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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

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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

Prospective Payment Integrity

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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HRP Executive Release Notes - Q2 2024

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

HRP Executive Release Notes - Q2 2024

How to Modernize Health Plan Core Administrative Processing Systems

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

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 + HealthEdge Source™

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

HealthRules Payer Release Notes - Executive Summary

HealthRules Payer

HealthRules® Payer – Exciting New Features & Improvements

Configuration as a Service Expedites Time-to-Value for Health Plans

A Member Journey After the No Surprises Act: How Plans Meet Regulatory Mandates and Satisfy Members with HealthRules® Payer