BOSTON, Oct. 01, 2026 (GLOBE NEWSWIRE) — HealthEdge®, the AI-powered operational infrastructure for health plans, today introduced a newly unified platform and portfolio of integrated solutions that are designed to deliver measurable financial outcomes. The launch reflects the continued evolution of HealthEdge following its merger with UST HealthProof, bringing advanced payer technology together with implementation and operational expertise in a seamless offering. By aligning software, delivery and ongoing execution, HealthEdge is taking greater responsibility for modernizing health plan operations and the financial and operational performance that follows.
Health plans face growing pressure to replace fragmented legacy systems, operate more efficiently and respond faster to regulatory changes, market conditions and member expectations. Yet traditional modernization programs can require health plans to accept years of implementation risk, unpredictable expenses and continued dependence on disconnected systems and vendors. HealthEdge offers a more accountable path by connecting data, technology and execution across core health plan operations. With an established track record of successful implementations and 110 million covered lives served across the health care ecosystem, HealthEdge combines proven operating experience with a modern platform, built for scalability and AI at its core, to apply automation and drive continuous improvements that compound over time.
“Health plans know they need to modernize, but they should not have to accept open-ended costs and operational disruption as the price of change,” said Kevin Adams, CEO of HealthEdge. “By bringing technology, implementation and operations together, we’re able to define the financial commitment upfront, assume more of the risk, and stand behind our guarantee of delivering cost savings in the range of 25 to 40% for qualifying engagements. That’s the accountability health plans deserve from a transformation partner.”
Financial Accountability from the Outset
HealthEdge establishes the foundation for an enduring financial edge at the outset of each engagement. This starts by developing a clear view of a payer’s current operating costs, workflows and performance, and is followed by identifying opportunities to reduce administrative expense, improve accuracy and automate work. Performance commitments are tailored to this evaluation with an agreed per-member-per-month (PMPM) operating cost for qualifying engagements. Through its Enduring Edge BPaaS delivery model, HealthEdge shares financial risk for implementation and operation, aligning with a health plan’s goals of reducing cost and improving efficiency, and, in qualifying engagements, delivering 25-40% in total cost savings backed by SLA-enforced contractual commitments.
One Platform Spanning Critical Health Plan Operations
HealthEdge combines flexible delivery models with an integrated suite of software solutions to transform payer operations, connecting data, workflows and performance across the health plan enterprise. Instead of relying on untested homegrown systems or separate vendors for individual functions, payers gain a coordinated foundation that can improve efficiency, reduce operational friction and strengthen financial performance.
The newly unified HealthEdge portfolio includes:
Delivery Models
- Enduring Edge (Business Process as a Service) – A full-service performance partnership that integrates HealthEdge’s AI-powered technology platform with end-to-end operational execution: reducing costs, managing risk, and delivering sustained financial improvements that compound over time.
- Integration Edge (Ecosystem Platform as a Service) – A risk-free implementation model that connects HealthEdge’s technology, workflows, and domain expertise into a single operating environment: accelerating measurable performance improvement without requiring full operational support.
Solutions
- HealthRules® Edge (formerly HealthRules Payer) – A cloud-native core administrative processing system built on more than two decades of expertise to power accurate, efficient claims administration for health plans of every size with AI embedded directly into claims workflows.
- Payment Accuracy Edge (formerly HealthEdge Source™) – Prospective payment integrity and accuracy capabilities that unify claims pricing, editing and real-time analytics in one streamlined platform to ensure accurate payments for continuous cost containment.
- Clinical Edge (formerly GuidingCare®) – An integrated care management platform that streamlines workflows, supports better care-quality outcomes and helps manage costs.
- Provider Atlas Edge (formerly HealthEdge Provider Data Management) – A centralized, reliable source of provider information that reduces operational friction, administrative risk and compliance exposure across the health plan ecosystem.
- Revenue Align Edge (Prospective and Retrospective Risk Adjustment solutions) – Real-time prospective and retrospective risk adjustment solutions that provide a clearer, data-driven view of risk across the health plan enterprise, supporting proactive management and stronger compliance.
Health plans can deploy the components of the platform they need today and incorporate capabilities from HealthEdge and its ecosystem of partners as needed. This integrated technology foundation is designed to reduce fragmentation while supporting evolving business needs.
A Platform Built for Scale with AI Embedded at its Core
HealthEdge embeds AI directly into the systems of record and everyday workflows that run health plan operations. This approach allows AI to work within the operational context of claims, payments, care management, provider management, and risk adjustment to access the information used by health plan teams, assist with decisions and support action without creating another disconnected technology layer. By combining intelligent automation with the rules, controls and data that govern critical operations, HealthEdge can connect AI adoption directly to measurable improvements in cost, accuracy and speed.
The HealthEdge platform is engineered to deliver AI-powered operations at scale and exceed the demands of the nation’s largest health plans. Working with Amazon Web Services, HealthEdge has demonstrated that a single instance of HealthRules Edge can process the claims volume of a health plan with more than 40 million members while reducing latency for key transactions by more than 50%. With cloud infrastructure that scales dynamically alongside transaction volume, the platform gives health plans the capacity to support membership growth, rising claims complexity and expanding business needs without sacrificing performance or reliability.
HealthEdge’s model is already delivering results at scale today. The platform supports six of the nine largest national health plans, along with regional and local payers nationwide. For more information on the HealthEdge platform and solutions that reach across the health plan enterprise, visit healthedge.com.
About HealthEdge
HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. Combining an integrated technology platform across claims administration, payment integrity, care management and more, with its Enduring Edge BPaaS delivery model, HealthEdge harnesses AI to drive measurable financial outcomes that compound over time, enabling payers to not just reduce costs, but execute better across every critical operation. This gives modern payers the speed and flexibility they need to compete. For more information, visit www.healthedge.com.
Media Contacts
HealthEdge Communications Team
pr@healthedge.com
