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Care-Payer Integration

HealthEdge Care-Payer Integration

Seamless Connectivity for Unparalleled Operational Efficiency

Traditional silos between core administrative systems and care management platforms hinder efficiency and create barriers to optimal care delivery. That’s where Care-Payer steps in. Care-Payer, the API-based integration between HealthRules® Payer and GuidingCare®, provides real-time data exchange that ensures accuracy, eliminates redundancies, and offers care insights when they are needed most. This innovative solution enables health plans to streamline authorization entry, enhance utilization management, and improve member outcomes while reducing administrative burdens.

Through Care-Payer, care teams, UM staff, and providers gain instant access to up-to-date benefit information–creating a more connected, transparent, and efficient care ecosystem.

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"As a user of multiple HealthEdge products, we see tremendous value in the tight integration between the platforms. Things like being able to match on authorizations can not only help streamline care management, but also improve payment accuracy to facilitate better relationships with our providers."
-Health Plan Director of Strategy and Ops

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"HealthEdge’s willingness to help customers configure data transitions to create a solid ecosystem was communicated far better than the competitors in the national arena."
-SVP and Chief Operating Officer

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"As a user of multiple HealthEdge products, we see tremendous value in the tight integration between the platforms. Things like being able to match on authorizations can not only help streamline care management, but also improve payment accuracy to facilitate better relationships with our providers."
-Health Plan Director of Strategy and Ops

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Features

Vector
Smooth Implementation

Streamline implementations with HealthEdge’s product expertise, standardized processes, and seamless data-sharing for efficiency and collaboration.

Vector (1)
Shared Data Sets

Unified data sets between HealthRules Payer and GuidingCare ensure consistent, accurate information, enhancing efficiency across all applications.

Frame
New Levels of Operational Efficiency

Revolutionize operational efficiency with Care-Payer’s industry-standard authorization data source. Designed for Authorized Entry and Medical Management, it delivers real-time, reliable guidance for seamless utilization management, ensuring precision and speed in every decision.

Frame (1)
Improved Payment Integrity

Care-Payer seamlessly creates authorizations from GuidingCare in HealthRules Payer, eliminating manual workbooks and boosting auth-claim matching for greater accuracy.

Frame (2)
Certified Data Exchange

With any upgrade, data exchange between the applications is tested for compatibility. All data is also kept safe in HealthEdge’s HITRUST and SOC2 certified platform, minimizing the need for data exchange to third-party systems.

HealthEdge Solutions

Core Administrative Processing System (CAPS)

Our advanced Core Administrative Processing System can provide you with the efficiency, flexibility, insights and agility necessary to control costs, embrace change, and move quickly to take advantage of new opportunities.

HealthRules Solutions Suite

Care Management Workflow Solution

Our Care Management workflow platform offers both health plans and providers easy-to-use, next-generation data integration and workflow management tools that streamline workflows, facilitate coordination and collaboration, accelerate quality improvement, and promote provider and patient engagement.

GuidingCare Solution Suite