Dynamic state-by-state regulatory and payment environments make it challenging to stay up to date – and even the best programs are still sacrificing accuracy. HealthEdge Source™ Medicaid Reimbursement requires no research, no maintenance and no IT lift from your organization – finally making accuracy easy. By delivering, managing and maintaining accurate and compliant state-specific pricing data, we’re helping payers establish a solid foundation to pay more accurately and efficiently. Our solution is uniquely designed to integrate policy edits, pricing algorithms, and rate schedules and process them in parallel to improve accuracy and increase speed. Our depth of content includes all provider types and settings, eliminating the need to piece together multiple data sources so you can ensure Medicaid payment integrity and pay claims accurately, quickly and comprehensively – the first time.

Features

Medicaid Content

HealthEdge Source subject matter experts research, develop and maintain full coverage of state-specific Medicaid reimbursement rates and payment policy for all provider types.

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.

Parallel Processing

HealthEdge Source offers integrated claims processing in parallel with policy edits, pricing algorithms, and rate schedules covering all Medicare markets in the United States for comprehensive reimbursement - enabling faster processing of claims with a single API call.

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.

CMS Reference Tool

Our CMS data reference tool provides a source of truth for all payment policies and edits with comprehensive policy explanation.