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

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

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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

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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

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Case Study: Highmark Wholecare, Delaware Health Options, West Virginia Health Options

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Case Study: Highmark Wholecare, Delaware Health Options, West Virginia Health Options

Case Study: How One Regional, Provider-Owned Health Plan Streamlined Care Management Reporting for Better Regulatory Compliance

Case Study: How To Build A Digital Adoption Ecosystem And Deliver Greater Value To Members

Case Study: How One Regional Health Plan Created a Member-Centric Digital Ecosystem

Case Study: SummaCare's Secret to Payment Integrity Success

Case Study:Transforming Payment Accuracy and Operational Efficiency at a Large National Health Plan

Case Study: Medica Partners With HealthEdge To Improve Member Lives In The Moments That Matter

How HealthEdge®’s HealthRules® Payer Helped Medica Transform Claims Operations through Strategic Automation

Case Study: Modernizing with HealthEdge® to Drive Expansion

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

Case Study: Health Plan for Large Metropolitan Area Transforms Care and Operations with HealthEdge® Solutions

Case Study: Empowering Innovative Healthcare with Integrated HealthEdge® Solution

Case Study: Digital Health Improves Care Transitions For Members With Multimorbidities

Demonstrating the value of digital health with a new methodology

Driving Care Management Capacity and Engagement with Wellframe Digital Health

Report: Digital Care Management can help lower blood pressure by more than 9%

Report: Digital Care Management can help lower blood sugar by more than 25%

Case Study: Improving Maternal Health Outcomes Through Digital Engagement

HealthRules Payer Case Study with Presbyterian

Case Study: VillageCare - Leveraging Business Intelligence to Accelerate Digital Transformation

Case Study: Managing Payment Complexity to Improve Operational Efficiency