HealthEdge Source is the preeminent digital prospective payment integrity solution, specifically designed for health plans to revolutionize claims payment accuracy and integrity. The platform's core value proposition is shifting the payment integrity process from reactive, post-pay recovery to a smarter, proactive, pre-pay approach, which significantly reduces waste and lowers administrative costs.
The solution is a comprehensive, cloud-based platform that provides a single point of truth for both pricing and editing functions, empowering better decision-making and reducing reliance on post-adjudication vendors. HealthEdge Source offers a suite of specialized solutions:
- Reimbursement: Delivers, manages, and maintains accurate CMS pricing data and state-specific policies for Medicare, Medicaid, and Commercial claims.
- Editing: Features an advanced editing library with history-based capabilities, including reimbursement, clinical, and coding edits, alongside a user-friendly interface for custom edit creation.
- Analytics: Provides an embedded analytics suite with real-time insights, comprehensive financial impact modeling, and intuitive dashboards to identify claim errors early.
Target users are large to enterprise-level health plans (payers) looking to automate business workflows, ensure regulatory compliance, and achieve greater transparency and control over their payment integrity operations. The platform, originally launched as Burgess Source® in 2017, processes millions of claims and is continually enhanced with cutting-edge features, including agentic AI for payment integrity. It also offers a seamless Payer-Source Integration with HealthRules® Payer for continuous management of core administrative processes.
