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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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Infographic: HealthEdge Annual Planning Report 2025

Explore key priorities, investments, and challenges facing health plan executives in the coming year.

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Infographic: HealthEdge Annual Planning Report 2025

Webinar: Path to Payment Integrity - Enhance Payment Accuracy with HealthEdge Source™ Editing

IMPACT Spring 2025

3 Benefits of a Third-Party Payment Integrity Ecosystem

Set the Bar for Payment Integrity with Enterprise Payment Accountability

Streamline Healthcare Contract Negotiations and Reviews with HealthEdge Source™ What-If Modeling

Case Study: How One Regional Health Plan Created a Member-Centric Digital Ecosystem

Case Study: SummaCare's Secret to Payment Integrity Success

Case Study:Transforming Payment Accuracy and Operational Efficiency at a Large National Health Plan

Infographic: Top 5 Payment Integrity Trends

Improve Data Security & Compliance with a Prospective Payment Integrity System

Webinar: Transform Contract Negotiations with Data-Driven Insights

Top 6 AI Trends in Payment Integrity for Detecting and Preventing Fraudulent and Inaccurate Claims Payments

HealthEdge Source Demo

How Health Plans Can Use Advanced Analytics to Address Common Challenges

Video: HealthEdge Source™ Analytics Overview

Top 5 Payment Integrity Trends Health Plans Should Respond To For 2025

Infographic: Transform Your Claims Processing with Pre-Pay Model

Data Sheet: HealthEdge Source™ Product Overview

Data Sheet: HealthEdge Source™ - Medi-Cal Reimbursement

Improve Pre-Pay Accuracy with Prospective Payment Integrity Solution