HealthEdge Named a Sample Vendor for Next-Gen Core Administrative Processing and Prospective Payment Integrity Solutions in the Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2022

HealthEdge today said it has again been mentioned as a Sample Vendor for both its Core Administrative Processing (CAPS) and Prospective Payment Integrity (PPI) solutions in the Gartner Hype Cycle for U.S. Healthcare Payers, 2022.ⁱ This year is the 12^th in a row for HealthEdge to be mentioned as a CAPS Sample Vendor and the fourth consecutive year to be mentioned as a PPI Sample Vendor (formerly Burgess Source).

“We are excited to be recognized by Gartner yet again for these solutions in our next-gen SaaS product suite,” said Alan Stein, Chief Commercial Officer for HealthEdge. “The industry is embracing digital-based technologies that drive cost savings for health plans while enhancing the evolution of customer engagement. HealthEdge is building on its unique value proposition as an integration solution that enables clients to reduce administrative spend and allows them to focus on strategic organizational goals like client adoption/satisfaction and care programs that promote health and well-being.”

Per the Gartner report: “CAPS modernization is a payer strategic imperative that delivers operational improvements and administrative cost savings through increased efficiency and accuracy, freeing funds and resources for innovation. Monolithic legacy CAPS hinder business leaders’ ability to bring new products to market quickly or support regulatory changes. Next-generation CAPS is an incremental step toward composable architecture – offering modern architecture, flexible delivery models and robust integration options.”

HealthRules^® Payor is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. Health plans have used it for more than a decade to quickly address market opportunities and stay in front of their competition. The solution is unique in its use of a patented, English-like vernacular that delivers a revolutionary approach to configuration, claims processing and transparency of information.

Also per the Gartner report: “PPI solutions mitigate a broad range of potentially improper claims payment activities – spanning revenue integrity, payment accuracy and FWA prevention solutions – by identifying, and correcting for, claims inaccuracies prior to claims payment. The Department of Health and Human Services estimated it paid more than $153 billion in healthcare claims improperly in 2021 and the Department of Justice recovered over $5 billion in fraudulent claims.”

The Source platform provides an interoperable, cloud-based solution designed to deliver rich pricing and editing content, with technology that enables payers to address root-cause issues and unparalleled transparency for control over their payment integrity operations. Its position as a pricer ensures that reimbursement and configurations are accurate, reducing downstream needs for editing suites.

ⁱGartner, “Hype Cycle for U.S. Healthcare Payers, 2022,” Mandi Bishop and Connie Salgy, July 2022.

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About HealthEdge

HealthEdge^® strives to innovate a world where healthcare can focus on people, advancing a digital revolution in healthcare through transaction automation and enabling real-time business and clinical engagement among payers, providers and members. HealthEdge pursues this mission through the delivery of the HealthEdge Digital Platform, consisting of the health insurance industry’s leading cloud-based SaaS applications for core administration (HealthRules^® Payor), payment integrity (Source), care management (GuidingCare^®), and digital health management and consumer engagement (Wellframe). Offered individually and as an integrated suite, HealthEdge Digital Platform applications provide modern, disruptive healthcare IT solutions that enable health insurers to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect key stakeholders in the healthcare delivery cycle. Follow HealthEdge on Twitter or LinkedIn.

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