Legacy Systems

HealthRules Payer Case Study with Presbyterian

HealthEdge had the opportunity to sit down with Presbyterian Health Plan leadership to learn more about why their organization decided to make the switch to HealthRules Payer as it's CAPS partner.

Data Sheet: Achieving Transparency Compliance Through HealthRules Payer

Achieving regulatory compliance in the healthcare industry is a complex and evolving challenge, particularly with mandates such as the Transparency in Coverage (TIC) Final Rule and the No Surprises Ac

Infographic: Traditional Claims Editing Software vs. HealthEdge Source

Data Sheet: HealthEdge Source - Software for Health Plans With Home & Host Capabilities

HealthEdge Source™ is a cloud-based solution designed to enhance payment accuracy and integrity for health plans with home & host capabilities.

Data Sheet: Platform Access Delivers a Transformative Approach to Payment Integrity

Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report (PDF)

HealthRules Payer has been named “Best in KLAS” by KLAS Research for Claims & Administration Platforms for the second year in a row.

Data Sheet: Point-of-Service Payment System Success - Integrated Ecosystems (PDF)

Traditional claims systems are often fragmented and inefficient, leading to significant errors and unnecessary operational costs.

Cloud-Based Data Delivery in Healthcare: Point-of-Service Payment Success Path

In today's healthcare landscape, the complexity and inefficiencies of payment systems are a common source of frustration for patients, providers, and payers alike.

Data Sheet: Point-of-Service (POS) Payment Success in Healthcare - Process Automation & Intelligent Workflows

What if we could develop a smart and efficient workflow that ensures payment accuracy from the start?

Data Sheet: Source 3rd Party Integrations Partnerships

White Paper: Prospective Payment Integrity Moving from Pay and Chase to Predictive

This Spotlight examines payer payment integrity platforms and how payers can aggressively apply analytics and coordinate workflows to move "left" from reactive postpay to proactive, predictive prepay.

White Paper: Prospective Payment Integrity Solution Partner

Traditional multi-vendor payment integrity systems, while well-intentioned, often complicate IT environments with disjointed data sources and inconsistent workflows.

Infographic: Top 9 Reasons More Payers Choose GuidingCare Than Any Other Care Management System

This infographic sheds a light on the key benefits GuidingCare has to offer- and what makes us different; from clinical expertise and operational efficiency to ease.

eBooks: Challenging Reimbursement in Healthcare Claims Payments With Source

When it comes to handling reimbursement, dealing with incorrect payments caused by inaccessible pricing data and disjointed payment solutions can be a significant issue.

Case Study: Easing Healthcare Preauthorizations - Priority Health

New Authorization Portal speeds approvals and boosts provider satisfaction

Data Sheet: GuidingCare Medication Therapy Management

The Importance of Medication Therapy Management

White Paper: Open & Flexible Care Management Systems to Transform Healthcare

In today's rapidly evolving healthcare landscape, traditional IT systems and monolithic care management solutions are becoming obsolete.

eBooks: Understanding the Role of Open and Flexible Care Management Solutions

As the pace of change in the healthcare industrycontinues to accelerate at record speeds, care management teams within health plans struggle to adapt their monolithic, legacy care management systems.