Payer-Source Integration

Integration Overview

Payer-Source is the direct API-based data exchange between HealthRules® Payer and Source that enables continuous management of core administrative processes and payment integrity between the platforms. Healthcare payers using HealthRules Payer can readily leverage the suite of features and capabilities available in Source, including pricing, editing and analytics.

Payer source integration overview

KLAS 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 2021 Hype Cycle for 11 consecutive years

Gartner sample vendor

Key Customer Benefits

Single Source of Truth

A single source of pricing and editing combining HealthRules LanguageTM and a single pricing/editing call for industry-leading claims accuracy.

Increased Accuracy

Pricing and editing content libraries are automatically updated every two weeks, with comprehensive access to claims history for history-enabled editing.

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Reduced Organization-Wide IT Lift

Native integration reduces strain on internal IT resources and lowers risk through a combined deployment.

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Improved Payment Integrity

Comprehensive, holistic view of a health plan’s payment integrity ecosystem with the ability to edit at multiple points in the adjudication workflow.

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Streamlined Support Model

Partnership with our executive leadership and account management for streamlined communication, combined user groups, and integrated roadmap visibility.

HealthEdge Solutions

Core Administrative Processing System (CAPS)

The HealthRules® Solutions Suite includes the industry's leading, digital, next-generation claims administration processing system, business intelligence, integration capabilities, a unique to industry configuration and promotion application, and home and host processing support available on both public and private clouds.

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Prospective Payment Integrity

Source is a preeminent digital prospective payment integrity solution that natively brings together claim payment automation with proactive business intelligence, enabling payers with Medicare, Medicaid and commercial lines of business to have better relationships with providers, reduce waste and improve their financial performance.

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