Medicare

eBooks: CMS Transparency in Coverage Rule

The Transparency in Coverage Guide (CMS-9915-F) is a pivotal regulation aimed at increasing transparency in healthcare pricing, enabling consumers to access price information before receiving services

HealthEdge Source: Data Reference Module

Data Reference, which can be accessed through your instance of Source, provides insight into any current or historical fee schedules, rates, payment policies, and provider-level data.

Data Sheet: Navigating the No Surprises Act - The Right Tools for Health Plan Success

The No Surprises Act (NSA) marks a significant regulatory milestone aimed at protecting consumers from surprise medical bills and enhancing transparency in healthcare.

Data Sheet: Configuration as a Service Expedites Time-to-Value for Health Plans

HealthEdge's Configuration as a Service optimizes HealthRules® Payer system configurations, accelerating time-to-value for health plans.

Data Sheet: HealthEdge Source: Software for Health Plans With Home & Host Capabilities

Brochure: Value-Based Care - Health Plans With Home & Host Capabilities Are Market Leaders

In our work with HealthRules® Payer clients, we have gained first-hand experience, supporting these plans with the technology they need to lead value-based care and healthcare transformation.

Data Sheet: HealthRules Payer Benefits - Resiliency to Change (PDF)

Data Sheet: Platform Access Delivers a Transformative Approach to Payment Integrity

Data Sheet: Optimize Payment Accuracy with History-Based Editing

As more contracts and policies shift toward value-based care and billing requirements, evolve, the opportunities for inaccurate payments increase...

Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report (PDF)

HealthRules Payer has been named “Best in KLAS” by KLAS Research for Claims & Administration Platforms for the second year in a row.

White Paper: Prospective Payment Integrity Moving from Pay and Chase to Predictive

This Spotlight examines payer payment integrity platforms and how payers can aggressively apply analytics and coordinate workflows to move "left" from reactive postpay to proactive, predictive prepay.

Infographic: Top 9 Reasons More Payers Choose GuidingCare Than Any Other Care Management System

This infographic sheds a light on the key benefits GuidingCare has to offer- and what makes us different; from clinical expertise and operational efficiency to ease

Data Sheet: Source Claims Modeling

HealthEdge Source™ (Source) contract modeling solution empowers health plans to leverage modeling of historical claims data.

Data Sheet: GuidingCare Utilization Management

Data Sheet: HealthRules Payer + Source Integration

Data Sheet: GuidingCare Appeals & Grievances