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.
Learn MoreKLAS Research named HealthRules® Payer its 2022 “Best in KLAS” payer claims and administration platform
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Gartner has named HealthEdge® as a Sample Vendor for HealthRules® Payer in the 2022 Hype Cycle for 12 consecutive years
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Features
Smooth Implementation
Streamline implementations with HealthEdge’s product expertise, standardized processes, and seamless data-sharing for efficiency and collaboration.
Shared Data Sets
Unified data sets between HealthRules Payer and GuidingCare ensure consistent, accurate information, enhancing efficiency across all applications.
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.
Improved Payment Integrity
Care-Payer seamlessly creates authorizations from GuidingCare in HealthRules Payer, eliminating manual workbooks and boosting auth-claim matching for greater accuracy.
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 SuiteCare 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