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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

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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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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

HealthRules® Payer + HealthEdge Source™

Infographic: Legacy vs. Next-Generation Core Administrative Processing Systems (CAPS)

How a Modern Healthcare CAPS UI Improves Workflow Efficiency

Data Sheet: Optimize Efficiencies with Integrated HealthRules Payer Solutions

Data Sheet: askHE Chatbot for the HealthEdge® Help Center

How to Modernize Health Plan Core Administrative Processing Systems

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

Improve Payment Calculations and Transparency with HealthRules® Payer Machine Readable Files

HRP Executive Release Notes - Q2 2024

Webinar: Proactively Addressing Regulatory Complexities in California and Beyond

HealthEdge® Machine Readable Files Suite for HealthRules® Payer

HealthEdge® Help Center

HealthRules® Payer Horizons: Improve Member Engagement and Satisfaction

HealthRules® Payer Horizons: Uncomplicate Value-Based Reimbursement

HealthRules® Payer Horizons: Expanding New Business Opportunities

HealthRules® Payer Horizons: Enabling Health Plan Automation With Integration

HealthRules® Payer Horizons: Automating regulatory compliance and accuracy

HealthRules® Payer - IMPACT Spring 2024

Data Sheet: HealthRules® Payer Named “Best in KLAS®” Three Years in a Row

HealthRules Payer Case Study with Presbyterian

HealthRules® Payer Named “Best in KLAS” for Third Consecutive Year in 2024