HealthRules® Payer

HealthRules Payer is even more powerful when combined with GuidingCare®. Our unique Care-Payer Data Exchange solution provides the API-based integration that enables the continuous management of member care and core administrative processes.

Care-Payer provides a range of vital capabilities, including:

• Standardized core data delivery from HealthRules Payer to GuidingCare
• Authorization entry workflow improvement, including single-case agreement and referral category enhancement
• Near real-time authorization delivery from GuidingCare to HealthRules Payer

Most notably, Care-Payer includes Benefit Predictor integration. This unique feature enables GuidingCare users to quickly and easily answer complex benefit questions prospectively from members and providers. This Benefit Predictor integration is incorporated into several key workflows, giving Utilization Management staff and care managers unparalleled access to near real-time benefit information.

Care-Payer Data Exchange delivers significant benefits to your organization, including:

• Smooth implementation through HealthEdge expertise and standardized processes
• Synchronized data sets between HealthRules Payer and GuidingCare
• New levels of operational efficiency in authorization entry and medical management
• Improved payment integrity
• Certified data exchange

The integration between HealthRules Payer and Source creates a new level of operational efficiency and accuracy in claims pricing and editing. With the continuous management of payment integrity and core administrative processes between platforms, the Payer-Source integration enables:

• A single source of truth
• Increased accuracy
• Organization-wide IT lift
• Improved payment integrity
• Streamlined support model

The increased transparency gained from the Payer-Source integration improves payer-provider relations and member satisfaction.