HealthRules Overview
The HealthRules product suite includes next-generation claims and benefit administration, business intelligence and portal solutions that were designed to help transform today’s payor organizations into tomorrow’s healthcare leaders.
Built on a modern technology platform and delivered by HealthEdge, a 21st century company that has become known for rapid innovation, HealthRules brings agility to organizations pursuing a competitive position in the dynamic new healthcare marketplace.
HealthRules Language Example
Your benefit: Members who are being managed for heart disease should receive 100% coverage for the first $1,000 of cardiac preventative care and 90% coverage for additional preventative care.
Your benefit in HealthRules Language: Benefit for service category “Cardiac Preventative Care” and member with health condition of “Heart Disease” 100% of service cost until member receives $1,000 reimbursement within 1 calendar year then 90% of service cost.
What makes HealthRules different from any other solution on the market is its use of the patented HealthRules Language™, a revolutionary new approach to configuration that enables payor organizations—for the first time—to quickly and easily configure anything they can imagine.
Delivered as either a turn-key or an ASP offering, HealthRules is the only solution that was built to help payors survive and thrive in the rapidly changing healthcare economy.
HealthRules Product Suite
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HealthRules Payor—next-generation claims and benefits administration solution that delivers payor organizations the ability to quickly offer the innovative products the market demands, while simultaneously reducing administrative costs and increasing operational efficiencies.
HealthRules Answers—state-of-the-art, web-based business intelligence solution that enables company leaders to fully understand, manage, and grow their businesses while simultaneously providing important, up-to-the-minute information to their customers and their partners.
HealthRules Portal—allows payor organizations, for the first time, to truly link everyone involved in healthcare delivery. Unlike other “one-size-fits-all” offerings, HealthRules Portal provides a rich set of tools that can be used either together, or separately, to deliver a solution that will meet each payor’s specific needs.
HealthRules Connector— robust, enterprise-class integration layer that provides real-time and batch access to all HealthRules data and functionality, allowing HealthRules to easily integrate with a wide variety of other systems, partners, and exchanges.