HealthEdge, founded in 2005 and headquartered in Burlington, Massachusetts, develops technology for health plans operating across 48 U.S. states. The company serves over 130 health plan customers collectively covering more than 110 million lives. Its platform focuses on core administrative processing, payment integrity, care management, and digital member engagement.
The company's flagship product, the HealthRules product suite, is a patented platform for claims processing that enables health plans to bring new products to market and modernize their operations. HealthEdge has expanded its capabilities through acquisitions, including GuidingCare for care management, Wellframe for digital member engagement, and The Burgess Group (Source) for payment integrity. Together, these products form a comprehensive digital healthcare platform.
HealthEdge's technical work spans AI-driven business intelligence, touchless transaction processing, and prospective payment integrity. The company's stated aim is to reduce administrative costs and improve clinical outcomes by helping health plans evolve from payers into partners in care delivery. It has invested over $125 million in intellectual property to support this mission.
