HealthEdge

HealthEdge, founded in 2005 and headquartered in Burlington, Massachusetts, builds software for health plans. Its core product, HealthRules, is a patented administrative processing system that handles claims and transaction automation for insurers; the company says the product suite was built on more than $125m of acquired intellectual property. The system is intended to let plans bring new products to market quickly and shift their business models, work that touches core administrative processing, real-time transaction handling and payment integrity.

Three further products have been added through acquisitions. Source, from The Burgess Group, covers payment integrity; GuidingCare, from Altruista Health, covers care management; and Wellframe provides digital member engagement. The company organises its technical work around four areas: touchless transaction processing, prospective payment integrity, care integrity and AI-driven business intelligence. Engineering problems span claims adjudication at scale, transaction automation and real-time engagement platforms linking payers, providers and patients.

HealthEdge reports more than 130 health plan customers covering over 110m lives across 48 U.S. states. Its stated objectives are to reduce administrative costs and improve clinical outcomes, and to help plans act as partners in care delivery rather than payers alone.