Case Study: a large national health insurer streamlines claims payments and saves millions with HealthEdge Source

Helping the organization manage payments across lines of business, at scale

A large national health insurer with over 6 million members was facing challenges due to a legacy claims system that could not handle the complexities of new government programs. The system required slow, expensive IT configuration for each change and struggled with keeping pricing data in sync. To support growth and streamline operations, the insurer partnered with HealthEdge to implement its Source Payment Integrity solution for payment automation, modeling, and auditing.

HealthEdge implemented a multi-stage plan to transition payment operations, automating the claims reimbursement process with tools that handle complex situations and custom payment formulas. This solution increased auto-adjudication and accuracy while decreasing manual processing. As a result, the insurer now processes over 1,000,000 claims per month automatically, saves millions of dollars annually, and has improved provider relationships. The successful 23+ year relationship with HealthEdge has expanded across multiple lines of business.