About Us

The HealthEdge Story

HealthEdge® was founded in 2005 to deliver a next-generation Core Administrative Processing System – one that would not only increase accuracy and efficiency but also enable health plans to innovate and bring new lines of business to market swiftly.

That product – HealthRules® Payer – quickly gained acceptance and led Gartner to name HealthEdge as a sample next-generation CAPS vendor for 13 consecutive years. HealthEdge has continuously innovated since its founding, adding new capabilities, modules and services to fulfill a broader range of customer needs and enable health plans to pursue their digital transformation.

Today, the first-of-its-kind HealthRules Payer solution suite comprises three best-in-class, cloud-based solutions that drive the three most important value streams within a health plan: the administrative costs of running the business, the medical expenses of paying claims, and the effort to help members with acute or chronic conditions comply with their treatments and obtain better care and better lifestyles.

Working together, these solutions enable a vision where claims processing is enhanced with software-driven payment integrity at the point of service, feeding data to an end-to-end care management solution, resulting in lower administrative and healthcare costs and improved patient outcomes and quality.