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 * 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.
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         * 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.
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     * * Prospective Payment Integrity
         * Source is the preeminent digital prospective payment integrity
           solution, combining claim payment automation with proactive business
           intelligence.
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         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
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CONNECT TO
A COMPREHENSIVE DIGITAL TRANSFORMATION.A TRULY MEMBER-CENTRIC EXPERIENCE.MORE
AUTOMATED OPERATIONS.THE NEXT GENERATION OF SERVICE.A COMPREHENSIVE DIGITAL
TRANSFORMATION.A TRULY MEMBER-CENTRIC EXPERIENCE.MORE AUTOMATED OPERATIONS.THE
NEXT GENERATION OF SERVICE.A COMPREHENSIVE DIGITAL TRANSFORMATION.

HealthEdge® solutions – deployed as standalone next-generation SaaS or together
as an integrated platform – help payers accelerate their digital transformation
and position them for continuous success.

Make the connection

The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience

The individual healthcare experience has three dimensions. Each dimension
requires deep application focus and an integrated approach to applications and
data.

READ MORE

Health Insurance Today: The Current State of Member Satisfaction

HealthEdge surveyed +2800 healthcare consumers nationwide to help payers better
understand what members care most about today.

See Survey Results

HealthRules® Payer named “Best in KLAS®”

HealthRules Payer has been named "Best in KLAS" by KLAS Research for Claims &
Administration Platforms for the second year in a row.

READ MORE

The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience

The individual healthcare experience has three dimensions. Each dimension
requires deep application focus and an integrated approach to applications and
data.

READ MORE

Health Insurance Today: The Current State of Member Satisfaction

HealthEdge surveyed +2800 healthcare consumers nationwide to help payers better
understand what members care most about today.

See Survey Results

HealthRules® Payer named “Best in KLAS®”

HealthRules Payer has been named "Best in KLAS" by KLAS Research for Claims &
Administration Platforms for the second year in a row.

READ MORE

The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience

The individual healthcare experience has three dimensions. Each dimension
requires deep application focus and an integrated approach to applications and
data.

READ MORE
 * 1
 * 2
 * 3


HEALTHEDGE BY THE
NUMBERS


81+

MILLION COVERED LIVES SERVED BY 4 SOLUTIONS

See Our Solutions



120+

CUSTOMERS

See Our Solutions



100+

INTEGRATIONS WITH THIRD-PARTY SOLUTIONS

See Our Solutions



48+

STATES SUPPORTED WITH 23 MEDICARE ADVANTAGE CLIENTS

See Our Solutions



WHAT CAN HEALTHEDGE
DO FOR YOU?

Our healthcare SaaS software provides payers with a digital foundation that
enables them to deliver a transparent and consumer-centric experience at lower
cost while offering higher quality and higher service levels to their members,
providers and partners.

see our solutions

X


A TRULY CONNECTED
ECOSYSTEM

Whether connecting to our best-of-breed applications or other third-party
systems, HealthEdge enables health plans to access data within and between
systems for new digital member experiences. HealthEdge is on a digital journey
with our customers to make it easy to exchange real-time data and streamline
workflows across once-siloed functional areas and data.

See Our Solutions

HEALTHEDGE

Digital Transformation in Healthcare

HEALTHRULES PAYER

Core
Administration

SOURCE

Prospective
Payment Integrity

WELLFRAME

Member
Experience

GUIDINGCARE

Care
Management



ENABLING THE DIGITAL
PAYER

What does it mean to be a digital payer in today's highly complex and dynamic
health insurance market? It means every aspect of your business is constantly
improving. While working with hundreds of payers, we consistently see the
following five attributes in our digital-first customers:

Become a Digital Payer

EVER-EVOLVING FOCUS ON THE MEMBER AND END-USER EXPERIENCE

Modern technology and seamless exchange of real-time data facilitate a better
experience

EVER-DECLINING TRANSACTION COSTS

Automating business processes based on accurate data drives down costs and
drives up productivity

EVER-IMPROVING QUALITY

Accessing accurate insights from real-time data across lines of business and
care provider networks results in better health outcomes

EVER-INCREASING SERVICE LEVELS

Empowering team members with modern technology and up-to-the-minute data results
in better service

EVER-IMPROVING BUSINESS TRANSPARENCY

Greater visibility and robust analytical tools lead to more informed business
decisions


FURTHER RESOURCES


 * A MEMBER JOURNEY AFTER THE NO SURPRISES ACT
   
   Read More


 * INTEGRATED SECONDARY EDITING SOLUTION NOW AVAILABLE TO HEALTHRULES® PAYER
   CLIENTS
   
   Advanced secondary editing from HealthEdge Source™ helps reduce inappropriate
   claims before they are paid.
   
   Read More


 * NAVIGATING THE NO SURPRISES ACT: THE RIGHT TOOLS FOR HEALTH PLAN SUCCESS DATA
   SHEET
   
   HealthRules Payer® is a modern and flexible core administrative processing
   system that can help health plans navigate the No Surprises Act and
   transparency requirements with ease and efficiency.
   
   Read More


 * FUTURE-PROOF CLAIMS EDITING FOR REAL SAVINGS WITH SOURCE EDITING
   
   EditingHealthEdge® listed as a Representative Vendor in the 2023 Gartner® How
   U.S. Healthcare Payer CIOs Can Future-Proof Claims Editing report.
   
   Read More


READY FOR YOUR DIGITAL TRANSFORMATION?

Meet with a transformational expert today to talk about how we can help you
solve today’s challenges while setting you up for future success.

SCHEDULE A CONSULTATION
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   * Request a Demo
   * About Us
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   * Customer Login


PRIVACY POLICY | EOO STATEMENT | YOUR PRIVACY CHOICES

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Language™, GuidingCare®, and the Wellframe logo are registered trademarks of
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