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.

Payer source integration overview

Integrated Secondary Editing Solution Now Available to HealthRules® Payer Clients


A Modern Combination: Claims Administration & Payment Integrity


KLAS 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.

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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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