HealthEdge Software, Inc.

HealthEdge Software, Inc. is a healthcare technology company based in the US, specializing in innovative software solutions that streamline healthcare management for health plans, enhancing efficiency and accuracy across the industry. Founded in 2004 in Burlington, US, HealthEdge Software, Inc. develops advanced software solutions for healthcare management.

The company was founded by Steven Trinh and has undergone significant growth since its inception. The most recent funding round was a Secondary Buyout in April 2025, raising USD 2. 6 billion, with Bain Capital as the investor. HealthEdge has secured a total of USD 2.

6 billion in funding through 11 deals. HealthEdge Software, Inc. specializes in healthcare technology solutions, primarily offering an integrated platform that includes several core products designed to optimize healthcare management for health plans. Their flagship offerings encompass the HealthRules® Solutions Suite, a digital claims administration processing system that enhances operational efficiency and accuracy, and HealthEdge Source, which focuses on prospective payment integrity through automated claim payment processes and proactive business intelligence.

Additionally, HealthEdge provides GuidingCare®, a widely adopted care management platform that streamlines workflows and improves quality of care, and Wellframe, a digital member engagement solution that empowers health plans to better connect with members. The company targets health plans, including commercial, government, Medicare, Medicaid, and dual eligible plans in the United States, with a customer base that includes over 130 health plan clients and serves more than 110 million covered lives across 48 states. HealthEdge generates revenue primarily through a subscription-based model, wherein clients pay for access to their SaaS products and services. The structure of these transactions typically involves annual or multi-year agreements, providing health plans with continuous access to HealthEdge's suite of solutions, which include HealthRules®, HealthEdge Source, GuidingCare®, and Wellframe.

Each of these services is designed to enhance operational efficiency, improve member experiences, and ensure payment accuracy. Given the comprehensive nature of their solutions, clients engage with HealthEdge through direct partnerships, aligning their operational needs with the software capabilities offered. The pricing specifics for individual products or services are structured to reflect the value delivered in optimizing healthcare technology solutions, although precise figures are proprietary. In April 2025, Bain Capital agreed to acquire HealthEdge Software, Inc.

for USD 2. 6 billion. This acquisition will provide HealthEdge with additional resources and expertise to accelerate growth and innovation, particularly in deploying generative AI in health plans. The company plans to expand its product offerings and invest in developing new technologies to enhance its healthcare management solutions.

Additionally, HealthEdge is targeting expansion into new geographic regions and markets to further its reach and serve a broader client base.