HealthRules® Payer: Next-Gen Claims Administration for Health Plans

HealthEdge HealthRules® Payer delivers next-generation claims administration that transforms how modern health plans operate. Through advanced automation, seamless integration, and highly configurable business logic, this comprehensive platform solves today's critical challenges while positioning your organization for future market demands.

Key Advantages of HealthRules Payer

• Exceptional Automation Performance: HealthRules Paer customers regularly achieve auto-adjudication rates up to 90% with financial accuracy as high as 99%. This significantly reduces manual processing, lowers operational costs, and increases overall efficiency.

• Rapid Policy Implementation: During unprecedented events like the COVID-19 pandemic, our customers enacted major policy changes in days, not months, demonstrating superior resiliency and adaptability without business disruption.

• Streamlined Integration Capabilities: Our platform ensures real-time API integration with best-of-breed systems using a suite of powerful tools, including HealthRules Connector, Upgrade Assurance, a Portal Integration Kit, and the HealthRules EDI Gateway. It also works seamlessly with our solution for Claims Editing and Payment Integrity.

• Reimagined Upgrade Process: We've reduced upgrade timeframes from months to just weeks. This approach lowers costs, shortens your time-to-value, and guarantees forward compatibility across all future versions of the platform.

Advanced Configuration and Operational Efficiency

The platform’s patented HealthRules Language engine empowers business users to configure complex benefits and reimbursement logic without writing custom code. The comprehensive core administrative processing suite includes:

• HealthRules Administration: For complete user management and permissions control.

• HealthRules Designer: To intuitively configure product designs and benefit structures.

• HealthRules Manager: For handling all standard insurance operations and processing tasks.

Our Business Configuration Tools further accelerate your time-to-market with a Benefit Plan Wizard, template-based plan management, reusable benefit components, and flexible management of service categories and code sets.

Proven Results and Market Trust

HealthEdge is the trusted partner for over 110 health plans, covering more than 110 million members across 48 states. Our customers consistently report significant operational improvements.

"The efficiencies were so high I was able to redirect staff." - Lee Ditkowsky, AVP Claims, Elderplan

"HealthEdge is the source that is fueling our digital strategy." - VP, Advancement Office, Blues Plan

This next-gen claims administration platform delivers unparalleled operational efficiency and the flexibility to adapt to evolving healthcare market dynamics.

Ready to transform your claims administration? Request a demo of HealthRules Payer today.