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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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Data Sheet: GuidingCare Appeals & Grievances

October 28, 2022

Meet Regulatory demands and ensure compliance with GuidingCare Appeals & Grievance.

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Data Sheet: GuidingCare Appeals & Grievances

HealthRules Payer Case Study with Presbyterian

Data Sheet: Navigating the No Surprises Act - The Right Tools for Health Plan Success

Data Sheet: Achieving Transparency Compliance Through HealthRules Payer

Source Platform Access Delivers a Transformative Approach to Payment Integrity

Infographic: Traditional Claims Editing Software vs. HealthEdge Source

Data Sheet: HealthEdge Source: Software for Health Plans With Home & Host Capabilities

Data Sheet: HealthRules Payer - Resiliency to Change

Data Sheet: Platform Access Delivers a Transformative Approach to Payment Integrity

Case Study: SummaCare - How do you see Source helping you long term

Data Sheet: Point-of-Service Payment System Success - Integrated Ecosystems (PDF)

Cloud-Based Data Delivery in Healthcare: Point-of-Service Payment Success Path

Data Sheet: Point-of-Service (POS) Payment Success in Healthcare - Process Automation & Intelligent Workflows

White Paper: Prospective Payment Integrity Moving from Pay and Chase to Predictive

White Paper: Prospective Payment Integrity Solution Partner

Infographic: Top 9 Reasons More Payers Choose GuidingCare Than Any Other Care Management System

eBooks: Challenging Reimbursement in Healthcare Claims Payments With Source

Case Study: Easing Healthcare Preauthorizations - Priority Health

Data Sheet: GuidingCare Medication Therapy Management

White Paper: Open & Flexible Care Management Systems to Transform Healthcare

eBooks: Understanding the Role of Open and Flexible Care Management Solutions