Data Sheet: Custom Code Services for HealthRules® Payer

Expert Custom Code Services to Accelerate Success with HealthRules® Payer

HealthEdge Global Professional Services (GPS) constitutes a team of elite experts dedicated to designing and deploying custom code solutions for the HealthRules® Payer platform. Our services provide the critical flexibility required to solve complex business problems that extend beyond standard product functionality.

Leveraging extensive knowledge of the HealthRules Payer application and its underlying data architecture, our team builds solutions that integrate seamlessly, maintain optimal performance, and adhere to HealthEdge's leading practices. We partner with health plans to understand unique challenges, design tailored solutions, and develop custom code that aligns with specific business objectives, maximizing your investment in HealthRules Payer.

Why Partner with HealthEdge GPS?

To remain agile in a rapidly evolving healthcare landscape, health plans require partners who understand the nuance of their technology stack.

• Deep Product Expertise: Our team possesses an in-depth understanding of HealthRules Payer, ensuring all custom solutions are built with product nuances in mind.

• Seamless Integration: Custom code is designed to integrate flawlessly with existing HealthRules Payer modules and third-party systems.

• Proven Methodologies: We leverage industry best practices and HealthEdge's proven methodologies to deliver reliable and effective solutions.

Automating Complex Logic

While HealthRules Payer offers powerful tools to define claims and benefit logic, certain complex scenarios require a custom approach to ensure accurate and efficient processing. Our GPS team develops Custom Code Services for HealthRules® Payer that enhance its out-of-the-box capabilities, automating intricate logic that would otherwise demand manual workarounds.

We work with your teams to design and implement robust custom code that integrates directly into your existing environment. This allows you to configure the business with greater precision and efficiency.

Our custom code solutions address a variety of complex scenarios, including:

• Advanced pricing methodologies

• Unique benefit accumulations

• Complex provider reimbursement rules

• Custom claim edits and audits

• Intricate medical policies

Custom Correspondence and Data Extracts

Health plans must structure and deliver correspondence according to unique branding, regulatory nuances, and member population needs. The GPS team provides end-to-end support to identify, extract, and structure the right data elements for accurate, vendor-ready correspondence files.

Custom Interfaces for Seamless Data Exchange

HealthRules Payer often serves as the core claims processing engine, requiring seamless integration with other critical applications like membership systems and payment platforms. While standard integration is available, unique business needs often demand custom interfaces.

Our GPS team specializes in developing robust, secure, and scalable Custom Code Services for HealthRules® Payer that enable flawless communication between systems. We ensure that integration comes easy and that data integrity is maintained across your entire technology ecosystem.

Our custom interface solutions include:

• Inbound and outbound data feeds, including HealthRules Payer + Source Integration

• Real-time data synchronization

• API integrations

• Legacy system connectivity

• Data transformation and mapping

Custom Reporting for Actionable Insights

With HealthRules Payer at its core, a health plan's data ecosystem is both powerful and accessible. The GPS team extends this capability by building custom reports that transform operational data into actionable insights. This ensures your teams receive the right metrics at the right time to drive confident decision-making.

Our process for delivering custom reporting includes:

1. Requirements Gathering: We begin by gathering requirements and creating schema documentation.

2. Data Warehouse Utilization: We utilize the HealthRules data warehouse to access comprehensive data.

3. Data Mapping: Our team performs report data mapping and database navigation to locate the correct information.

4. Testing and Validation: We thoroughly test and validate all reporting outputs for accuracy.

5. Ongoing Maintenance: We provide ongoing maintenance and assistance for all custom reports.

Enhance Your Experience

Connect with our Global Professional Services team to explore how our Custom Code Services for HealthRules® Payer can address your unique business challenges. Together, we can build a more efficient, agile, and future-ready health plan and help you optimize efficiencies with integrated HealthRules Payer solutions.