HealthEdge® GuidingCare Launches Decision Intelligence Ecosystem with Anterior, Latitude Health and Case Health AI

Integrations with leading clinical AI solutions give health plans access to best-in-class 
decision-making capabilities to transform utilization management

BOSTON, Feb. 25, 2026 (GLOBE NEWSWIRE) -- HealthEdge®, the technology and services company powering health plans' most important value streams, today announced the introduction of a first-of-its-kind ecosystem of leading clinical AI solutions to support the transformation of utilization management (UM). The HealthEdge GuidingCare® Decision Intelligence Ecosystem launches with three leading clinical AI vendors ─ Anterior, Latitude Health and Case Health AI ─ giving health plans the flexibility to select a solution that meets their strategic priorities for next-generation decision automation while leveraging GuidingCare’s market-leading care and utilization management platform.

Health plans are facing unprecedented pressure across UM, including rising administrative costs, delays in care, regulatory requirements and clinician burnout. Prior authorization alone accounts for $35 billion annually in administrative spending, with 94% of patients experiencing care delays and 78% abandoning treatment when prior authorization processes take too long.

The first-of-its-kind GuidingCare Decision Intelligence Ecosystem addresses these challenges by providing health plans with proven tools to accelerate decision-making, improve clinical consistency, increase transparency, demonstrate compliance and utilize staff where they're needed most – on complex, high-touch cases.

This new ecosystem represents the first phase of a broader, multi-vendor strategy focused on supporting high-impact clinical decisions across payer organizations. Through seamless integration with GuidingCare via secure APIs, UM nurses can now leverage cutting-edge decision support tools without disrupting existing workflows. The platform's advanced rules and APIs enable efficient authorization assignment and data exchange, while resulting decisions and AI-driven reasoning are seamlessly passed back to GuidingCare for human-in-the-loop validation and audit, ensuring accuracy and compliance.

"With the introduction of our Decision Intelligence Ecosystem, GuidingCare is transforming utilization management from a fragmented process into an intelligent, automated workflow," said Bobby Sherwood, VP of Product Management at HealthEdge. "By partnering with the industry's leading AI innovators, we are empowering health plans to deliver faster, more accurate, and more transparent clinical decisions while reducing administrative burden and supporting regulatory demands. Health plans can select from best-in-class AI partners within the ecosystem, ensuring they work with the vendor whose capabilities align most closely with their unique requirements."

The inaugural vendors included in the Decision Intelligence Ecosystem were selected for their exceptional technology and proven capabilities. These vendors deliver measurable results:

• Anterior achieves 99.24% clinical decision-making accuracy (validated by KLAS Research) with a 74% reduction in manual review times in production.
• Latitude Health delivers over 3x greater clinical review throughput across prior authorization, concurrent review, and appeals, while automating up to 80% of intake workflows.
• Case Health AI accelerates prior authorization processing from days to minutes, cutting decision times by up to 75% while maintaining over 99.6% clinical accuracy.
  

By embedding these advanced decision-making capabilities directly into the GuidingCare workflow, health plans can streamline UM operations while ensuring each determination is fast, transparent, auditable, and clinically sound.

The Decision Intelligence Ecosystem will focus initially on streamlining prior authorizations, with plans to expand capabilities to support Appeals & Grievance Decision Intelligence. In addition, HealthEdge will seek and vet additional partners to continue strengthening the Decision Intelligence Ecosystem and look to introduce new use cases through dedicated ecosystems of vendors in other disciplines.

About Anterior
Anterior is the clinician-led company using responsible AI to automate and accelerate payer workflows. Its clinical AI drives complete health plan transformation (across prior authorization, payment integrity, risk adjustment and beyond) — generating medical and operational savings at scale. Trusted by clinicians and loved by technology teams, Anterior supports organizations covering 50 million lives. The company recently closed additional funding bringing total investment to $64M, with deployments at major health plans, including Geisinger Health Plan.

About Latitude Health
Latitude Health is transforming Utilization Management (UM) and Prior Authorization with AI-native technology that drives better outcomes for organizations. Latitude’s platform empowers UM teams to work smarter and faster – reducing costs, increasing review volume, and improving decision quality and consistency across prior authorization, concurrent review, and appeals & grievances. Latitude safely automates up to 80% of intake workflows and supports plan-configurable, policy-aligned auto-approvals where criteria are clearly met, while keeping clinicians in control of complex determinations. By equipping teams with tools and insights, Latitude supercharges your greatest asset – your people – while delivering impact across the full spectrum of UM operations.

About Case Health AI
Case Health AI automates pharmacy and medical prior authorizations, appeals, and provider outreach for Medicare and Medicaid health plans using AI and voice agents. It delivers over 99% medical-necessity review accuracy, automates over 70% of PA volume, and drives over 15x ROI in administrative savings.

Fully integrated with GuidingCare®, it runs seamlessly in the background and is built by founders with hands-on experience in prior authorizations and Care Management at large health plans.

About HealthEdge
HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit HealthEdge.com.

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Contacts
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HealthEdge Communications Team : pr@healthedge.com