List of HealthEdge Source Customers
Burlington, 1803, MA,
United States
Since 2010, our global team of researchers has been studying HealthEdge Source customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased HealthEdge Source for Payment Integrity from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using HealthEdge Source for Payment Integrity include: Blue Cross and Blue Shield of Nebraska, a United States based Insurance organisation with 1600 employees and revenues of $720.0 million, Highmark Wholecare, a United States based Insurance organisation with 1000 employees and revenues of $150.0 million, SummaCare, a United States based Insurance organisation with 300 employees and revenues of $43.0 million, Community Health Options, a United States based Insurance organisation with 170 employees and revenues of $22.0 million and many others.
Contact us if you need a completed and verified list of companies using HealthEdge Source, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The HealthEdge Source customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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Blue Cross and Blue Shield of Nebraska | Insurance | 1600 | $720M | United States | HealthEdge Software | HealthEdge Source | Payment Integrity | 2024 | n/a |
In 2024, Blue Cross and Blue Shield of Nebraska implemented HealthEdge Source to support Payment Integrity for Medicare Advantage claims processing. The engagement included a defined contract period from January 2024 through December 2024 with ITS Medicare Advantage Consultant activity to support implementation, testing, and operational handoff.
The implementation centered on HealthEdge Source as the payment integrity and claims orchestration platform, with configuration work focused on claims edit mapping, adjudication rule configuration, compliance validation, and reporting workflows. Project activities included testing and configuration of Source modules, iterative edit mapping exercises, and documentation of optimal processing steps to support accurate and compliant claims handling.
Integrations were executed between HealthEdge Source and Health Rules Payor, HRP, with regular edit mapping exercises to ensure data consistency and processing alignment across systems. The program required coordination between internal teams in testing, configuration, and operations, and engagement with external vendors and partners to validate end to end functionality and system interfaces for Medicare Advantage claims.
Governance activities emphasized CMS compliance and Medicare Advantage program policies, including reviews of CMS Transmittals and Inter Plan Medicare Advantage Program Policies and Provisions IPP. The ITS consultant work included oversight to ensure accurate, complete, and compliant processing, identification and implementation of process improvements, resolution of claims discrepancies, and contribution to program documentation and reporting, supporting a successful implementation of HealthEdge Source for Payment Integrity.
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Community Health Options | Insurance | 170 | $22M | United States | HealthEdge Software | HealthEdge Source | Payment Integrity | 2023 | n/a |
In 2023, Community Health Options implemented HealthEdge Source to support Payment Integrity. The initiative centered on deploying HealthEdge Source to centralize claims review and payment accuracy functions across the insurer's claims operations and payment integrity teams.
HealthEdge Source was configured to leverage a rules engine for systematic claim screening, automated adjudication pathways, exception routing for manual review, and persistent audit trails to support detection of improper payments and potential recoveries. The implementation included configuration patterns for provider data validation and alignment with the organization’s credentialing and enrollment controls, reflecting the team’s focus on data integrity and plan configuration.
Governance emphasized plan configuration ownership and iterative rule management, with the Sr. Manager, Health Plan Configuration named as a configuration lead and handoffs established to claims examiners and payment integrity analysts. Operational rollout prioritized change control, rule tuning workflows, and cross-functional coordination among claims, provider services, and enrollment to embed Payment Integrity controls alongside plan configuration and credentialing practices.
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Highmark Wholecare | Insurance | 1000 | $150M | United States | HealthEdge Software | HealthEdge Source | Payment Integrity | 2024 | n/a |
In 2024 Highmark Wholecare implemented HealthEdge Source as part of a coordinated, multi-state initiative alongside Delaware Health Options and West Virginia Health Options to strengthen Payment Integrity across Medicaid and Dual Special Needs Plans. The deployment targeted operational claims processing for more than 450,000 lives in Delaware, Pennsylvania, and West Virginia, with a focus on increasing auto-adjudication and improving claims accuracy across those business lines.
HealthEdge Source was implemented in tight integration with HealthEdge HealthRules Payer to centralize payment accuracy workflows and enable configurable medical policy edits. Teams configured plan-specific policy edits and an uncommon family-type accumulator within HealthRules Payer, demonstrating the combined solution set’s configurability and the ability to embed complex medical policy logic directly into the claims editing and payment integrity layer.
Operational integrations included automated receiving workflows, the ingestion of enrollment data to support Medicaid redetermination activities, and the incorporation of third-party liability and coordination of benefits data into claims processing. These integrations were applied across Medicaid operations in the three states to reduce downstream rework, lighten adjustment team workloads, and support first pass correct claim processing through the coordinated HealthRules Payer and HealthEdge Source workflow.
Governance and process changes emphasized in-plan configuration ownership and audit readiness, leveraging HealthEdge Source to instrument payment integrity controls and HealthRules Payer to manage evolving state rules. Reported outcomes included higher auto-adjudication rates moved into the top quartile and resulting administrative savings, reflecting improved claims accuracy and reduced reprocessing for Medicaid operations.
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Insurance | 300 | $43M | United States | HealthEdge Software | HealthEdge Source | Payment Integrity | 2021 | n/a |
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