Case Study: Elderplan lowers administrative costs and boosts efficiency with HealthEdge HealthRules Payer

Elderplan uses HealthRules® Payer to Lower Administrative Costs, Maximize Operational Eciency, and Be Resilient to Change

Elderplan, a not-for-profit health plan organization based in New York, faced the challenge of high administrative costs and operational inefficiency due to a heavy reliance on manual claims adjudication. This process required significant manpower and led to tens of thousands of claims needing manual adjustments each month. To become more productive and control costs, they turned to HealthEdge and its HealthRules Payer solution.

HealthEdge implemented its HealthRules Payer solution to automate key processes and improve operational cohesiveness. The results were significant, including over $1.6 million in administrative savings and a dramatic revenue increase from a $28 million loss to a $20 million gain. The solution also led to a 96% increase in auto-adjudication rates for Medicare claims and a 95% decrease in pending claims, providing the resiliency needed to quickly adapt to regulatory changes during the COVID-19 pandemic.

Elderplan

Daniel Ramos

Assistant Director