deliver seamless, whole-person care at scale. This collaboration addresses the Social Determinants of Health (SDOH) needs of members by leveraging the SMART on FHIR interoperability standard. HealthEdge’s GuidingCare® integrates with the Unite Us platform to connect members with essential SDOH resources, such as food and housing services.

HealthEdge®, a leader in next-generation health management solutions, achieved its 5th consecutive NCQA HEDIS® Allowable Adjustment (AA) certification for a select group of measures for Measurement Year 2024. This certification underscores HealthEdge's commitment to its GuidingCare® customers by empowering them to effectively assess and enhance the quality of care and services delivered to their members.

HealthEdge® and Codoxo announce a strategic partnership to provide healthcare payers with the industry’s most cutting-edge solutions and services. This partnership will streamline and enhance their respective end-to-end payment integrity processes by leveraging HealthEdge Source™ in conjunction with Codoxo’s GenAI-driven Unified Cost Containment Platform. By joining forces to deliver an end-to-end payment integrity solution, healthcare payers will benefit from the ability to consolidate vendor solutions, improve data integrity, and accelerate time-to-value.

HealthEdge, a visionary leader in the healthcare technology industry, proudly announces the opening of its new office in Bangalore. This strategic expansion underscores HealthEdge’s commitment to fostering innovation and improving the healthcare industry. This move to an expanded workspace in Bangalore, one of three HealthEdge locations in India alongside its Hyderabad and Pune offices, contributes to growing the company's global footprint and reinforcing its dedication to the Indian market.

HealthEdge®, a leader in healthcare technology solutions, has released its annual survey of the healthcare payer market revealing the top priorities, investments, and challenges for the coming year. The survey, of more than 450 executives, found that health plans are prioritizing enhancements to integrated solutions or services (62%), digital transformation or technology upgrades (49%), and new product lines (47%).

HealthEdge and Zelis have announced a strategic partnership aimed at modernizing the healthcare payment landscape. The collaboration will leverage HealthEdge's next generation core administrative processing system (CAPS) and the Zelis Advanced Payments PlatformSM (ZAPP) to enhance the efficiency, accuracy, and transparency of healthcare payments.

HealthEdge, a leader in healthcare technology solutions, welcomes Robert Duffy as its new Chief Technology Officer (CTO), marking a transformative moment for the company. With a proven history of developing large-scale integrated platforms at industry giants like Salesforce, Amazon, and Expedia, Duffy is set to elevate HealthEdge's cross-product engineering team to a new level of interoperability, scalability, and innovation.

HealthEdge, a next-generation healthcare SaaS company, today released a substantial consumer survey of 3,500 healthcare members to gain insights into their challenges and evolving expectations. Most health plan members (<86%) are ‘very satisfied’ or ‘satisfied’ with their insurers, but one-third of respondents are likely or very likely to switch insurers next year.

HealthEdge, a next-generation healthcare SaaS company, today released its annual survey of the healthcare payer market. The survey features insights from over 350 US health plan executives and reveals top-of-mind objectives in 2024.

HealthRules® Payer from HealthEdge has been recognized for the third straight year as the “Best in KLAS” Claims & Administration Platform by KLAS Research in its 2024 healthcare software and services report. The report recognizes the software platforms ranked #1 in software categories based on the feedback of healthcare professionals and clinicians through 25,000 interviews across more than 4,500 organizations.

Next-generation healthcare SaaS company HealthEdge® is recognized in three categories of the Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2023 report. The report names HealthEdge a Sample Vendor for Next-Gen Core Administrative Processing Solutions, Prospective Payment Integrity Solutions and AI-Enabled Fraud Detection. According to the report, “U.S. healthcare payer chief information officers (CIOs) should use this to plan new and manage existing investments for business optimization and transformation.”

Next-generation healthcare SaaS company HealthEdge® today announced the release of a first-of-its-kind application that makes running a health plan faster and easier than ever. The web-based configuration management tool HealthRules® Promote is available to all HealthRules Payer customers.

New research released today by next-generation healthcare SaaS company HealthEdge reveals that only 45% of healthcare consumers are fully satisfied with their health insurance. In a survey of more than 2,800 participants, an overwhelming 55% of beneficiaries want more from their health plan — signaling shortcomings in payers’ ability to provide personalized care.

Next-generation healthcare SaaS company HealthEdge® today announced that its flagship solution, HealthRules® Payer, has been selected as the winner of the Best Core Administrative Processing System 2023 MedTech Breakthrough Award. The independent market intelligence organization selected HealthEdge from more than 4,000 nominations for its prestigious annual awards program honoring top companies in the global health and medical technology market.

Next-generation healthcare SaaS company HealthEdge® announced its flagship solution, HealthRules® Payer, earned Best in KLAS recognition for the second year in a row. The 2023 KLAS Research designation reflects the application's #1 ranking among all fully rated payer claims and administration platforms. KLAS rankings are based on the opinions of healthcare professionals in more than 4,500 organizations.

HealthEdge announced today that Heather Bender has joined the company as Chief People Officer, overseeing the global Human Resources function. Bender brings over 25 years of experience in HR leadership to HealthEdge, with an emphasis on global workforce planning, talent management and culture development.

HealthEdge, a next-generation healthcare SaaS company that provides a digital foundation for healthcare payers, today announced the expansion of Dr. Sandhya Gardner’s role from Chief Medical Officer, Wellframe to Chief Medical Officer, HealthEdge Clinical Solutions.

HealthEdge today said it has again been mentioned as a Sample Vendor for both its Core Administrative Processing (CAPS) and Prospective Payment Integrity (PPI) solutions in the Gartner Hype Cycle for U.S. Healthcare Payers, 2022.i This year is the 12th in a row for HealthEdge to be mentioned as a CAPS Sample Vendor and the fourth consecutive year to be mentioned as a PPI Sample Vendor (formerly Burgess Source).

HealthEdge, a next-generation healthcare SaaS company that provides a digital foundation for healthcare payers, today released results of its annual Voice of the Market: 2022 Digital Transformation Survey. The survey reflects the opinions of over 300 respondents from a wide range of payer types, with the purpose to help health plan leaders better understand what is top of mind among their peers and what health plans are doing to keep up with today’s highly dynamic and challenging market and regulatory environment.

HealthEdge announced today that veteran Alan Stein has joined the company as Chief Commercial Officer, responsible for go-to-market strategy, customer growth, and adoption of the HealthEdge Digital Platform. Stein brings more than 25 years of experience in healthcare technology to HealthEdge, with a strong emphasis on marketing, strategy, commercialization, customer success, and corporate development.

HealthEdge announced two strategic additions to its sales leadership: Matt Francis, Senior Vice President, HealthRules Payor Sales, and Jeff Jacobs, Senior Vice President, Source Sales. They will be responsible for driving new customer growth and adoption of the HealthEdge Digital Platform, a suite of cloud-based SaaS applications for core administration (HealthRules Payor), payment integrity (Source), care management (GuidingCare), and digital health management (Wellframe). The expansion of the sales team will enable the company to meet the increasing demands of regional and national health plan customers.

HealthEdge said today it has formed a strategic partnership with CitiusTech for joint go-to-market implementation and consulting services for HealthEdge solutions in core administration, care management and payment integrity to health plans pursuing value-based care and streamlined operations.

HealthEdge Software, Inc.® (“HealthEdge”), provider of the industry’s leading next-gen integrated solution suite for health insurers, has completed its previously announced acquisition of Wellframe Inc. (“Wellframe”), a leading digital health management platform. As part of the transaction, HealthEdge is pleased to welcome new investors, including Coatue, HLM Venture Partners, and BlueCross BlueShield Venture Fund.

HealthEdge announced today its Burgess Source® payment integrity solution has earned Certified status for information security by HITRUST. HITRUST CSF Certified status demonstrates that the HealthEdge Source solution meets key regulations and industry-defined requirements and is appropriately managing risk.

HealthEdge Software today said it is excited to upgrade long-time Altruista Health customer Colorado Access to a fully integrated ecosystem with the addition of HealthRules Payor® (HRP) to its operations via HealthEdge’s complementary Business Process as a Service (BPaaS) partner, UST HealthProof, a UST company. Colorado Access has relied on Altruista’s GuidingCare® care management platform to manage plan members for more than a decade, and is now poised for a major transformational effort to integrate the HealthEdge solution in core administrative processing. It will be one of the first health plans to adopt all three HealthEdge solution suites as it adopts Burgess Source® payment integrity software in 2022.

HealthEdge executive and co-founder of Altruista Health, Ashish Kachru, has been named the 2021 “Best Tech Manager” for the Washington, DC, region by the 7th Annual Timmy Awards. The Timmy Awards recognize tech executives and visionaries who “personify leadership, innovation and positive influence, going beyond the required duties of a manager to empower their teams in a changing world.”

HealthEdge today announced two key additions to its leadership team to help lead the journey in serving customers at an enterprise scale. Anshul Pande joins HealthEdge as Senior Vice President of Research and Development, and Angelo Devita joins the organization as Vice President of Enterprise Account Management. HealthEdge provides modern technology solutions that health plans use to innovate around new business models, improve outcomes, reduce administrative costs, and delight members.

HealthEdge Software said today it has been named a Sample Vendor for the Next-Generation Core Administrative Systems category in the Gartner “Hype Cycle for U.S. Healthcare Payers, 2021” i report for the 11th consecutive year. HealthEdge provides mission-critical HealthRules Payor® CAPS solution to healthcare payers. It enables them to seamlessly and efficiently administer benefits, configure plans, manage providers and enroll participants.

HealthEdge®, a healthcare innovator providing next-generation technology and solutions, announced today that Ryan Mooney has joined the company as Executive Vice President and General Manager for its Payment Integrity product division. Burgess Source® is an innovative payment integrity software solution that improves healthcare payment operations for payers.

HealthEdge Software, Inc.® ("HealthEdge"), a leading provider of next-generation technology solutions for healthcare payers and plan administrators across core administrative processing systems, payment integrity, and care management, announced today the results of its Voice of the Market Survey: Market Pressures Shifting Priorities for Health Plan Executives (“survey”). The survey reflects the opinions of over 200 health insurance executives weighing in on the challenges and benefits impacting their key constituents. Survey results can be downloaded on the HealthEdge website.

HealthEdge Software, Inc.® (“HealthEdge”), a leading provider of next-generation technology for healthcare payors and plan administrators across core administrative processing systems, payment integrity, and care management, announced today the addition of Matt McLaughlin as the company’s new Chief Financial Officer (CFO). HealthEdge is the health insurance industry’s first digital nervous system that provides automation and seamless connectivity between all aspects of a payor’s administrative and clinical systems.