Data Sheet: HealthRules Language

The HealthRules Language™ is the foundation of the HealthRules^® Payer Solution Suite, offering a next-generation approach to core administrative processing systems for health plans. This patented, English-like healthcare-specific vocabulary allows business analysts to define rules, terms, and business logic intuitively, enhancing flexibility and accuracy in configuration tasks.

Key Features and Benefits:

• User-friendly language: Easily understood by all users, allowing for efficient configuration without extensive training.
• Reusable components: Enables the creation of multiple benefit plans with identical structures, minimizing manual effort and duplication concerns.
• Enhanced testing: Improved transparency and reuse lead to faster, high-quality configurations.
• Adaptability: Quickly respond to market and regulatory changes, ensuring compliance and operational efficiency.
• Value-based models and regulatory alignment: Supports complex capitation arrangements, narrow network designs, and automated benefit, pricing, and billing incentives, promoting better care and patient outcomes while controlling costs.

Case Studies:

• Independent Health achieved full capitation contracts with primary care providers, improving patient outcomes and lowering healthcare costs.
• HealthEdge customers swiftly adapted to regulatory changes, such as CMS's directives on social determinants of health and COVID-19 policy shifts.
• Medica Health Plans rapidly reinstated products in response to unexpected regulatory changes, achieving high auto-adjudication rates and boosting member satisfaction.

Operational Efficiencies:

The HealthRules Language’s flexibility and innovative design enable health plans to offer new products quickly while reducing administrative costs and increasing operational efficiencies. It simplifies complex configurations, ensuring that even intricate business models remain transparent and manageable.