Case Study: a not-for-profit Medicare company achieves scalable growth with HealthEdge

Modernizing with HealthEdge® to Drive Expansion

A not-for-profit Medicare company faced significant challenges due to its outdated core administrative processing system, which limited its agility for expansion, incurred high maintenance costs, and struggled with cumbersome payment integrity processes. To support its growth strategy into new states and commercial and Medicaid lines of business, the company selected HealthEdge and implemented its HealthRules Payer platform integrated with the HealthEdge Source payment integrity solution.

By implementing HealthEdge's solutions, the company modernized its operations. The integrated platform provided the agility to expand into new markets and significantly improved auto-adjudication rates to over 90% with 99% accuracy. HealthEdge enabled the company to reduce costs, simplify complex editing processes, and improve payment accuracy through native integration and automated content updates, positioning it well for future growth and regulatory changes.