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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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HealthRules Payer Release Notes - Executive Summary

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

HealthRules Payer Release Notes - Executive Summary

IMPACT Spring 2025

Build an Integrated Technology Ecosystem with a Next-Generation Core Administrative Processing System (CAPS)

Expand to New Markets Using a Next-Generation Core Administrative Processing System (CAPS)

3 Healthcare Market Trends Driving the Need for Advanced Regulatory Support

Case Study: How One Regional Health Plan Created a Member-Centric Digital Ecosystem

Case Study: Medica Partners With HealthEdge To Improve Member Lives In The Moments That Matter

Data Sheet: HealthRules® Payer Web User Interface

Leverage Next-Generation CAPS to Drive Competitive Advantage and Adaptability

The Hidden Costs of Legacy Core Administrative Processing Systems (CAPS)

How HealthEdge®’s HealthRules® Payer Helped Medica Transform Claims Operations through Strategic Automation

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