Data Sheet: What Sets Us Apart - Configure the Business
Implementation and maintenance of a new core administrative processing system (CAPS) traditionally requires highly skilled, well-trained Information Technology resources to interpret..
Configure the Business with HealthRules® Payer
The rapidly evolving healthcare payer market necessitates swift adaptation for health plans to thrive. HealthRules® Payer, part of the HealthRules Solution Suite powered by the English-like HealthRules Language™, emerges as the ideal solution for simplifying complex health plans and transforming organizational operations.
Key Benefits of HealthRules Payer
- Efficient Configuration: Say goodbye to traditional, time-consuming processes that require highly skilled IT resources. With HealthRules Payer, business analysts can configure any benefit plan, provider contract, or core business process rapidly, reducing implementation time from months to hours.
- User-Friendly Interface: HealthRules Payer uses an intuitive, English-like language that allows health plans to easily tailor the system to their unique rules and regulations without needing extensive programming knowledge.
- Flexibility and Reusability: The reusable nature of the system ensures that multiple benefit plans can be configured with identical structures but different copays, deductibles, and coverage levels with minimal manual effort. Any adjustments made cascade through the system, eliminating the need for redundant corrections.
Core Applications
1.HealthRules Administration:
- Manage users, user groups, permissions, and supervisors.
- Ensure secure access and efficient operation of HealthRules Payer applications.
2. HealthRules Designer:
- Design new products and update existing ones.
- Configure complex provider contracts, utilization management guidelines, and claim policies.
3. HealthRules Manager:
- Handle standard health insurance operations, including claims processing, enrollment, customer service, and billing.
Transformative Impact
HealthRules Payer revolutionizes the configuration process, enabling health plans to bring new products to market that would otherwise be infeasible with older core administrative systems. The system promotes easy, efficient, and limitless configuration possibilities, driving competitive advantage and operational excellence.
About HealthEdge
HealthEdge is committed to transforming the healthcare industry by providing modern, disruptive IT solutions that automate processes, reduce administrative costs, and improve outcomes. With the patented HealthRules Solution Suite, HealthEdge connects every part of a payer's administrative and clinical systems seamlessly, ensuring a robust digital transformation in healthcare.
For more information, visit healthedge.com or contact us at 781.285.1300.
