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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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Navigating Digital Care Management Transformation: Delivering on Consumer Expectations with Effective Change Management

New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Navigating Digital Care Management Transformation: Delivering on Consumer Expectations with Effective Change Management

Webinar: Transform Contract Negotiations with Data-Driven Insights

HealthEdge CEO, Steve Krupa, Vision Overview - Leadership Forum 2024

HealthEdge CTO, Rob Duffy, Vision Overview - Leadership Forum 2024

HealthEdge Source Demo

Video: HealthEdge Source™ Analytics Overview

Video: Wellframe - Digital Care Management

HealthEdge Source™ Webinar: Advanced Editing - Build Custom Edits & Take Control of Business Rules

Welcome to Wellframe by HealthEdge

HealthEdge Source™: Advanced Custom Edits

Webinar: Using Digital Care Management to Meet Members & Care Managers Where They Are

Webinar: Proactively Addressing Regulatory Complexities in California and Beyond

Video: Machine Readable Files - HealthRules Suite 3.x (Part 2)

Video: Machine Readable Files - HealthRules Suite 3.x (Part 1)

Activate Today's Medicare Member: Effective Engagement Strategies

HealthEdge Source: Optimizing Retroactive Configuration Changes

Webinar: Empowering Modern Health Care Consumers Insights from the 2024 Survey

Leadership Forum 2024 Teaser

Webinar: Leveraging Clinical Expertise and Compliance Support to Serve Your Most Vulnerable Members

HealthEdge Leadership Forum 2024 - Teaser Video

HealthEdge Source™: Unlocking the Advantages of Data Research Module