Payer-Source Integration
Integration Overview
Payer-Source is the direct API-based data exchange between HealthRules Payer® and HealthEdge Source™ that enables continuous management of core administrative processes and payment integrity between the platforms.
As part of HealthEdge's integrated next-generation solution suite, Source and HealthRules Payer offer significant value when combined, including:
- Increased automation and accuracy
- Improved workflow efficiencies
- Enhanced claims processing with software-driven payment integrity.
The integrated secondary editing solution is now available to HealthRules Payer customers to help reduce inappropriate claims before the are paid.
Integrated Secondary Editing Solution Now Available to HealthRules® Payer Clients
LEARN MOREA Modern Combination: Claims Administration & Payment Integrity
LEARN MOREKLAS Research named HealthRules® Payer its 2023 “Best in KLAS” payer claims and administration platform
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HealthEdge® recognized as Sample Vendor in 3 categories in the Gartner® Hype Cycle™ for US Healthcare Payers in 2023
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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.
Reduced Organization-Wide IT Lift
Native integration reduces strain on internal IT resources and lowers risk through a combined deployment.
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.
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.
Learn MoreProspective 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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