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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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A Health Plan Story: The Impact of Effective Care Management on the D-SNP Population

May 5, 2022

HealthEdge

New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

A Health Plan Story: The Impact of Effective Care Management on the D-SNP Population

Transforming Payment Integrity with Generative Artificial Intelligence (GenAI): HealthEdge® and Codoxo Announce Strategic Partnership

HealthEdge Expands Employer Presence in India with New Bangalore Office, Promoting High Tech Innovation and Jobs in Healthcare

HealthEdge® Survey Reveals Top Health Plan Priorities for 2025

Edifecs and HealthEdge®, Two Best in KLAS Technology Vendors, Announce Strategic Partnership to Deliver Seamless Healthcare Data Exchange

HealthEdge® and Zelis® Announce Strategic Partnership to Streamline Healthcare Payments

HealthEdge® Appoints Robert Duffy as Chief Technology Officer to Lead Disruptive Technology Transformation in Healthcare

HealthEdge Survey: Health Plan Members Report High Satisfaction with Their Insurers

HealthEdge® Named in the Gartner® Hype Cycle™ for US Healthcare Payers, 2023

Innovative New Tool Empowers Unprecedented Health Plan Efficiency

55% of Healthcare Consumers are not Fully Satisfied with their Health Insurance

MedTech Breakthrough Names HealthEdge a Top Company in Health Technology

HealthRules Payer Awarded ‘Best in KLAS’ for Second Consecutive Year

HealthEdge announces the expansion of Sandhya Gardner, MD’s role from Chief Medical Officer, Wellframe to Chief Medical Officer, HE Clinical

HealthEdge Named a Sample Vendor for Next-Gen Core Administrative Processing and Prospective Payment Integrity Solutions in the Gartner® Hyp

HealthEdge Survey Highlights Growth Opportunities and Challenges for Health Plan Leaders

Industry Veteran Alan Stein Joins HealthEdge as Chief Commercial Officer

New Sales Leadership Joins HealthEdge to Accelerate Growth and Support the Expansion of Digital Health Platform

HealthEdge Announces Strategic Partnership with CitiusTech to Enhance Offerings to Health Plans

HEALTHEDGE’S HEALTHRULES PAYOR RANKED #1 IN CAPS AND NAMED ‘BEST IN KLAS’

HealthEdge Completes Acquisition of Wellframe