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

Healthfirst HealthEdge Presentation

October 12, 2023

Download PDF

New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Healthfirst HealthEdge Presentation

Wellframe Care Program Overview 2024

Maternal_Health__Prenatal_and_Postpartum_Support_Storyboard-en

Foundational Data Export 2024

Leadership Forum 2024 - Health IT Trends for Healthcare Payers

Leadership Forum 2024 - Harnessing Data to Drive Progress Insights for Transformative Change

Leadership Forum 2024 - Intro

Leadership Forum 2024 - Building Tomorrow’s Integrated Digital Platform Today

Leadership Forum 2024 - Interoperability and Regulatory Update

Leadership Forum 2024 - HealthEdge AI Now and Next Use Cases

Medicare Member Impact Report Wellframe

AI in Care Management Use Cases - Now and Next

2024 Healthcare Consumer Survey Results

Leveraging GuidingCare Technologies and Tools for the Hardest Clinical Populations and Use Cases (LTSS, D-SNP, Medicaid, Medicare, etc.)

Benefits and Opportunities of an Integrated Care Management Experience

A Historic Context for Measuring the Value of Technology Innovation in Care Management

New and Exciting Member Content in Maternity, Menopause, Behavioral Health, and More

Nationwide Top Ride-Along Recommendations

Welcome Remarks

2023 Case Studies: Secondary Editing

2023 Case Studies: Retroactive Change Manager