Data Sheet: HealthRules Payer for Plans with Home & Host Capabilities
Health plans with home and host capabilities have been leading the healthcare industry since 1929 and continue to hold strong with top industry rankings today.
HealthRules Payer for Plans with Home & Host Processing
Health plans with home and host capabilities have been at the forefront of the healthcare industry since 1929, ranking highly due to factors like coverage, benefits, provider choice, and administrative efficiency. This executive summary highlights how HealthRules® Payer continues to lead healthcare transformation through compliance, automation, and rapid implementation, thereby maintaining positive provider relationships and trust.
Compliance with Regulatory Requirements:
- HealthRules Payer ensures adherence to evolving CMS, federal, and state policies.
- Features include real-time data feeds, platform interfaces meeting HITRUST standards, and a cloud-based repository for compliance artifacts.
Claims Automation and Accuracy:
- Automation of claims processing is essential for freeing up resources without sacrificing accuracy.
- HealthRules Payer boosts auto-adjudication rates from 50% to 80% for Medicare Advantage, with a financial accuracy rate up to 99%.
- Partnering with HealthEdge means working with experts who understand the everyday challenges of the claims process.
Rapid Implementation:
- Configuration over programmatic setup allows for quicker onboarding and flexibility.
- HealthRules Payer reduces benefit configuration time from days or weeks to just hours, accommodating complex VBC contracts swiftly.
Benefits of HealthRules Payer:
Efficiency:
- Delivers 90%-97% first-pass auto-adjudication rates and supports 99%+ accuracy.
Agility:
- Rapidly adapts to regulatory changes and market pressures.
Value-Based Care:
- Facilitates new reimbursement models, benefit plans, and provider contracts.
Business Insights:
- Provides data-driven insights to improve outcomes, lower costs, and increase transparency.
HealthEdge's HealthRules Payer empowers health plans with home and host capabilities to stay ahead of the curve, driving transformed care and maintaining top industry rankings. With over 25 clients and industry accolades such as Best in KLAS in 2022 and 2023, HealthRules Payer proves to be a critical asset in achieving efficiency and competitive advantage.
Discover how HealthRules Payer can transform your healthcare plan. Learn more about our home and host capabilities or contact a HealthEdge representative today.
