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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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Data Sheet: GuidingCare Business Intelligence

November 2, 2022

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Data Sheet: GuidingCare Business Intelligence

Data Sheet: HealthEdge Source™ Product Overview

Data Sheet: Optimize Efficiencies with Integrated HealthRules Payer Solutions

Data Sheet: Wellframe Care Programs Overview

Video: Care-Payer

Data Sheet: Configuration as a Service Expedites Time-to-Value for Health Plans

Data Sheet: Member Travel Card & HealthRules Payer

Data Sheet: HealthRules Payer for Plans with Home & Host Capabilities

Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report (PDF)

Data Sheet: What Sets Us Apart - Configure the Business

Data Sheet: HealthRules Payer Best in KLAS Report

Collaboration in a Competitive Marketplace

Stop Recurring Post-Payment Issues with an Open Book Approach to Payment Integrity

Gartner Reports Next-Gen CAPS Technology Will Be Standard By 2024

Why Prospective Payment Integrity Solutions Are Must-Have Tech for Health Plans

Advancing Care Management Through Digital Transformation

Contract Modeling: The Key to Fostering a Positive Health Plan-Provider Relationship

Optimize Payment Accuracy with History-Based Editing

Becoming a Digital Payer: Enabling Business Transparency

Becoming a Digital Payer: Constantly Striving for Higher Quality

Top 5 Challenges of Medicaid Healthcare Payers