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The implementation of the Interoperability and Prior Authorization Final Rule mandate (CMS-0057-F) in early 2024 is more than just a compliance requirement—it’s an opportunity for health plans to modernize and streamline their operations. But for payers still dependent on outdated and legacy technology systems, it can be difficult to turn requirements into regeneration opportunities.

This was the subject of a recent IDC white paper entitled, “Compliance with Prior Authorization Mandates is a Strategic Opportunity for Payers,” by Jeff Rivkin, IDC Research Director. In the report, Rivkin explains the importance of investing in modern, highly interoperable solutions, and how these solutions can be a true catalyst for digital transformation—a goal many health plans are striving to accomplish.

5 Key Prior Authorization Takeaways for Health Plans 

Rather than viewing compliance with CMS-0057-F as a regulatory burden, health plan leaders can use it as an incentive for digital transformation. By investing in next-generation core administrative processing systems and care management platforms, health plans can achieve the following strategic advantages:

Trend 1: Operational Efficiencies through Integrated Systems

One of the key challenges posed by CMS-0057-F is the need to integrate disparate systems to support real-time data sharing and streamlined workflows. Health plans that invest in modern, integrated platforms can automate manual processes, reducing the administrative burden on staff.

For example, a transformational core administrative processing system, such as HealthEdge’s HealthRules® Payer, can automate prior authorization workflows, manage claims, and synchronize data between clinical and administrative systems. By unifying these functions, health plans can respond faster to authorization requests, improve accuracy, and reduce manual intervention.

Trend 2: Improved Provider Collaboration and Member Engagement

The transparency and data-sharing requirements of CMS-0057-F are designed to improve collaboration between health plans, providers, and members. Health plans that invest in robust care management systems can enhance provider communication, streamline care coordination, and ensure that members have timely access to the care they need.

A comprehensive platform like GuidingCare® from HealthEdge can facilitate this collaboration by providing providers with real-time access to patient data, including the status of prior authorizations. This reduces the back-and-forth communication often associated with the prior authorization process, accelerating approvals and improving the member experience.

Trend 3: Data-Driven Decision-Making and Reporting

CMS-0057-F places a significant emphasis on transparency, requiring health plans to report key performance metrics related to their prior authorization processes. Health plans that invest in business intelligence and analytics tools can not only meet these reporting requirements, but also use the data to optimize their operations.

By leveraging the robust reporting capabilities of a care management platform like GuidingCare, health plans can track key metrics like approval and denial rates, turnaround times, provider performance, and more. This data can be used to identify inefficiencies, make data-driven decisions, and continuously improve the prior authorization process—beyond remaining compliant with CMS-0057-F.

Trend 4: Scalability and Futureproofing

It is imperative that payers invest in a modular and agile technology platform to scale their operations alongside their growing member base. Legacy systems are often rigid and unable to adapt to changing regulatory requirements or market conditions. In contrast, forward-thinking CAPS and care management platforms are designed to be flexible, allowing health plans to easily adapt to new regulations or business needs.

Considering the ever-evolving Centers for Medicare & Medicaid Services (CMS) regulations, health plans that invest in scalable technology are better positioned to adapt to future changes without costly system overhauls. This futureproofing is essential for long-term operational success.

Trend 5: Choosing the Right Technology Partner

Investing in the right technology starts with finding the right partner. Look for highly interoperable solutions that work together seamlessly to offer real-time data sharing, support business rules engines, and deliver robust reporting and analytics capabilities.

While meeting the compliance requirements of CMS-0057-F is crucial, it also opens the door to much broader opportunities for health plans to become digital payers. By embracing modern, integrated technology platforms like those offered by HealthEdge, health plans can ensure compliance and also create a foundation for long-term operational success.

Learn more about how compliance with this new rule can be leveraged as a strategic opportunity for your organization. Download the full IDC whitepaper.

At HealthEdge®, we are continually seeking ways to improve our users experience and help maximize the value customers get from our solutions. That’s why we designed the HealthEdge Help Center, a one-stop online platform that helps users leverage our solutions more effectively by enabling them to quickly locate the information they need. The Help Center provides convenient access to resources like documentation and troubleshooting, as well as on-demand training assets.

Below, we’ve highlighted a few ways the Help Center benefits HealthEdge customers.

Empowering Users With An Exceptional Experience

We built the Help Center with efficiency in mind. It offers a centralized location where users can easily search and access relevant information, so teams can spend less time looking and more time doing. The Help Center even allows for printing or PDF downloads to offer flexibility and inclusivity in information access.

Comprehensive Trainings Accessible Any Time

The Help Center provides on-demand training videos, FAQs, quick tips, and other insights. It is accessible at any time, so users can find the data and documentation they need at their convenience. The Help Center includes documentation for the HealthRules® Payer, Connector, Installer, and Provider Data Management solutions, with more to come.

Through the Help Center, users can also find comprehensive documentation for all HealthEdge product releases, making it easier to stay informed about system updates and improvements.

Built For Ongoing Evolution

HealthEdge built the Help Center to be highly scalable, allowing ongoing improvement to both the content and features it provides. Platform analytics help us measure which resources and features drive the greatest value for our customers.

The Help Center is just the beginning. We are continuously working on improvements to further assist our users, such as AI-powered personalized content recommendations, and enhanced mobile support.

Accessing the HealthEdge Help Center 

The Help Center is available to all customers upgrading to HealthRules Payer 24.1. To learn more and see how you can gain access to the Help Center, contact your Upgrade/Implementation team or Customer Service Executive.

Not a current HealthEdge customer but interested in learning more? Contact us here.

Join us in this transformative journey towards a digital healthcare system. The HealthEdge Help Center is here to help you make the most of your HealthEdge experience.

Member satisfaction is vital for health plans to grow communities and improve outcomes. At the AHIP Consumer Experience & Digital Forum (CDF) 2024, Susan Beaton, Vice President of Health Plan Strategy at HealthEdge, addressed this topic with her presentation on “Driving Member Satisfaction Through an Integrated Care Management Strategy.”

The presentation highlighted how integrating digital tools with traditional workflows can transform care management delivery to drive member satisfaction. This is especially important considering care managers’ increasing responsibilities, the direct connection between member experience and satisfaction, and the rising demand for innovative digital solutions from members.

Key takeaways from the presentation include:

1. Care Managers Face Increasing Responsibilities And More Significant Challenges Than Ever Before

Care managers face rising challenges as their responsibilities expand to address a wide range of complex business and member needs. Workforce shortages make their role even more complicated, while manual administrative tasks take up valuable time that could be spent on direct member care. Members’ expectations are rising for more personalized interactions and immediate information. Navigating complex regulatory requirements only adds to care managers’ workload while they perform an essential role in a member’s care journey.

2. The Care Manager’s Experience Directly Impacts Member Satisfaction

Improving care managers’ experience through digital tools enhances efficiency, improves member outcomes, and increases satisfaction. Streamlining their workflows and providing user-friendly tools that reduce manual administrative work allows them to apply their expertise effectively, so they spend more time addressing member needs and providing personalized and proactive care. Care managers who are empowered to consistently anticipate and meet member needs foster trust with members, drive better health outcomes, and create a more positive overall member experience.

3.Members Expect Innovation And Are Comfortable With Digital Tools

As technology transforms members’ daily lives, they are increasingly comfortable using digital tools to manage their health. The 2024 HealthEdge® Consumer Survey found that 64% of members are comfortable using mobile apps to access health information, while 65% are open to utilizing AI-powered tools provided by their health insurers. These findings highlight the rising expectations for innovation and digital engagement in healthcare, as members now anticipate seamless, technology-driven interactions like those in retail, travel, and other areas of their lives.

4. It’s Time For Health Plans To Rethink Care Management Delivery

The increasing challenges for care managers, alongside rising expectations from members, present an opportunity for health plans to apply modern technology to enhance traditional workflows. Integrated Digital Care Management merges traditional care management practices with digital tools and technologies to improve efficiency, effectiveness, and reach. This approach combines clinical data, real-time member insights, and traditional care workflows to create a more efficient, member-centered approach, ultimately improving the care experience and delivering better health outcomes at lower costs.

A HealthEdge study using Wellframe data highlights how digital tools dramatically scale care management resources and boost member engagement with the same staff levels, leading to results such as:

• 2x increase in active caseload size, allowing care managers to handle more members without additional staff.
• 6x increase in member interactions, driven by enhanced digital engagement and self-service tools.
• 91% increase in successful outreach that improves care delivery and ensures members receive timely support.

This data shows how integrating digital tools can significantly enhance the effectiveness and reach of care management programs.

5. The Benefits Of Digital Tools Are Accelerating

Integrating digital tools in care management is proving transformative, significantly enhancing operational efficiencies and the scope of services to members. The benefits are only accelerating as tools become more mature and advance integrations with other platforms to streamline care team workflows. Additionally, sophisticated digital tools incorporate artificial intelligence (AI) technology into their platforms to drive further efficiencies and member personalization. These accelerated benefits support various business initiatives, from launching concierge services that provide targeted clinical support to identifying and driving new initiatives to improve the member experience and member satisfaction.

6. Successful Adoption Of Digital Tools Requires Change Management Best Practices

Organizations must prioritize robust change management strategies for digital tools to be effectively adopted by care managers and integrated into their daily workflows. This includes pillars such as focusing on the care manager’s experience with new tools and ensuring leadership commitment to transformation. Key strategies for success include digital transformation, aligning incentives, and collaborating with the right vendors to support long-term goals. In addition, health plans can benefit from intentional rollouts of new tools that focus on optimal use cases to establish high impact, early success, and internal buy-in.

7. The Time Is Now for Integrated Digital Care Management

As the healthcare industry evolves, the need for Integrated Digital Care Management is more urgent than ever to drive member satisfaction. Strategic concerns for health plans include the following:

• Market Dynamics and Consumer Expectations. With more health plan options available, members expect healthcare experiences that mirror the convenience and immediacy of digital retail services, which is crucial to drive member satisfaction.
• Regulatory Pressures. New regulations focusing on health equity and social determinants of health (SDOH) data require modern digital tools for compliance, which can impact member satisfaction scores and financial incentives like Star Ratings.
• Operational Efficiency and Cost Reduction. Digital tools, automation, and AI streamline administrative tasks, helping health plans do more with fewer resources, while alleviating the workload of care managers.
• Competitive Advantage. By adopting Integrated Digital Care Management, health plans can position themselves as innovators, gaining a competitive edge in attracting and retaining members, while preparing for future technological advancements.

Beaton’s presentation from AHIP CDF 2024 provides a roadmap for health plans to leverage digital tools to elevate care management practices, and enhance member and care manager experiences.

Using the Wellframe solution, a Blue Cross Blue Shield plan drove member engagement and increased care management capacity to better serve their 21 million members. To learn more about how the health plan improved phone call success rates, active caseload size, and member interactions, read the case study.

The ever-changing healthcare landscape requires health plans to have access to the insights and agility necessary to control costs, embrace change, and move quickly to take advantage of new opportunities. For many payers, upgrading to modernized health plan core administrative processing systems (CAPS) is a key strategy to remain flexible and competitive in the market.

To stay ahead of industry changes, many health plans are transitioning to cloud-based solutions. Doing so makes it easier for payers to consolidate their applications, reducing reliance on third-party point solutions and outdated proprietary systems. This forward-thinking approach streamlines operational efficiencies and meets the growing demand for agility in the ever-shifting healthcare regulatory environment.

Payers increasingly recognize that investing in modern health plan core administrative processing systems is essential to improving both member and provider experiences— needs that remain largely unmet by legacy systems. Leveraging cloud-based CAPS solutions make it easier for health plans to embrace the industry shift toward data accessibility and real-time claim adjudication while empowering them to react swiftly to stakeholder demands.

6 Key Trends Driving Investment in Health Plan Core Administrative Processing Systems

Healthcare payers must navigate a complex landscape of demands and opportunities to succeed. Several trends have emerged that are shaping payers’ decisions to reinvest in their existing CAPS solutions. An industry-wide shift toward a value-based care model is compelling executives to reevaluate their organizational workflows and internal processes. As a result, payers are more closely evaluating which CAPS partners will be ideal for long-term partnership in the dynamic healthcare environment.

1. Claims Processing for Non-Medical Services

One significant trend is the integration of claims processing for non-medical services. To support members holistically, payers are addressing social determinants of health (SDOH) by facilitating claims for services beyond traditional medical care. Examples of covered SDOH services include community-based programs—such as housing stabilization and emergency food access—as well as transportation to and from appointments. These offerings help support broader member needs, leading to better clinical outcomes, lower long-term care costs, and greater member satisfaction.

2. Low-Friction Support for Price Transparency and Interoperability

A regulatory focus on pricing transparency is driving payers to adopt integrated CAPS solutions that support low-friction access to updated pricing information. Delivering accurate pricing information not only satisfies compliance mandates but also empowers members to make more informed healthcare choices, fostering trust and improving satisfaction. Interoperability is the cornerstone of compliance for payers working across technology systems and disparate data sources, helping ensure seamless information sharing between stakeholders and across platforms.

3. Adoption of API & FHIR Capabilities

Data integration is vital for delivering accurate pricing information, enhancing the provider and member experience. The adoption of Application Programming Interface (API) and Fast Healthcare Interoperability Resources (FHIR) capabilities is a critical aspect of this strategy. These standards enable the efficient exchange of healthcare data between systems, empowering payers with the most accurate and up-to-date information available.

4. Transition to Commercial Cloud Hosting 

An industry-wide shift toward commercial cloud hosting demonstrates a significant increase in health plans’ agility and scalability in the market. By leveraging cloud services, payers can reduce IT overhead costs by reducing or eliminating the need for on-site hardware and servers. Cloud-based solutions also make it easier to increase data security and deploy updates more quickly—which are vital to earning and maintaining trust in the rapidly evolving healthcare industry.

5. Self-Serve Member & Provider Portals

When it comes to member engagement and support, healthcare consumers have high expectations. They’re looking for personalized, digital experiences that they can access when it’s convenient for them.

Investing in easy-to-navigate self-service portals can be valuable tools for improving member engagement and delivering more personalized support. Member care management apps or resource portals serve as hubs for provider communication, personalized resources, coverage information, and other valuable services. Solutions like these can empower members with the information they need at the right time, helping them make more informed health decisions while fostering trust in their health plan.

6. Value-Based Care Administration

Value-based care models have gained prominence in the healthcare industry and are redefining health plan operations. To take full advantage of the outcomes-based care model, health plans must shift their focus to prioritize care quality over service volume. If payers invest in CAPS solutions with robust analytics and performance tracking, they will be well-positioned in the evolving market.

Trends across the healthcare industry are pushing payers to invest (or reinvest) in CAPS solutions that facilitate data integration, transparency, and high care quality. Effectively leveraging capabilities like these can enhance operational efficiency and position health plans as trusted partners within the healthcare ecosystem. For leaders willing to adapt and embrace modern CAPS solution, there is no shortage of potential.

HealthRules® Payer is more than a health plan core administrative processing system—it is a revolutionary tool tailored to meet the demands of the modern healthcare industry. By leveraging cutting-edge technologies, including artificial intelligence (AI), HealthRules Payer provides payers with the efficiency, agility, and competitive advantage necessary to stay ahead of the market.

Not sure what to expect when it comes to a CAPS implementation? Check out our eBook, “5 Steps to a Successful CAPS Implementation”.

 

Latest Release: 2024 Gartner® Hype Cycle™ for U.S. Healthcare Payers

Gartner has published its highly anticipated Hype Cycle for U.S. Healthcare Payers. HealthEdge® was recognized as a Sample Vendor in two categories. Prospective Payment Integrity Solutions was named in the report since 2019, and we have been recognized for this category 3 consecutive times starting 2022. And AI-Enabled Fraud Detection has been named in the report since 2023, and we have been named as a Sample Vendor for both years – 2023 and 2024.

“This Hype Cycle provides critical input for strategic planning by tracking the maturity level and adoption rate of payer technologies and deployment approaches. U.S. healthcare payer CIOs should use this to plan new and manage existing investments for business optimization and transformation.” (1)

AI-Enabled Fraud Detection

Artificial Intelligence (AI) is one of the most prevalent terms in healthcare publications today, with use cases spanning from clinical to administrative functions. One of the more popular applications of AI in healthcare is fraud detection.

Fraud in the healthcare industry is believed to cost the U.S. healthcare system tens of billions of dollars annually. According to the National Health Care Anti-Fraud Association (NHCAA), financial losses due to health care fraud can range from a conservative estimate of 3% to as high as 10% of total healthcare expenditures. The General Account Office estimates that fraud, waste and abuse may account for as much as 10% of all healthcare spending. With healthcare expenditures now exceeding one trillion dollars every year, over $100 billion may be lost annually due to fraud, waste and abuse.

Health insurance companies are on the front line of detecting this fraud and often bear the brunt of these costs.

A Fresh Approach

The traditional approach to fraud detection and prevention has focused on rule-based systems within the claims processing workflows. This approach, while well-intentioned, is unable to keep up with the growing complexity of claims and sophisticated fraud schemes.

To enhance fraud detection and prevention, HealthEdge solutions seamlessly integrate with AI and machine learning (ML) engines. Additionally, HealthEdge is developing partner integrations to provide customers with built-in fraud detection technology.

Analytics tools by HealthEdge Source™ (Source) offer health plans valuable insights that directly impact their bottom line. Monitor Mode allows payers to view the financial impact of edits or new policies in real-time, while the Retroactive Change Manager automates the management of retroactive policy and pricing changes. Together, these tools streamline workflows, reduce costs, and improve the integrity of the claims process. By analyzing specific providers, regions, configurations, and contracts, business leaders can make well-informed business decisions.

Prospective Payment Integrity

Since their inception, health plans have often struggled to detect and prevent improper and inaccurate claim payments. In fact, Gartner states that “between 3% and 7% of all healthcare claims are paid inaccurately — and only a fraction of those claims payments are later corrected.” (1)

Traditionally, payers have layered multiple editing solutions to address payment integrity concerns. However, this approach has its own drawbacks:

• Each editing solution operates on its own update schedule and data sets, leading to fragmented processes and siloed information.
• The inherent incentive for primary and secondary editing vendors to protect their own intellectual property has hindered collaboration and sharing among stakeholders. This not only hampers the overall accuracy of the payment process, but also perpetuates a cycle of continuous charging for the same issues without any resolution.

What is Prospective Payment Integrity?

“Prospective payment integrity (PPI) solutions enable payers to proactively avoid paying claims improperly, versus paying and then chasing claims dollars. These technologies facilitate accurate claims processing with minimal payment leakage, addressing contracts and services, eligibility, and payment accountability, along with fraud, waste and abuse (FWA). They incorporate claims editing, data mining and complex clinical review, as well as advanced analytics and AI,” notes the Gartner report.

According to the 2024 Hype Cycle, PPI solutions are “early mainstream,” which in our opinion means that many health plans are still evaluating these solutions. This isn’t surprising, given the cost pressure health plans face, and the difficulty in qualifying cost-avoidance savings. Factors such as counterfactual analysis, indirect costs, and data limitations can make it challenging to accurately measure savings. Despite these challenges, PPI solutions are still considered valuable investments for health plans looking to improve operational efficiency. Reducing the percentage of claims that require rework and limiting the manual effort involved are key strategies that health plan leaders believe can help achieve their efficiency goals.

HealthEdge Source challenges the traditional approach to payment integrity by offering a single platform for accessing and leveraging all data for true payment accountability. This platform approach empowers payers to identify the root causes of payment inaccuracy and correct the issues early on, leading to greater efficiency and lower contingency fees. By streamlining workflows and automating processes, Source enables health plans to insource more functionality, reducing reliance on third-party vendors for overpayment and underpayment recovery. This not only saves time and money, but also provides greater control over the claim’s payment process.

Real-World Case Studies: Cost Savings vs. Cost Recoveries

Source’s Data Study team collaborates with health plans to measure the potential savings when implementing the Source payment integrity solution. Here are a few examples of what those savings can be:

• Mid-sized Regional Health Plan (Medicare Advantage):
• Claims Analyzed: 1.7 million claims
• Total Spend: $648 million
• Incremental Savings: 1.6%, or $11.1 million
• Regional Health Plan (Medicaid):
• Claims Analyzed: 2.1 million claims
• Total Spend: $571 million
• Incremental Savings: 1.6%, or $9.1 million
• National Health Plan (All Lines of Business):
• Claims Analyzed: 5.1 million claims from Medicaid and Dual Eligible members
• Total Spend: $790 million
• Incremental Savings: 1.1%, or $8.7 million

(1) Gartner, Hype Cycle for U.S. Healthcare Payers, 2024. Mandi Bishop, Austynn Eubank, Connie Salgy, 29 July 2024

GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally, and HYPE CYCLE is a registered trademark of Gartner, Inc. and/or its affiliates and are used herein

Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

To learn more about what Source prospective payment integrity solution can do for your organization, visit www.healthedge.com.

Healthcare is experiencing a significant digital transformation, and the HealthRules® Payer Machine Readable Files (MRF) Suite is at the forefront of this revolution. This innovative software suite, developed for HealthRules® Payer, is an industry game-changer, offering a superior solution to manage and publish Machine Readable Files (MRF) of negotiated rates and allowed amounts.

What is the HealthRules® Payer Machine Readable Files Suite?

The HealthRules Payer Machine Readable Files (MRF) Suite is a cloud-based SaaS application specifically designed to help health plans streamline the process of calculating and publishing rates.

With the Machine Readable Files suite, health plans can create accurate, comprehensive MRF files swiftly and efficiently via a user-friendly web interface. Users can also manage, track, and establish operational processes to publish multiple MRF files as needed to maintain compliance. This cutting-edge solution is an essential tool for complying with the mandate from the Centers for Medicare & Medicaid Services (CMS) for Transparency in Coverage and MRF Requirements.

Benefits of using the HealthRules® Payer Machine Readable Files Suite

What do health plans get with the HealthRules Payer Machine Readable Files Suite? Using this innovative offering, our customers gain access to benefits such as:

Industry-Leading Accuracy: The MRF Suite calculates negotiated rates based on Supplier Contract Agreements and historical billing code combinations through a partial adjudication process to help ensure highly accurate results.

Faster Execution Time: Intelligent rate processing features significantly reduce redundant processing and increase billing code coverage.

Flexible and Intuitive Configuration: The solution features an easy-to-navigate, web-based user interface that makes it easier to configure, manage, and track MRF generation.

CMS-Compliant Files: With the MRF Suite, users can produce files compliant with the CMS schema for negotiated rates, allowed rates table of content files

Key Features of the HealthRules® Payer Machine Readable Files Suite

How are our customers achieving these critical business goals? By leveraging MRF Suite features such as:

Intelligent Rate Processing

With the MRF Suite, users can calculate negotiated rates for up to 4.8 million provider billing code combinations daily. The solution also uses historical negotiated rates and shorter runs to refresh changing rates as configured. Plus, users can reuse and map existing negotiated rates.

Flexible Web-based UI

The MRF suite offers an intuitive user interface (UI) that facilitates file configuration, management, and tracking—including asynchronous initiation and monitoring. Users can access flexible configuration options to generate different MRF files according to their unique needs. Health plans can also use the solution to monitor the status of MRF processing runs with a live throughput and count of the claims’ combinations. And, as an added bonus, users can download intermediate files generated in the MRF pricing process.

Data Optimization and Processing

MRF suite users can reduce processing and execution time by storing and reusing generated data. Automated data cleanup and re-evaluation helps to ensure data accuracy and storage optimization, and scheduled incremental runs more easily update negotiated rates. Health plans can adhere to compliance rules and make sure their files are published on time.

Next-Generation Performance

Avoid rate reprocessing rates in case of MRF run failures. Incremental rate updates in the MRF suite generate more comprehensive billing code sets. The web-based UI simplifies and automates monthly operational tasks and monitoring for faster completion—and a 70% time reduction with incremental runs.

Enhance Performance with Machine Readable Files

The latest version of the MRF Suite enhances value for health plans with a 25% reduction in execution time and a 40% improvement in performance—while helping maintain accuracy and storage optimization. It also facilitates more timely publishing of on-demand MRF to improve compliance and reduce operational costs.

Health plans utilizing the MRF Suite have witnessed substantive improvements in performance and compliance. With the updated MRF suite, users see a 40% average increase in daily provider billing code rates throughput and a 28% faster execution time. And the inclusion of incremental runs leads to a 70% reduction in execution time and a larger coverage of billing codes.

HealthEdge is on a mission to drive digital transformation in healthcare, connecting health plans, providers, and members with cutting-edge technology solutions. Our end-to-end digital technology solutions support rapid member growth, new business models, and improved health outcomes.

If you’re looking to transform your health plans’ MRF publishing processes, the HealthRules® Payer Machine Readable Files could be the solution you’ve been waiting for. To find out more or to schedule a demo, watch our videos:

Video part one and video part two.