Get an ‘EDGE’ in Recapturing Lost Revenue

Is your health plan missing out on significant reimbursement because of inaccurate or non-compliant claims? Wish you had more control over your EDGE submissions?

Babel Health’s risk adjustment solution for EDGE puts you — not your vendor or IT department — in the driver’s seat. Our powerful platform speeds and simplifies the submission process while helping you ensure complete, ACA-compliant claims. Reduce re-dos, improve acceptance rates and realize more of the revenue you’re owed. Gain greater visibility of your members and real-time insights into the financial and risk performance of your Marketplace programs — so you can plan better for the future.

Babel Health’s risk submission management solution for EDGE:

  • Imports any file format — and lets you easily map and transform data to meet guidelines
  • Ranks error correction activities by risk/revenue — so you can prioritize them
  • Eliminates the need for orphan management — plan ID integration throughout the data upload process means claims are automatically matched to eligibility
  • Tracks and aggregates interim bills to ensure complete costs are submitted
  • Offers integrated analytics that let you analyze holistic revenue gaps — orphans, enrollment, claims and supplemental, and non-claims-based information
  • Maintains pre-existing mask IDs to eliminate complications with changing systems
  • Reconciles client-attested baseline results to Babel Health’s EDGE server results
  • Auto-detects changes to enrollment and applies the appropriate EPAI values
  • Automatically flags mom/baby claims for error correction prior to submission
  • Provides visibility into cross-year claims and EDGE server system-generated enrollment
  • Automatically maps and transforms your inbound EDGE data values to reduce errors
  • Absorbs data from numerous sources and automatically compiles it
  • Allows you to measure your progress to forecasted actuarial goals


As an ACA plan, you’re required to pull off a skilled balancing act between the demands of the government, MLR, actuarial forecasting and member needs. Babel Health can help you maintain control of all of those pieces. With the time savings and peace of mind our solution provides, you can focus your efforts where they’re needed most — on providing high-quality healthcare to your members.

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RAPS/EDPS Medicare & Medicare Advantage
EDGE Affordable Care Act (ACA)
APCD All-Player Claims Databases