HealthEdge Source™ is a prospective commercial reimbursement solution designed specifically to enable payers to pay claims accurately, quickly and comprehensively – the first time. Our transformative solution sets a new standard for reimbursement across your organization, equipping you with up-to-date regulatory data, claims pricing and editing in a single pass, flexible contract configuration, and accurate modeling capabilities – all within a single IT ecosystem. Our Commercial Reimbursement solution radically reduces contract maintenance by up to 90%, minimizing strain while optimizing results for your organization.

Features

Cloud-Based

As a cloud-based solution, HealthEdge Source was designed to automatically deliver IT infrastructure and content updates every two weeks – reducing IT lift organization-wide.

Customized Pricing

User-driven customization allows users to freeze rates, establish unlimited payment carveouts, and accommodate complex scenarios.

Enterprise Benchmarking

Reprice every production claim at any frequency in a post-return analytics queue and create a 100% Medicare baseline result grouped by dozens of categories in multi-dimensional reports.

Production Metrics

Real-time production metrics include data on claims volume and financial impact of edits, among other items, to give you an up-to-date snapshot of your claims operations.

Financial Impact Analysis

Evaluate financial performance of configurations against various standards, including impact of edits in production for enhanced automation.

Workflow Capabilities

Natively manage interoperability between claims editing, pricing and business intelligence reporting.

Audit Support

Our Advanced Audit Trail tracks all edits and prices and provides supporting documentation including date-time stamped rules for comprehensive assistance with provider, security and compliance inquiries.