HealthRules® Payer – Exciting New Features & Improvements

HealthEdge

The HealthRules^® Payer engineering team has been working on several critical projects, and the January 2024 release of the solution is packed with new features and improvements. While each release will always include new features, one driving theme for this release is the optimization and refinement of existing capabilities.

Accurate, Real-Time Data – Seamless Sharing

The claims value team is extending its Persisted Accumulator feature to make it much easier for payers to share accurate, real-time accumulator data with third parties, such as Pharmacy Benefits Administrators, trading partners, and other vendors, seamlessly. In addition, the enhanced accumulator data will be made available in the data warehouse so customers can quickly generate and share reports.

Performance Improvements

Within the financial area, our primary focus is on improving the solution's performance, which can be complicated by the configuration and flexibility of the application. For this release, we’ve invested in refactoring the way capitation payments are created to reduce the overall processing time for making payments. The system will compile rate lines throughout the month instead of waiting to process them all at the end of the month. Another excellent example of performance enhancements being made is a change in the way the system processes large claim payments, which will reduce overall payment processing time.”

Online Help Tool Introduction

To help our users get the maximum benefit from the application, the platform team is delivering an online help tool to make it easier for HealthRules Payer users to access and access the latest product documentation and information.

HealthRules Promote Enhancements

Finally, the capabilities of HealthRules Promote, our standalone, web-based application that enables business analysts to quickly and confidently create, manage, track, and promote HealthRules configurations, are being extended to help users accelerate the triage process by adding transaction-specific detailed logs to the user interface and allowing them to download these logs directly from the Promote user interface for any further analysis.