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What does it take to pay a claim correctly? In healthcare, “editing claims” goes beyond surface-level checks—it’s about ensuring accuracy, compliance, and efficiency. Each claim must align with provider contracts, state and federal regulations, and demonstrate medical necessity. The challenge for many health plans lies in navigating the diverse payment policies while minimizing delays or rework. Payment integrity is about maintaining this intricate balance.

Payment accuracy, operational efficiency, and cost management are critical priorities for health plans navigating an increasingly complex claims landscape. Errors in claims processing can disrupt operational workflows, increase expenses, and damage relationships with healthcare providers.

In the recent webinar, “Path to Payment Integrity: Enhance Payment Accuracy with HealthEdge Source™ Editing,” our experts shared actionable ways payers can address common challenges to claims accuracy. This blog will explore 5 of the key obstacles health plans face during claims processing and how the HealthEdge Source Editing tool helps contribute to cost savings by enhancing accuracy and efficiency.

5 Challenges Health Plans Face in Claims Management

The claims payment process often involves multiple, disparate technologies. Juggling multiple vendors and point solutions can lead to workflow inefficiencies and increased operating costs. If claims management feels overwhelming, you’re not alone. These are 5 of the most common challenges payers face.

1. Regulatory Complexity

Keeping up with constant updates from the  Centers for Medicare and Medicaid Services (CMS), state Medicaid programs, and other federal agencies requires meticulous oversight and prompt action. Health plans often struggle to keep up with the pace of change, leading to non-compliance risks and operational disruption.

2. Too Many Vendors

Health plans rely on a fragmented approach with multiple vendors managing separate parts of post-pay processes. This “stacked vendor” system can lead to inefficiencies, delayed guideline updates, varying data accuracy, and higher administrative costs.

3. Rising Administrative Costs

On average, each medical claim carries a financial cost of $12 to $19. Complex manual processes and workflow inefficiencies in claim processing can significantly increase these administrative costs. Reliance on manual claims processing also causes issues for health systems, costing an average of $5 million in losses per year and increasing provider abrasion.

4. Limited Internal Claims Editing Capabilities

Many health plans lack effective in-house tools to align claims editing and pricing systems. Relying on disparate third-party claims editing systems can create mismatches between pricing, policies, and regulations—leading to denials and rework.

5. Provider Abrasion

Delays, rework, and reimbursement issues damage provider trust in your health plan, making an already complex system even harder to manage.

Payment Integrity Insights from Payers

During the webinar, participants were surveyed about the top challenges and priorities at their health plans.

Top Challenges in Claims Payment Accuracy

“Increasing regulatory complexity” emerged as a primary concern for payers, followed closely by a “lack of in-house claims editing capabilities.” These findings highlight that staying compliant while managing cost and operational efficiency remains a delicate balance.

Primary Drivers for Improving Payment Integrity

Many payers identified “reducing overall costs” and “optimizing operations for efficiency” as the main drivers for modernizing payment integrity efforts. These priorities go hand-in-hand as health plans strive to streamline workflows and eliminate wasteful spending.

Most Helpful Tools for Claims Accuracy

Participants emphasized the need for “real-time performance metrics” and “stronger system integrations” as critical enablers for success. Streamlined insights and a cohesive ecosystem are essential for navigating the complexities of payment integrity.

Benefits of HealthEdge Source Editing

Real-Time Claims Accuracy

With HealthEdge Source Editing, claims processing is automated to streamline operations and reduce the need for manual review. Automating processes helps cut down on expensive claims rework and reduces provider abrasion due to delays.

HealthEdge Source combines editing, pricing, and analytics into one integrated system, catching errors and flagging inconsistencies in real-time. This proactive approach uncovers the root causes behind recurring payment issues. With these insights, health plans can fine-tune their processes, implement corrective strategies, and address systemic inefficiencies, all while maintaining a clear focus on cost containment and operational excellence.

Regulatory Compliance Made Easy

HealthEdge Source simplifies compliance for your team through automatic cloud-based, regulatory updates, eliminating the burden on your internal teams. With constantly updated code edits, automated claims auditing, and detailed audit trails, staying compliant has never been easier.

The platform is fully customizable for state and payer-specific requirements, giving your health plan the flexibility to adapt to shifting guidelines. By automating compliance checks, HealthEdge Source can help minimize penalties, save time, and enhance accuracy—letting you focus on your members.

Seamless Integration

Our solution seamlessly integrates with existing claims systems, third-party tools[DN1] , and pricers to enhance capabilities without costly disruptions. Third-party integrations make it easier for payers to streamline data flow, eliminate silos, and enable real-time validation, ensuring accurate claims processing and payment calculations upfront. Leveraging third-party tools also helps improve fraud detection and data enrichment. The result is a cohesive ecosystem that allows your health plan to deliver both financial and operational excellence without compromise. 

Increased Customization and Control

HealthEdge Source Editing allows your health plan to tailor rules and configurations to match unique provider contracts, policies, and regulatory requirements. This flexibility improves accuracy while helping payers adapt to evolving business needs.

Actionable Business Intelligence

The HealthEdge Source platform provides transparent insights into claims performance through a unified interface. The modeling tool allows health plan teams to test and refine new edits before implementation, reducing errors and ensuring alignment with business goals. And advanced analytics highlight trends and potential challenges, enabling health plans to make data-driven decisions and proactively adapt to emerging demands.

Efficiency and Cost Savings

By streamlining payment integrity operations, HealthEdge Source Editing helps payers reduce administrative costs and save time. This allows internal teams to focus on strategic initiatives, rather than repeatedly fighting the same fires.

HealthEdge Source Editing provides a comprehensive solution that combines real-time accuracy, seamless integration, regulatory adaptability, and actionable insights, enabling your organization to streamline processes, reduce costs, and build stronger relationships with providers.

Watch the video to see how your health plan can leverage HealthEdge Source Editing.

Ready to learn more about HealthEdge Source? Explore what the solution can do for your health plan by visiting our resources page for additional tools, insights, and expert guidance. Empower your organization to deliver excellence in payment integrity today.

 

Optimizing healthcare technology solutions is no longer just a nice-to-have—it’s a strategic move that can drive significant improvements in efficiency and cost saving. From reducing operational costs to improving member and provider experiences, well-executed technology optimization can deliver measurable benefits across your organization.

But how do you unlock the full potential of your digital solutions? Where do you even start?

The first—and most crucial—step is an optimization assessment. Designed to evaluate your current system setup and workflows, an optimization assessment identifies opportunities for improvement in your workflows and technology use, helping ensure your business maximizes the value of its technology solutions.

This blog will address common questions about optimization assessments and provide guidance for health plans considering technology optimization initiatives.

What Is an Optimization Assessment?

An optimization assessment is a detailed evaluation of your digital solutions, such as Core Administrative Processing Systems (CAPS) and Care Management. With the help of expert teams, an optimization assessment identifies potential pain points and recommends best practices to maximize your technology investment.

Key outcomes include enhanced system performance, more streamlined workflows, and empowered end users who understand how to best leverage the tools available to them.

But how exactly does this benefit your organization?

How Can My Health Plan Benefit from an Optimization Assessment?

Optimization assessments aren’t just about fixing what’s broken—they focus on empowering health plans to better leverage the solutions they already have to achieve their strategic goals. Here are three ways these assessments can create value for health plans like yours:

1. Increase Operational Productivity

By conducting a deep analysis of your current workflows and system setups, optimization assessments help identify inefficiencies that may be slowing your team down. Perhaps processing times are lagging, or manual workarounds have crept into daily operations. Through customized recommendations, experts can help your team work more efficiently, reduce manual input, and improve overall productivity.

2. Leverage New Functionality and Updates

Technology evolves rapidly—especially in the ever-shifting healthcare industry. With each new product release, features and capabilities are updated to keep your organization on the cutting edge. An optimization assessment ensures that your organization continues to get the most value out of its HealthEdge solution as it grows and evolves.

3. Empower End Users with Training

Your system is only as effective as the individuals who use it every day. A key component of optimization assessments involves engaging directly with end users, addressing process gaps, answering their workflow questions, and providing targeted training. The result? A more confident, knowledgeable workforce that can leverage your technology more effectively.

What Types of Optimization Assessments Does HealthEdge® Offer?

HealthEdge offers two key types of optimization assessments tailored to address your specific organizational needs. Whether you require laser-focused insights on a particular challenge or a broad system evaluation, there’s an assessment type designed for you.

Targeted Assessments

Targeted assessments are designed to investigate and solve specific issues within your systems, such as:

• Addressing low auto-adjudication rates
• Streamlining care coordination
• Improving the end-user experience

The findings and recommendations you’ll receive focus entirely on resolving the identified issue, outlining actionable steps that can be implemented quickly for measurable improvements.

Comprehensive Assessments

Comprehensive assessments take a holistic approach by evaluating your entire HealthEdge solution, including configurations, workflows, and user processes.

Many customers choose to conduct a comprehensive assessment three to six months after implementing a new HealthEdge solution. Why? It provides an opportunity for payers to make usage adjustments, refine workflows, and focus on additional training as part of the broader optimization process. Optimization assessments can also serve as a vital step in preparation for new strategic initiatives, like expanding into different markets or serving new member populations.

3 Steps of the GuidingCare® Optimization Assessment

When it comes to GuidingCare, the care management solution from HealthEdge, optimization assessments follow a structured three-step process for maximum impact.

Leadership Alignment Meeting: We start by meeting with your leadership team to align on key goals, identify specific areas of improvement, and establish expectations for the assessment.

End-User Group Sessions: Next, we engage directly with your end-user groups—such as care management, utilization management, medical directors, and others. These sessions involve day-to-day process observations and workflow evaluations, identifying opportunities for optimization and training.

Recommendations and Follow-Up: A detailed report outlines the findings discovered during the assessment, with actionable next steps to address gaps and enable improvements. Then we coordinate a leadership session to review the insights and assist your organization to formulate an action plan and ensure alignment moving forward.

[H3] 5 Steps of the HealthRules® Payer Optimization Assessment

For HealthRules Payer, optimization assessments use a five-step methodology designed to uncover inefficiencies and improve outcomes more broadly across the organization.

Preparatory Meeting: We work with your health plan’s leadership to define the business problem and set expectations with project sponsors and stakeholders.

Project Startup: Using information from the initial meeting, we determine the scope of the assessment and align stakeholders on deliverables through a structured work plan.

Workflow Assessment: At this stage, we interview subject matter experts, collect and review system and workflow data, and evaluate configurations and resource inputs impacting performance.

Operational Analysis: Our team conducts a SWOT analysis to identify gaps, pain points, and configuration improvement opportunities.

Health Plan Recommendations: The final report provides key findings and recommended action items. We review the benefits and impact of suggested improvements and outline clear next steps.

How Can Your Health Plan Get the Most Value Out of an Optimization Assessment?

To get the most out of your optimization assessment, preparation and transparency are key.

For GuidingCare Assessments

• Opt for On-Site Assessments: Whenever possible, conduct assessments on-site. This allows for direct observations of user workflows and tools for a richer understanding of challenges and potential improvements. For remote assessments, your health plan may have to make additional preparations.
• Pre-Visit Preparation: Collaborate with HealthEdge to collect necessary data, align department representatives, and coordinate schedules beforehand to ensure a smooth process.

For HealthRules Payer Assessments

• Define Clear Outcomes: Our team will work with your leadership to define the scope of the engagement, assess and evaluate your current systems and workflows, diagnose any problems or issues, and deliver a report of key findings and recommendations.
• Focus on Transparency: Provide full and accurate data on pain points, KPIs, and areas for ROI estimates to better enable HealthEdge to effectively diagnose issues and deliver impactful recommendations.

Move from Optimization to Transformation

An optimization assessment isn’t just about improving the technical side of your system—it’s an opportunity to align your technology and processes with your broader business goals. By streamlining workflows, empowering end users, and keeping your organization ahead of technology trends, optimization assessments unlock both immediate and long-term benefits.

Still on the fence? HealthEdge’s proven track record includes transforming inefficient workflows, enabling features that reduce operational costs, and boosting overall system performance for health plans just like yours. By leveraging an optimization assessment tailored to your needs, you’ll not only maximize your existing technology investment but also set the stage for sustainable growth.

To learn more or schedule your assessment, contact your HealthEdge customer success executive today. The sooner you begin, the sooner your health plan will reap the benefits of streamlined operations and improved outcomes.

Provider data is the backbone of operational efficiency for health plans. From ensuring accurate claims processing to improving member satisfaction, maintaining an up-to-date and reliable provider database is essential. However, traditional provider data management strategies may not be equipped to handle the volume and variety of data that payers must review and reconcile.

Advanced Provider Data Management solutions are developed with integration and automation in mind, making it easier for health plans to understand and utilize data more effectively. Leveraging an integrated Provider Data Management platform can streamline data sharing across payer organizations to redefine efficiency, elevate member experiences, and maintain regulatory compliance.

In an episode of the Becker’s Payer Issues Podcast, Senior Director of Product Management for HealthEdge®, Parvathy Sashidhar,  shared her experiences working with health plans to modernize Provider Data Management. Discover two of the most common pain points payers face in managing provider data. Plus, learn the three key risks of working with inaccurate provider data.

Common Obstacles In Provider Data Management

Data Integrity: Frequent changes to provider networks, contract details, and credentialing can make it challenging for payers to maintain data integrity when it comes to updated provider records.

Technology integration and data transparency: Health plans receive information from multiple sources and in multiple formats. Collecting and reconciling this data into a cohesive repository can be complex, and without the right system integrations, important data could become siloed.

Payers face a lot of pressure to ensure the timeliness and accuracy of provider data across their systems. Use of inaccurate data can lead to delays in payments, higher rates of error, and costly administrative rework. Integrated Provider Data Management solutions help payers overcome these obstacles using workflow automation that empowers payers to meet member needs at scale.

Mitigate The Risks Of Using Inaccurate Provider Data

Healthcare payers face significant risks by continuing to use outdated systems with inaccurate data. Risks generally fall into two categories: risks to operational efficiency and risks to member engagement and the member experience. An advanced Provider Data Management system can help mitigate these and other risks through data integration and transparency.

Operational Risks

Claims processing errors: Incorrect provider data can lead to claims processing errors, such as overpayments, incomplete reimbursements, and denials—negatively affecting payer cash flow as well as straining provider relationships.

Administrative Overload: Resolving inaccuracies consumes significant time and resources. Not only does this delay payment processing, but it also increases the administrative burden on teams that are already busy.

Regulatory Penalties: Publishing outdated information in a provider directory can result in penalties and fines, damaging a payer’s reputation in the industry and sacrificing member trust. Plus, improve customer price transparency and payment accuracy.

Member Experience Risks

Accurate provider directories are vital for members seeking affordable, in-network care. In addition to incurring noncompliance penalties, incorrect directory data can lead to other complications.

Barrier to health access: Outdated directory information could lead to members unknowingly visiting or being referred to providers who are out-of-network or are no longer practicing. In addition, if members can’t find nearby, in-network doctors, they may forego care altogether – leading to more complex care needs in the future.

Decreased member satisfaction: Members may become frustrated if they can’t find an appropriate provider, or experience delays in their claims reimbursements. These members may lose confidence in their health plans and decide to change insurers.

Automate Provider Data Management

Advanced Provider Data Management solutions help mitigate these risks by offering real-time updates, integration, and robust validation protocols. These platforms are built to harmonize data across sources and formats to create a “golden record” of provider information for your health plan and your members.

Some solutions also offer automated updates for regulatory guidelines and data processing, resulting in lower error rates, less administrative burden, and resolving claims disparities in less time. By ensuring provider data accuracy, payers can enhance not only operational efficiency but also member satisfaction—a key differentiator in today’s competitive healthcare market.

HealthEdge Provider Data Management: Built for Growth

At HealthEdge, we recognized payers have a critical need for a more accurate, efficient, and reliable way to manage provider data. The healthcare industry is evolving, putting increasing pressure on payers to leverage real-time data across their organizations.

We designed a modern Provider Data Management platform capable of handling dynamic updates in real time. Our cloud-native platform ensures that health plans always have access to the most current and accurate data.

The platform also integrates seamlessly with HealthEdge systems like HealthRules® Payer, as well as other third-party solutions to facilitate faster implementation and minimal disruptions. Our automation capabilities help enrich data processing, validation checks, and workflows, reducing human error at every step.

Unlock Efficiency with HealthEdge Provider Data Management

Accurate provider data is no longer a “nice-to-have” for health plans—it’s a necessary competitive advantage. With Provider Data Management from HealthEdge, payers can enhance operational efficiency, reduce administrative bottlenecks, and deliver unparalleled member experiences.

Want to see how HealthEdge Provider Data Management can transform your operations? Read our blog, “Unlocking Efficiency: How Provider Data Management for Health Plans Drives Success.”

Effective care management begins with getting members onboarded. For health plans, the onboarding process sets the tone for the member’s experience while also building the foundation for long-term engagement and partnership. But listing an 800 number on your website isn’t enough to meet the needs or expectations of today’s members. To truly optimize care management utilization, leveraging digital tools is essential.

To better support members as they get started, health plans must leverage digital care management tools to create accessible, personalized, and seamless onboarding experiences. This blog explores how health plans can leverage digital tools to revolutionize member engagement, improve care coordination, and foster stronger connections between payers, care teams, and members.

Move Beyond the 800 Number to Enhance Digital Onboarding

Traditional onboarding processes aren’t always equipped to meet members where they are. If your care management onboarding relies on a hotline or generic welcome emails, you might be missing a critical opportunity to catch your members’ attention. Digital tools bring onboarding into the modern age, offering flexible and accessible interactions for your members.

By integrating digital care management solutions, health plans can build a digital adoption ecosystem that can help:

• Improve accessibility through web and mobile channels.
• Provide consistent access to care resources and support.
• Reduce barriers to engagement, especially for high-risk populations.

Meet Members Where They Are

Many health plans find it challenging to reach and engage with diverse member populations. From managing chronic conditions to navigating social determinants of health, members have unique needs and preferences. Digital engagement tools allow you to tailor outreach efforts, delivering personalized messages, resources, and care options to the right members at the right time.

Empower Members with Digital Engagement Opportunities

A wide array of digital tools empowers members to take an active role in their health and condition management. These tools remove friction in the engagement process and foster self-advocacy in members. Key features include:

• Two-Way Chat: HIPAA-compliant messaging simplifies communication between members and care teams, enabling real-time or asynchronous conversations. Members and care teams can share links and upload attachments to help answer important questions faster.
• Digital Surveys & Assessments: Gather critical insights into member needs to catch problems early and close gaps in care, in less time than it takes via phone call.
• Curated Resources: On-demand articles and educational materials within the solution so members can better understand and manage their care options.

By equipping members with these tools, health plans make it easier for individuals to engage with their health proactively.

Improve Care Coordination and Efficiency

Digital tools aren’t just beneficial for members; they also provide care teams and payers with actionable insights. Payers can leverage integrated digital care management tools to:

• Gain access to real-time member data that helps anticipate and address needs before they escalate.
• Better inform care teams of member engagement trends to refine their approach accordingly.
• Help ensure vital data flows seamlessly between systems, reducing administrative burden and improving operational efficiencies.

Meet Member Expectations for Personalization & Experience

Members today expect personalized, convenient experiences from their health plans. Digital tools enable payers to deliver on this expectation by crafting tailored outreach and engagement programs. The result? Improved member satisfaction, greater health plan loyalty, and better health outcomes.

Consistency builds trust, and trust strengthens relationships. Digital care management tools ensure a seamless and cohesive member experience through innovative features like:

Mobile App Cobranding

Digital engagement solutions like Wellframe™ allow health plans to customize the member experience with their own branding. Modifying app colors, logos, and design elements provides consistency between the member experience and your brand identity. This reinforces trust and enhances brand recognition.

Single Sign-On (SSO)

Members often grapple with “password fatigue” as they juggle multiple logins for various platforms. Simplify their experience by enabling single sign-on capabilities, to give members instant, secure access without additional hurdles. This convenience makes it easier for members to engage regularly with your digital platform.

Take the First Steps Toward Transformation

Modern member onboarding begins with the right digital care management tools. With solutions like Wellframe, your health plan can:

• Optimize existing resources for better efficiency.
• Drive stronger engagement through personalized experiences.
• Build trust and loyalty among members.

Want to learn more? Download the Integrated Digital Care Management eBook to see how Denver Health Medical Plan is utilizing the HealthEdge solutions Wellframe and GuidingCare® to address the complex needs of its members. This transformation is enabling better care delivery, increased member engagement, and enhanced operational efficiency—all without overstretching limited resources.

Looking to get started? Contact us today to explore our suite of digital care management solutions can help transform your approach to care management utilization and discover how they can help you reimagine member onboarding.

Effective healthcare delivery relies on seamless communication and collaboration between payers and providers. But inefficient workflows and outdated technology solutions can put a strain on these relationships by offering limited interoperability and scalability. The result? Fragmented processes, tension in collaborations, and a ripple effect on the quality and timeliness of care for patients.

Enter the next-generation Core Administrative Processing System (CAPS). Designed to streamline processes and foster transparency, a modern CAPS solution helps health plans address challenges while fostering mutual trust and ultimately improving patient care.

In this blog, we break down how adopting a next-generation CAPS can help health plans reduce costs, improve patient care, and stay competitive in a rapidly evolving industry.

Confront Common Barriers to Building Provider Trust

Despite shared goals, payers and providers often find themselves at odds due to workflow inefficiencies and a lack of real-time collaboration tools. Common challenges include:

• Claims Delays: According to the 2025 HealthEdge® Payer Report, 60% of providers cite claims processing delays as a top frustration, slowing reimbursements and creating administrative bottlenecks.
• Lack of Transparency: With 43% of providers identifying limited claims transparency as a recurring issue, trust is frequently eroded between payers and providers.
• Data Silos: Poor interoperability hinders access to real-time data, complicating decision-making and care coordination for both payers and providers.

A modern CAPS solution can form the base of an integrated technology ecosystem at your health plan to improve transparency and deliver actionable insights.

5 Ways Next-Generation CAPS Helps Improve Provider Relationships

1. Claims Transparency

By offering providers real-time claims statuses and detailed adjudication processes, a next-generation CAPS minimizes the frustration caused by opaque systems. Plus, intelligent automation minimizes the need for manual intervention, streamlining claims submission and adjudication. These automated workflows greatly reduce human error while speeding up payment timelines, allowing providers to focus more on patient care.

For example, Medica, a nonprofit payer, achieved a high first-pass auto-adjudication rate using HealthRules Payer. This resulted in faster claims resolution and improved relationships with network providers.

2. Streamlined Payment Integrity

Payment delays are a primary source of tension between payers and providers. Seamless integrations and real-time APIs allow payers to track claims, resolve issues at their source, and make more informed decisions using the most updated data available. This reduces underpayments, overpayments, and the associated rework, fostering greater trust and reducing provider abrasion.

3. Support for Value-Based Care

The shift to value-based care requires stronger partnerships between payers and providers. A next-generation CAPS facilitates secure, real-time communication between payers and providers. These tools improve coordination for value-based care models and enable more responsive issue resolution, strengthening the partnership between payers and providers.

4. Data-Driven Collaboration

With advanced analytics at its core, a modern CAPS equips providers with the actionable insights they need to align their practices with payer goals. For example, predictive analytics can flag claims anomalies, forecast care trends, and even suggest preventative measures that enhance patient outcomes. Plus, real-time comparisons of performance metrics can incentivize proactive measures and reward providers for delivering improved patient outcomes.

Real-World Outcomes of Implementing CAPS

Faster Claims Processing

By automating workflows, CAPS reduces average claims adjudication times from weeks to mere days. For payers, this improves operational efficiency, while providers benefit from faster reimbursement cycles—freeing up resources to invest in patient care.

Stronger Provider Trust

Transparency tools and timely payments go a long way in building trust. Providers who feel confident in their administrative partners are more likely to continue collaborations, strengthening the payer’s network in the long term.

Improved Patient Outcomes

Efficient payer-provider collaboration directly impacts patient care. When administrative delays are minimized, providers can maintain uninterrupted treatment plans. Additionally, data-sharing capabilities enable more personalized, coordinated care.

Why Invest in CAPS Now?

The healthcare industry is evolving, and payers relying on legacy CAPS solutions risk falling behind. Adopting a next-generation CAPS solution can help your health plan:

• Boost Efficiency: Automated workflows and advanced analytics streamline processes, lowering costs for both payers and providers.
• Remain Competitive: Flexible architecture and real-time updates prepare health plans to adapt to regulatory changes and value-based care models.
• Strengthen Partnerships: Transparent data-sharing, faster payments, and better collaboration tools enhance provider relationships, making you a preferred partner in the long run.

Building the Future with Next-Generation CAPS

Implementing a modern CAPS is not just about staying up to date with new technologies—it’s about transforming relationships and reimagining how payers and providers collaborate to improve patient care. By investing in an updated CAPS solution, you’re ensuring your organization is ready to meet the demands of a dynamic healthcare landscape, while paving the way for stronger, trust-based partnerships with providers.

Take the Next Step with HealthRules Payer

Want to see how health plans like yours are using the HealthRules Payer CAPS solution to enhance provider relationships and streamline operations? Discover how a regional health plan worked with HealthRules Payer to create a member-centric digital ecosystem with improved data access. Read the case study.