Case Study: a top-15 insurance company reduces erroneous claims and saves millions with HealthEdge payment integrity

Top-15 Insurance Company - Customer Case Study

A top-15 insurance company sought to grow its government business and streamline operations but required a fully automated claims reimbursement process to succeed at scale. To meet this challenge, they partnered with HealthEdge and implemented its Software as a Service (SaaS) payment integrity platform.

HealthEdge executed a multi-stage rollout of its solution, which expanded from existing use cases to include Medicaid and dual-eligible programs. The implementation was highly successful, automating the claims process and becoming the client's source of truth. HealthEdge's solution decreased erroneous claims by approximately 800,000 per year, saving an estimated $4 million annually, while automated pricing saved $6-12 per claim and reduced IT overhead by $350-500K each year.