HealthEdge

HealthEdge, founded in 2005 and headquartered in Burlington, Massachusetts, builds software for health plans. Its flagship product, HealthRules, is a patented core administrative processing system that lets payers process claims, launch new products and change business models. The company says the suite rests on more than $125m in acquired intellectual property.

Around this core, HealthEdge has assembled a broader platform through acquisitions. Source, bought from The Burgess Group, handles payment integrity; GuidingCare, from Altruista Health, covers care management; and Wellframe provides digital member engagement. The combined offering spans claims processing automation, real-time data exchange and AI-driven business intelligence. The company frames its work around four pillars: touchless transaction processing, prospective payment integrity, care integrity and AI-driven business intelligence - with the aim of cutting administrative costs and improving clinical outcomes.

HealthEdge reports more than 130 health-plan customers covering over 110 million lives across 48 US states. Its stated goal is to help plans move from acting as payers to acting as partners in care delivery, through transaction automation and real-time engagement among payers, providers and patients.