healthedge-prospective-payment-integrity

JSON twin: https://www.healthaidb.com/software/healthedge-prospective-payment-integrity.json

Company Name

HealthEdge

Product URL

https://healthedge.com/solutions/prospective-payment-integrity/

Company URL

https://healthedge.com/

Categories

Summary

HealthEdge Source is a cloud-based prospective payment integrity (PPI) platform that automates claims editing, reimbursement/pricing, and real-time analytics to prevent improper payments before payout.

Description

HealthEdge Source combines Medicare, Medicaid, and commercial reimbursement engines, rich editing libraries (including history-based and custom edits), retroactive-change monitoring, real-time analytics and platform access to centralize claims pricing, reduce vendor dependency, improve transparency, and enable enterprise-level payment accountability and root-cause remediation.

Api Available

yes

Certifications

Company Founding

2005

Company Offices

Compliance

Customers

Data Residency

Supports deployment on public or private cloud (no region-specific residency details published)

Data Standards

Deployment Model

Features

Id

P0707

Integration Partners

Integrations

Languages Supported

Last Updated

2025-09-07

License

commercial proprietary

Links

Market Segment

Optional Modules

Os Platforms

Pricing Details

Contact vendor for licensing and implementation pricing; enterprise deployments with professional services and platform access; demo available.

Pricing Model

enterprise_quote

Privacy Features

Ratings

Regions Available

Release Year

2017

Security Features

Specialties

Support Channels

System Requirements

Cloud-hosted (supports public and private cloud deployments); no customer on-prem hardware specified

Target Users

Training Options

Type

product

User Reviews

Version

1.0

Canonical JSON

{
  "company_name": "HealthEdge",
  "company_url": "https://healthedge.com/",
  "company_offices": [
    "United States",
    "India"
  ],
  "company_founding": "2005",
  "product_url": "https://healthedge.com/solutions/prospective-payment-integrity/",
  "categories": [
    "administrative",
    "payment integrity",
    "claims editing",
    "reimbursement/pricing",
    "analytics",
    "payer-facing",
    "cloud",
    "artificial intelligence"
  ],
  "market_segment": [
    "enterprise",
    "health plan / payer"
  ],
  "links": [
    "https://healthedge.com/solutions/prospective-payment-integrity/",
    "https://healthedge.com/resources/data-sheets/healthedge-source-product-overview",
    "https://healthedge.com/resources/medicare/prospective-payment-integrity-brochure",
    "https://healthedge.com/solutions/prospective-payment-integrity/source-editing/",
    "https://healthedge.com/solutions/prospective-payment-integrity/source-analytics/",
    "https://healthedge.com/solutions/professional-services/",
    "https://healthedge.com/about-us/",
    "https://healthedge.com/contact-us/",
    "https://healthedge.com/resources/overwhelming-data/the-history-of-healthedge-source-the-payment-accountability-platform",
    "https://healthedge.com/resources/press-releases/transforming-payment-integrity-with-generative-artificial-intelligence-genai-healthedge-and-codoxo-announce-strategic-partnership"
  ],
  "summary": "HealthEdge Source is a cloud-based prospective payment integrity (PPI) platform that automates claims editing, reimbursement/pricing, and real-time analytics to prevent improper payments before payout.",
  "description": "HealthEdge Source combines Medicare, Medicaid, and commercial reimbursement engines, rich editing libraries (including history-based and custom edits), retroactive-change monitoring, real-time analytics and platform access to centralize claims pricing, reduce vendor dependency, improve transparency, and enable enterprise-level payment accountability and root-cause remediation.",
  "target_users": [
    "health plan payers",
    "claims processors",
    "payment integrity analysts",
    "reimbursement managers",
    "policy/editing teams",
    "operations leaders",
    "finance/BI teams",
    "IT/integration teams",
    "professional services/consultants"
  ],
  "specialties": [
    "payment integrity",
    "prospective/pre-pay editing",
    "reimbursement/pricing",
    "Medicare reimbursement",
    "Medicaid reimbursement",
    "commercial contract modeling",
    "claims editing",
    "retroactive change management",
    "analytics & BI",
    "vendor integration"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "enterprise_quote",
  "pricing_details": "Contact vendor for licensing and implementation pricing; enterprise deployments with professional services and platform access; demo available.",
  "license": "commercial proprietary",
  "deployment_model": [
    "cloud (public)",
    "cloud (private)",
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Pre-pay and post-pay claim editing",
    "CMS Medicare reimbursement management",
    "Medicaid reimbursement management",
    "Commercial contract configuration and modeling",
    "History-based editing library",
    "Custom edit development",
    "Retroactive Change Manager (automated monitoring and repricing)",
    "Real-time analytics and financial impact insights",
    "Platform access with transparency into payment workflow",
    "Centralized claims adjudication and business intelligence",
    "Integrated third-party content ecosystem",
    "Automated updates to pricing and rules"
  ],
  "optional_modules": [
    "Source Analytics",
    "Medicare Reimbursement module",
    "Medicaid Reimbursement module",
    "Commercial Reimbursement module",
    "Source Editing advanced tools",
    "Source Platform Access",
    "Professional Services"
  ],
  "integrations": [
    "HealthRules Payer (Payer-Source integration)",
    "American Society of Anesthesiologists (ASA) RVG",
    "Codoxo",
    "Concert Genetics",
    "Fair Health",
    "MediQuant",
    "RJ Health (drug pricing - AWP/ASP/WAC)",
    "3M / Solventum",
    "Generic: third-party pricing and editing content providers"
  ],
  "data_standards": [],
  "api_available": "yes",
  "system_requirements": "Cloud-hosted (supports public and private cloud deployments); no customer on-prem hardware specified",
  "compliance": [],
  "certifications": [],
  "security_features": [],
  "privacy_features": [],
  "data_residency": "Supports deployment on public or private cloud (no region-specific residency details published)",
  "customers": [
    "SummaCare",
    "WEA Trust",
    "Medica"
  ],
  "user_reviews": [
    "HealthEdge is very eager and flexible. They will do any payment...",
    "HealthEdge Source is a highly integrated system. The good thing about...",
    "I would like HealthEdge to focus on payment integrity and claims...",
    "It would be nice if HealthEdge priced things together. I work with a...",
    "One thing I like is that HealthEdge is not like a typical vendor that..."
  ],
  "ratings": [
    "KLAS Research — HealthEdge Source 2023 (KLAS report available)",
    "G2 — HealthEdge Software (vendor page listing product reviews)",
    "Glassdoor — HealthEdge employee rating ~3.5/5 (company-level)"
  ],
  "support_channels": [
    "email",
    "phone",
    "ticketing",
    "webinars",
    "professional_services"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "professional_services"
  ],
  "release_year": "2017",
  "integration_partners": [
    "Codoxo",
    "Gynisus",
    "The Burgess Group (Burgess Source acquisition)",
    "SoftwareOne"
  ],
  "id": "P0707",
  "slug": "healthedge-prospective-payment-integrity",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-09-07",
  "links_json": {
    "self": "https://www.healthaidb.com/software/healthedge-prospective-payment-integrity.json"
  }
}