Solutions
Solutions Solutions

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

Professional Services Customer Success Care-Payer Integration Payer-Source Integration Partners
Lines of Business
Commercial

Government

Medicaid Medicare Dual-Eligibles

Plans With Home & Host Capabilities

Dental

Consultants
Resources
Blog

Core Admin

Care Management

Payment Integrity

Member Engagement

Professional Services

Case Studies

Regulatory & Compliance

Advanced Automation

New Market Expansion

Value-Based Care

Events

Newsroom

Company News

Press Releases

Help Center

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

READ BLOG POST
About Us
Leadership

Careers

Life at HealthEdge US Office India Office Employee Testimonials

Job Openings

Creating ‘the Amazon experience’ in healthcare: Why patients want personalization

Melissa Garcia

New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Creating ‘the Amazon experience’ in healthcare: Why patients want personalization

See coverage

Alan Stein Of HealthEdge On How To Use Digital Transformation To Take Your Company To The Next Level

Cultivating success: How to scale a culture of continuous learning

Talent and learning leader Wendi Ellis shares secret ingredient for company’s success

The clinician of the future: A partner for health, access, collaboration and tech-savviness

How do payers approach care management strategies, technologies?

KLAS: HealthEdge a Market Leader in Payer Claims and Administration Platforms

Meet the exec aiming to improve health plan consumer experience

Innovative new tool empowers unprecedented health plan efficiency

More than half of health plan members less than happy with coverage, survey finds

Health plan members are dissatisfied — and the fix isn’t ‘one-size-fits-all’

Personalizing health means personalizing health insurance for plan members: Learning from HealthEdge

What health plans can do to improve member experience, satisfaction

HealthEdge launches novel web-based plan configuration management tool

Only 45% of consumers are fully satisfied with their health insurance

More than half of healthcare consumers not fully satisfied with their insurance

Only 45% of patients happy with their health insurance

Less than half of members are satisfied with their health plan: survey

55% of Healthcare Consumers are Dissatisfied with their Health Insurance, Research Suggests

55% of Health Plan Members Want More Personalized Care

Customer satisfaction with health insurance varies by generation