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HealthRules Payer 25.2 Release Showcase

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The HealthRules Payer 25.2 release advances HealthEdge’s vision of a compliant, modern Core Administrative Processing System (CAPS). It introduces AI-driven innovations, seamless integrations, and real-time data visibility to help health plans optimize costs and boost operational efficiency.

Key Highlights

1. AI and Modernized UI

  • AI Claims Summarizer (Beta): Uses Generative AI for real-time claim insights and chatbot queries.
  • Enhanced Web UI: Web-based interface improves accessibility and performance.

2. Advanced Reinsurance Management

  • Real-time tracking of reinsurance accumulators and contracts.
  • Granular financial details and direct analytics integration.

3. Seamless Integrations

  • Provider Data Management (PDM): Near real-time synchronization improves efficiency.
  • Smart Links: Quick access to editing and pricing details.
  • New Integration Platform: Real-time alignment of provider and member data.

4. Performance Dashboards

  • Transaction insights for 19 processes, updated daily.
  • Granular tracking of response times and system benchmarks.

Conclusion

HealthRules Payer 25.2 empowers health plans with AI, advanced reinsurance tools, and enhanced data management, enabling reduced costs, higher accuracy, and improved member outcomes.