Overview

HealthEdge® announced the launch of a unified, AI‑powered operational platform for health‑plan insurers, released simultaneously from Bengaluru, Karnataka, India and Boston, United States. The announcement follows HealthEdge’s recent merger with UST HealthProof, bringing together advanced payer technology and implementation expertise into a single offering.

Financial Commitment and Guarantees

The company states that for qualifying engagements it will define a per‑member‑per‑month (PMPM) operating‑cost target and, through its Enduring Edge Business Process as a Service (BPaaS) model, assume implementation and operational risk. HealthEdge guarantees total cost savings of 25 % to 40 % for these engagements, with the savings commitment enforced by service‑level‑agreement (SLA) contractual terms.

Delivery Models and Solution Portfolio

HealthEdge’s unified portfolio is delivered via two models:

  • Enduring Edge (BPaaS) – a full‑service partnership that integrates the AI‑driven platform with end‑to‑end operational execution, aiming to reduce costs, manage risk and deliver sustained financial improvements.
  • Integration Edge (Ecosystem Platform as a Service) – a risk‑free implementation approach that connects HealthEdge’s technology, workflows and domain expertise into a single operating environment, accelerating measurable performance gains without full operational support.

The solution suite includes:

1. HealthRules® Edge (formerly HealthRules Payer) – a cloud‑native core administrative processing system with AI embedded directly into claims workflows.

2. Payment Accuracy Edge (formerly HealthEdge Source™) – prospective payment integrity and accuracy capabilities that unify claims pricing, editing and real‑time analytics.

3. Clinical Edge (formerly GuidingCare®) – an integrated care‑management platform that streamlines workflows, supports better care‑quality outcomes and helps manage costs.

4. Provider Atlas Edge (formerly HealthEdge Provider Data Management) – a centralized source of provider information designed to reduce operational friction, administrative risk and compliance exposure.

5. Revenue Align Edge – prospective and retrospective risk‑adjustment solutions that provide a data‑driven view of risk across the health‑plan enterprise, supporting proactive management and stronger compliance.

Clients may adopt any combination of these components today and add further capabilities from HealthEdge and its ecosystem of partners as needed.

Scale, Performance and Market Reach

HealthEdge reports an established track record of serving 110 million covered lives across the health‑care ecosystem. In partnership with Amazon Web Services, a single instance of HealthRules Edge can process the claims volume of a health plan with more than 40 million members while reducing transaction latency by more than 50 %. The platform’s cloud infrastructure scales dynamically with transaction volume, enabling health plans to accommodate membership growth, rising claims complexity and expanding business needs without sacrificing performance or reliability.

Currently, the platform supports six of the nine largest national health plans in the United States, as well as a range of regional and local payers nationwide.

Contact and Disclaimer

For further information, interested parties may visit the HealthEdge website at www.healthedge.com or contact the HealthEdge Communications Team at pr@healthedge.com. The press release is distributed under an arrangement with Business Wire India; PTI assumes no editorial responsibility for its content.