healthedge.com Open in urlscan Pro
2606:4700::6812:e0f  Public Scan

Form analysis
2 forms found in the DOM

<form autocomplete="off" aria-label="Ajax search form">
  <input aria-label="Search input" type="search" class="orig" name="phrase" placeholder="Search here.." value="" autocomplete="off">
  <input aria-label="Autocomplete input, do not use this" type="text" class="autocomplete" tabindex="-1" name="phrase" value="" autocomplete="off">
  <input type="submit" value="SEARCH" style="width:0; height: 0; visibility: hidden;">
</form>

Name: options —

<form name="options" autocomplete="off">
  <input type="hidden" name="filters_changed" style="display:none;" value="0">
  <input type="hidden" name="filters_initial" style="display:none;" value="1">
  <div class="asl_option_inner hiddend">
    <input type="hidden" name="qtranslate_lang" id="qtranslate_lang1" value="0">
  </div>
  <fieldset class="asl_sett_scroll">
    <legend style="display: none;">Generic selectors</legend>
    <div class="asl_option">
      <div class="asl_option_inner">
        <input type="checkbox" value="exact" id="set_exactonly1" title="Exact matches only" name="asl_gen[]">
        <label for="set_exactonly1">Exact matches only</label>
      </div>
      <div class="asl_option_label"> Exact matches only </div>
    </div>
    <div class="asl_option">
      <div class="asl_option_inner">
        <input type="checkbox" value="title" id="set_intitle1" title="Search in title" name="asl_gen[]" checked="checked">
        <label for="set_intitle1">Search in title</label>
      </div>
      <div class="asl_option_label"> Search in title </div>
    </div>
    <div class="asl_option">
      <div class="asl_option_inner">
        <input type="checkbox" value="content" id="set_incontent1" title="Search in content" name="asl_gen[]" checked="checked">
        <label for="set_incontent1">Search in content</label>
      </div>
      <div class="asl_option_label"> Search in content </div>
    </div>
    <div class="asl_option_inner hiddend">
      <input type="checkbox" value="excerpt" id="set_inexcerpt1" title="Search in excerpt" name="asl_gen[]" checked="checked">
      <label for="set_inexcerpt1">Search in excerpt</label>
    </div>
  </fieldset>
  <fieldset class="asl_sett_scroll">
    <legend style="display: none;">Post Type Selectors</legend>
    <div class="asl_option_inner hiddend">
      <input type="checkbox" value="post" id="1customset_11" title="Hidden option, ignore please" name="customset[]" checked="checked">
      <label for="1customset_11">Hidden</label>
    </div>
    <div class="asl_option_label hiddend"></div>
    <div class="asl_option_inner hiddend">
      <input type="checkbox" value="page" id="1customset_12" title="Hidden option, ignore please" name="customset[]" checked="checked">
      <label for="1customset_12">Hidden</label>
    </div>
    <div class="asl_option_label hiddend"></div>
  </fieldset>
</form>

Text Content

Skip to content
Primary Menu
 * Become a Digital Payer
 * Solutions
   
   * * * SOLUTIONS
         
         
   * * * Core Administrative Processing System
         * The HealthRules® Solutions Suite includes the industry’s leading
           digital claims administration processing system – plus a host of
           additional value-added capabilities.
         * HealthRules Solution Suite
       * Care Management Workflow Solutions
         * GuidingCare®, our Care Management Workflow solutions, starts with the
           nation’s most widely adopted care management platform – and provides
           much more to improve quality of care.
         * GuidingCare Solution Suite
     * * Prospective Payment Integrity
         * Source is the preeminent digital prospective payment integrity
           solution, combining claim payment automation with proactive business
           intelligence.
         * Source Solution Suite
       * Member Experience
         * Wellframe Digital Care Management and Digital Customer Service
           solutions extend the reach of your staff to more fully engage and
           support members.
         * Wellframe Solution Suite
     * * Professional Services
       * Customer Success
       * Care-Payer Integration
       * Payer-Source Integration
       * Partners
 * Lines of Business
   * Commercial
   * Government
     * Medicare
     * Medicaid
     * Dual Eligibles
   * Plans With Home and Host Capabilities
   * Dental
   * Consultants
 * Resources
   * * * Blog
       * Brochures
       * Case Studies
       * Data Sheets
       * eBooks
       * Executive Summaries
     * * Infographics
       * Podcasts
       * Videos
       * White Papers
     * * Events
       * Newsroom
         * Company News
         * Press Releases
     
     * * NEW FROM HEALTHEDGE
         
         PRICING TRANSPARENCY & THE ONLINE SHOPPING/PRICE COMPARISON TOOL
         
         We are nearing the 1/1/23 requirement for health plans to provide
         online shopping/price comparison on health plan member portals for
         around 500 services. This is part of the Transparency in Coverage Rule.
         
         READ BLOG POST
 * About Us
   * Leadership
   * Careers
     * Life at HealthEdge
     * US Offices
     * India Offices
     * Employee Testimonials
   * Job Openings
 * Contact Us


Generic selectors
Exact matches only
Exact matches only
Search in title
Search in title
Search in content
Search in content
Search in excerpt
Post Type Selectors
Hidden

Hidden

HealthEdge
>
Solutions
>
Care Management Workflow Software
>
GuidingCare®

THE GUIDINGCARE SOLUTION SUITE


GUIDINGCARE®

The GuidingCare solution suite provides easy-to-use, next-generation data
integration and workflow management tools that help you operationalize an
evidence-based, person-centered Care Management strategy for your populations.
Its sophisticated data analytics, workflow management, care coordination, and
reporting capabilities enable your organization to better serve targeted
populations and maintain compliance every step of the way.

With GuidingCare, you can streamline coordination across the care spectrum,
seamlessly manage clinical and behavioral health needs, automate care and
service planning, and identify and target your high-risk populations, providing
whole-person care.


X
Previous

GUIDINGCARE PLATFORM ACHIEVES HITRUST CERTIFICATION



GUIDINGCARE ACHIEVES AA CERTIFICATION FOR HEDIS MEASURES SUBSET



GUIDINGCARE PLATFORM & MOBILE CLINICIAN APP EARN CA VERACODE VERIFIED STATUS



GUIDINGCARE ACHIEVES NCQA POPULATION HEALTH MANAGEMENT PREVALIDATION



GUIDINGCARE PLATFORM ACHIEVES HITRUST CERTIFICATION



GUIDINGCARE ACHIEVES AA CERTIFICATION FOR HEDIS MEASURES SUBSET



GUIDINGCARE PLATFORM & MOBILE CLINICIAN APP EARN CA VERACODE VERIFIED STATUS



GUIDINGCARE ACHIEVES NCQA POPULATION HEALTH MANAGEMENT PREVALIDATION



GUIDINGCARE PLATFORM ACHIEVES HITRUST CERTIFICATION


Next


FEATURES

MISSION-CRITICAL CLINICAL WORKFLOW SOLUTIONS

Drive superior outcomes in a value-based, patient-centric and fully-integrated
ecosystem

CARE MANAGEMENT

Streamline clinical workflows & care coordination

UTILIZATION MANAGEMENT

Effectively manage the authorization lifecycle

APPEALS & GRIEVANCES

Meet regulatory demands & ensure compliance

AUTHORIZATION PORTAL

Streamline workflows & communication with providers

BUSINESS INTELLIGENCE

Evaluate, track and measure outcomes; manage operations and stay compliant

POPULATION HEALTH

Engage care teams to drive population outcomes


REQUEST A DEMO

Find out what the healthcare industry’s number one Care Management platform can
do for your organization.

REQUEST A DEMO



WHY WE’RE DIFFERENT

DEEP CLINICAL EXPERTISE

Our seasoned clinical team has a deep understanding of clinical operations,
regulatory compliance and technical aspects of the business, bridging the
clinical and technical.

LEADING IN INNOVATION

Designed to enable the most complex clinical models today, with significant
investment and growth toward composable digital health solutions.

EASE OF INTEGRATION

Lower costs and improve member outcomes through interoperability. Easily connect
your vendor ecosystem with GuidingCare’s out-of-the-box integration suite.

OPERATIONAL EFFICIENCY

Leverage GuidingCare’s advanced rules engine to automate business processes and
take advantage of user-friendly workflows and features to streamline operations.

REIMAGINED IMPLEMENTATIONS & UPGRADES

Take advantage of the latest technology innovations at low cost and with ease,
incorporating standard new functionality and innovation frequently.

RESILIENCY TO CHANGE

Embrace change, stay competitive and take advantage of opportunities created by
a variety of market dynamics with highly configurable features and workflows.

ACTIONABLE INSIGHTS

Arm your leaders with near-real-time business intelligence to inform key
operational and clinical decisions.

REGULATORY & COMPLIANCE

Leverage robust enterprise compliance and security safeguards, reinforced by
HITRUST certification.




CARE-PAYER INTEGRATION

HealthRules Payer is even more powerful when combined with GuidingCare®. Our
unique Care-Payer Data Exchange solution provides the API-based integration that
enables the continuous management of member care and core administrative
processes.

Care-Payer provides a range of vital capabilities, including:

 * Standardized core data delivery from HealthRules Payer to GuidingCare
 * Authorization entry workflow improvement, including single-case agreement and
   referral category enhancement
 * Near-real-time authorization delivery from GuidingCare to HealthRules Payer

Most notably, Care-Payer includes Benefit Predictor integration. This unique
feature enables GuidingCare users to quickly and easily answer complex benefit
questions prospectively from members and providers.

This Benefit Predictor integration is incorporated into several key workflows,
giving Utilization Management staff and care managers unparalleled access to
near-real-time benefits information.

Care-Payer Data Exchange delivers significant benefits to your organization,
including:

 * Smooth implementation through HealthEdge expertise and standardized processes
 * Synchronized data sets between HealthRules Payer and GuidingCare
 * New levels of operational efficiency in authorization entry and medical
   management
 * Improved payment integrity
 * Certified data exchange

Learn More


THE GUIDINGCARE SOLUTION SUITE

GUIDINGCARE

GuidingCare is a comprehensive solution for whole-person, patient-centered care,
offering easy-to-use, next-generation data integration and workflow management
solutions and tools. Our feature-rich solution suite is easy to integrate with
existing systems and is highly configurable.

Learn More

GUIDINGCARE CARE MANAGEMENT

Our Care Management workflow software provides tools that help you
operationalize an evidence-based, person-centered care management strategy for
your populations.

LEARN MORE

GUIDINGCARE UTILIZATION MANAGEMENT

Our Utilization Management module supports the complete authorization lifecycle,
including clinical guidelines and authorization management workflows.

LEARN MORE

GUIDINGCARE AUTHORIZATION PORTAL

This intuitive and comprehensive electronic tool eases the preauthorization,
appeals, and messaging process for your Utilization Management staff and the
providers who interface with your plan.

LEARN MORE

GUIDINGCARE BUSINESS INTELLIGENCE

Our Reporting & Business Intelligence module provides more than 50 standard
reports to make ad hoc report-building and analysis simple and actionable.

LEARN MORE

GUIDINGCARE POPULATION HEALTH

Our web-based care coordination application for provider partners incorporates
gaps-in-care analytics that enable clinical staff to identify high-risk patients
and potential health improvement opportunities.

LEARN MORE

GUIDINGCARE APPEALS & GRIEVANCES

Our Appeals & Grievances module streamlines and consolidates the entire appeals
management process to help you meet regulatory demands for timely resolution and
correspondence.

LEARN MORE


ADDITIONAL OFFERINGS

GUIDINGCARE MEDICATION THERAPY MANAGEMENT

Enable pharmacists with a central location in which they can manage member
medications and intervene to prevent potentially harmful outcomes.

LEARN MORE

GUIDINGCARE PEDIATRIC POPULATION HEALTH

Standard and enhanced tracking and reporting to meet federal Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.

Learn More

GUIDINGSIGNS® ANALYTICS

A clinical decision support system that transforms data into actionable insights
for health care payers and providers.

LEARN MORE


FURTHER RESOURCES


 * EMPOWERING HEALTH PLANS TO ADVANCE CARE MANAGEMENT WITH GUIDINGCARE
   
   Read More


 * ADVANCING CARE MANAGEMENT THROUGH DIGITAL TRANSFORMATION
   
   Stuart Myer, Chief Information Officer, VillageCare, a community-based,
   not-for-profit organization in New York, recently joined HealthEdge leaders
   Christine Davis, Vice President, Product...
   
   Read More


 * GUIDINGCARE CARE MANAGEMENT
   
   Read More


 * ‘GOLD CARD’ APPROACH TO PRIOR AUTHORIZATION NO HURDLE FOR HEALTHEDGE
   
   States have been passing legislation in recent years to address the
   complaints of providers that they are subject to too many prior authorization
   requirements in advance of patient treatment. This...
   
   Read More


REQUEST A DEMO

Find out what the healthcare industry’s number-one Care Management platform can
do for your organization.

REQUEST A DEMO
 * Become a Digital Payer
   * Solutions
   * Lines of Business
 * Resources
   * Request a Demo
   * About Us
 * Contact Us
   * 1 (781) 285-1300
   * Customer Login

Privacy Policy | EOO Statement

©2022 HealthEdge Software, Inc. | HealthEdge®, HealthRules®, The HealthRules
Language™, GuidingCare®, and the Wellframe logo are registered trademarks of
HealthEdge Software, Inc. All Rights Reserved.