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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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eBook: Integrated Digital Care Management

August 1, 2024

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

eBook: Integrated Digital Care Management

How health plans can increase member satisfaction and engagement using digital care management

Demystifying Digital Care Management Integrations with HealthEdge®

Webinar: Using Digital Care Management to Meet Members & Care Managers Where They Are

Case Study: Digital Health Improves Care Transitions For Members With Multimorbidities

Activate Today's Medicare Member: Effective Engagement Strategies

Demonstrating the value of digital health with a new methodology

A large Blues plan uses Wellframe Digital Health Management to Drive Care Management Capacity and Member Engagement

What “digital health” means for health plans

Report: Digital Care Management can help lower blood pressure by more than 9%

Report: Digital Care Management can help lower blood sugar by more than 25%

Case Study: Improving Maternal Health Outcomes Through Digital Engagement

Infographic: Improving Member Satisfaction

Data Sheet: Wellframe Standardized Assessments

Data Sheet: Digital Care Management

Data Sheet: Care Program Content Updates Policy

Data Sheet: Wellframe Care Programs Overview

Data Sheet: Expanded Educational Content For All Members, Regardless Of Risk Level

Data Sheet: Closing Gaps In Care Through Better Member Relationships