HealthEdge has partnered with Ellipsis Health to integrate AI-powered virtual nursing into its Care Solutions suite. The collaboration brings Ellipsis Health's AI care management voice agent, Sage, to health plans seeking to scale member outreach whilst addressing clinical workforce shortages. Sage conducts autonomous phone conversations with members for high-volume outreach tasks including health risk assessments, post-discharge follow-ups, risk profiling and care gap closure. The system integrates with HealthEdge's GuidingCare platform, drawing on member data to personalise conversations and feeding outcomes back into the platform. Powered by Ellipsis Health's patented Empathy Engine, Sage analyses vocal cues in real time to assess emotional signals and adapt responses. The technology allows health plans to automate routine outreach, enabling nursing teams to focus on complex, high-touch interventions requiring clinical expertise.

HealthEdge has launched the GuidingCare Decision Intelligence Ecosystem, integrating three clinical AI vendors — Anterior, Latitude Health and Case Health AI — to transform utilisation management for health plans. The ecosystem enables health plans to select best-in-class AI solutions whilst using GuidingCare's care and utilisation management platform. Prior authorisation accounts for $35 billion annually in administrative spending, with 94% of patients experiencing care delays. The ecosystem addresses these challenges through seamless API integration, allowing UM nurses to leverage AI decision support tools without workflow disruption. The inaugural vendors deliver significant results: Anterior achieves 99.24% clinical accuracy with 74% reduction in review times, Latitude Health delivers over 3x greater review throughput, and Case Health AI cuts decision times by up to 75% whilst maintaining over 99.6% accuracy.

Setting the standard for payment integrity: HealthEdge Source(TM) named Best in KLAS. Published Date February 6, 2026 HealthEdge Source(TM) earned the 2026 Best in KLAS Awards: Software and Services as the leader in "Pre-Payment Accuracy & Integrity Solutions (Payer)" - with an overall score 8% higher than its competitors. HealthEdge Source was also the only solution to earn a higher overall score in 2026 than the previous year. This achievement not only highlights the HealthEdge(R) commitment to excellence, but its customers' recognition of the ongoing innovation and partnership HealthEdge Software, Inc. deliver. "The Best in KLAS awards recognize the vendors who consistently deliver excellence through partnership with healthcare organizations. Winning this award means customers trust you to help them succeed in our rapidly changing healthcare landscape." -Adam Gale, CEO, KLAS Research Across the healthcare industry, health plans are moving from traditional "pay-and- chase" models to making prospective payments. Solutions like HealthEdge Source help ensure payers are accurately processing claims the first time to improve cost avoidance and reduce downstream waste. What does it mean to earn "Best in KLAS"? KLAS is a trusted third-party research firm dedicated to improving healthcare by gathering, analyzing, and sharing insights based on direct feedback from thousands of healthcare professionals. Unlike other industry recognitions, the annual Best in KLAS reports are not based on marketing claims or theoretical performance. Instead, rankings are determined based on testimonials from anonymous, direct feedback from actual health plan customers. For payers, these rankings highlight vendor software solutions that excel in helping healthcare organizations ensure accurate payment and reimbursement. | Metric | HealthEdge Source | Segment Average | | Vendor Executive Involvement | 8.2 | 7.5 | | Forecasted Overall Satisfaction | 8.2 | 7.5 | | Quality of Support | 8.1 | 7.4 | | Ease of Use | 8.0 | 7.4 | | Product Works as Promoted | 7.8 | 7.6 | | Overall Satisfaction | 7.7 | 7.3 | | Proactive Service | 7.4 | 7.1 | These scores reflect a platform that is not only robust in its technical capabilities but also passionate about empowering health plan operations by being a true partner. Why the Best in KLAS designation matters. For health plan leaders, selecting a payment integrity solution is a strategic decision with long-term financial and operational implications. The Best in KLAS designation offers validation that HealthEdge Source delivers on its promises to streamline payment integrity workflows, reduce rework, and process claims correctly the first time. One statistic from the report stands out above the rest: when asked if they would adopt HealthEdge Source again and include it in their long-term plans, 100% of customers said "yes". This perfect loyalty score affirms the long-term commitment HealthEdge has made to helping payers optimize pre-payment integrity. It demonstrates that the platform is designed and supported by a team with the common goal to improve healthcare for everyone. Real results through a unified platform. Why do health plans choose to partner with HealthEdge Source? The answer lies in the shift from reactive, disjointed tools to a proactive, integrated ecosystem. While many traditional black-box payment integrity solutions offer limited visibility for health plans to address root-cause issues, HealthEdge Source provides an open book approach that empowers health plans to make edits in-house, proactively address errors, and reduce operational waste. The unique platform architecture provides health plans with control, transparency, and future-ready functionality, addressing the core challenges of modern claims processing. Configurable edits and rules. The platform does not force a "one-size-fits-all" approach. Instead, it offers advanced, configurable editing tools that can be tailored to each health plan's specific reimbursement models and clinical policies. This helps ensure precision and compliance with internal and external standards. Integrated payment integrity. Efficiency demands connectivity. HealthEdge Source seamlessly connects with core administrative systems, pricing engines, and external data sources for a unified and transparent workflow. This approach redefines payment integrity by providing platform-level access rather than isolated point solutions. Actionable intelligence. Data is only valuable when it drives informed decision-making. The platform provides intuitive dashboards and comprehensive audit trails, offering advanced analytics and radical transparency that support compliance and strategic decision-making. Keep your health plan up to Date. To help payers meet market needs, digital platforms need to operate with the latest intelligence and guidelines. HealthEdge Source delivers platform-wide updates on a 2-week cycle to help maintain accuracy and flexibility. Plus, the Retroactive Change Manager tool improves transparency throughout the claims management process by automatically flagging reconcilable claims, scheduling reviews, and reducing the need for manual intervention. Partner with the market leader in payment integrity. "Health plans need payment integrity that delivers accuracy, insight, and control at scale. Being named Best in KLAS validates HealthEdge Source as the modern standard for payment integrity - and we expect to continue raising the bar for the industry." -Ryan Mooney, Chief Product Officer at HealthEdge When they choose HealthEdge Source, health plans gain a partner that is dedicated to delivering a transparent, accurate, and open-book approach to payment integrity. From being the first solution in the market to include pricing and editing in a single module to integrating AI-powered features, the solution helps payers operate more efficiently and support their members more effectively. To see a breakdown of the data and learn more about how HealthEdge Source can transform payment integrity, download the data sheet.