Solutions
Solutions Solutions

Core Administrative Processing System

The HealthRules® Solutions Suite includes the industry’s leading digital claims administration processing system – plus a host of additional value-added capabilities.
Healthrules Solution Suite

Care Management Workflow Solutions

GuidingCare®, our Care Management Workflow solutions, starts with the nation’s most widely adopted care management platform – and provides much more to improve quality of care.
Guidingcare Solution Suite

Prospective Payment Integrity

Source is the preeminent digital prospective payment integrity solution, combining claim payment automation with proactive business intelligence.
Source Solution Suite

Member Experience

Wellframe Digital Care Management and Digital Customer Service solutions extend the reach of your staff to more fully engage and support members.
Wellframe Solution Suite

Professional Services Customer Success Care-Payer Integration Payer-Source Integration Partners
Lines of Business
Commercial

Government

Medicaid Medicare Dual-Eligibles

Plans With Home & Host Capabilities

Dental

Consultants
Resources
Blog

Core Admin

Care Management

Payment Integrity

Member Engagement

Professional Services

Case Studies

Regulatory & Compliance

Advanced Automation

New Market Expansion

Value-Based Care

Events

Newsroom

Company News

Press Releases

Help Center

New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

“Operating margin improvement is a top three critical outcome for digital investments in 2024 for 67% of U.S. healthcare payers.”

– Gartner®, Three Operational Excellence Best Practices to Optimize Costs for U.S. Healthcare Payers, 1 November 2023, Mandi Bishop 1

READ BLOG POST
About Us
Leadership

Careers

Life at HealthEdge US Office India Office Employee Testimonials

Job Openings

White Paper: Open & Flexible Care Management Systems to Transform Healthcare

Download PDF

New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

White Paper: Open & Flexible Care Management Systems to Transform Healthcare

Navigating Digital Care Management Transformation: Delivering on Consumer Expectations with Effective Change Management

Reduce Maternal Morbidity Risk for Black Women with Digital Care Management

Video: Wellframe - Digital Care Management

GuidingCare University: Optimizing Investment in Staff and Healthcare Technology

GuidingCare University: Advancing Product Knowledge for Existing Users

Paper: Compliance with Prior Authorization Mandates Is a Strategic Opportunity for Payers

GuidingCare® University: Streamlined Onboarding and Training for New Staff

The Future of Care Management Platform Training — GuidingCare® University

Case Study: Modernizing Care Management and Operations with HealthEdge® Solutions

Case Study: VillageCare

Infographic: Health Plan Member Satisfaction - The Current State

Infographic: Secrets of a Successful Care Management Implementation

Case Study: Denver Health Medical Plan Customer Spotlight

AHIP Webinar: Satisfying Your Members as Consumers: What Matters Most Today

Consumer Survey Satisfaction Insights Report 2023

Top Areas of Focus for 2023 Regulations and Beyond: Interoperability and Transparency

Data Sheet: GuidingCare SDOH Integrations

Interoperability Strategies for Successful Care Management

Webinar: Navigating Value-Based Care Through Technology and Automation

Infographic: EDGEcelerate