HealthEdge Administrators
HealthEdge Administrators is a third-party administrator (TPA) operating in California. For an ASC, what matters isn't the logo. It's how HealthEdge Administrators pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete HealthEdge Administrators analysis
Tell us where to send it. Our team will prepare an analysis of HealthEdge Administrators covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How HealthEdge Administrators pays
See how HealthEdge Administrators reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
HealthEdge Administrators's presence spans California. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for HealthEdge Administrators and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive HealthEdge Administrators's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking HealthEdge Administrators up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with HealthEdge Administrators
- Payer ID
- 95213 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to HealthEdge Administrators through a clearinghouse.
- Eligibility verification
- Coverage and benefits for HealthEdge Administrators members are verified before the date of service, through a clearinghouse using payer ID 95213or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with HealthEdge Administrators directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of HealthEdge Administrators the way it pays.
- What is HealthEdge Administrators's payer ID?
- HealthEdge Administrators's electronic payer ID is 95213. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to HealthEdge Administrators through a clearinghouse.
- How do ASCs verify eligibility for HealthEdge Administrators members?
- Eligibility and benefits for HealthEdge Administrators members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 95213) or through the payer's provider portal.
- Does HealthEdge Administrators require prior authorization for ASC procedures?
- Prior-authorization requirements for HealthEdge Administrators are set per plan and per procedure. Confirm whether an authorization is required with HealthEdge Administrators directly before the date of service.
- What type of payer is HealthEdge Administrators?
- HealthEdge Administrators is a third-party administrator (TPA) operating in California.
- How does HealthEdge Administrators compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where HealthEdge Administrators pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is HealthEdge Administrators paying my ASC below market?
- Put your own HealthEdge Administrators contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.