HealthEdge GuidingCare
Remove Barriers. Empower Teams. Transform Care.
Healthcare payers and providers face numerous challenges in delivering person-centered care. Fragmented systems, inefficient workflows, and lack of real-time data, and minimal coordination between medical, behavioral, and social care teams obstruct progress. GuidingCare eliminates these barriers with a proven, cutting-edge platform that simplifies workflows, enhances collaboration, and drives better outcomes.
Powered by advanced AI-capabilities, a flexible and modular platform, and clinical and regulatory expertise, GuidingCare streamlines care delivery, enhances member engagement, and ensures compliance with evolving standards. With easy-to-use, next-generation data integration and predictive analytics, GuidingCare equips health plans to successfully serve all lines of business.
LEARN MOREThe HealthEdge GuidingCare Solution Suite
GuidingCare
GuidingCare offers a comprehensive suite of modules tailored to meet the evolving needs of healthcare payers and providers. Designed to operate seamlessly within your existing ecosystem, our solutions ensure interoperability, adaptability, and future-proofed capabilities for today's evolving care environments.
Learn MoreGuidingCare Care Management
Effectively operationalize an evidence-based, person-centered care strategy with workflows that align with NCQA standards, CMS guidelines, and personalized care requirements. Enhance operational efficiency while enabling care teams to identify gaps and take targeted actions.
LEARN MOREGuidingCare Utilization Management
Simplify and optimize the complete authorization lifecycle with advanced tools that integrate clinical guidelines, predictive modeling, and AI-driven workflows to boost productivity and reduce administrative bottlenecks.
LEARN MOREGuidingCare Authorization Portal
Streamline provider interactions with an intuitive tool for preauthorization, messaging, and appeals. Empower providers and staff with an interface designed for clarity and simplicity while ensuring alignment with compliance standards.
LEARN MOREGuidingCare Appeals & Grievances
Streamline the appeals and grievances process to meet regulatory demands with automated workflows, task tracking, and correspondence. Configurable tools ensure compliance and timely resolutions for all grievance types.
LEARN MOREGuidingCare Business Intelligence
Make informed decisions with our comprehensive analytics suite, featuring interactive reports tailored to Utilization Management, Care Management, and Appeals & Grievances use cases, along with over 20 CMS Regulatory reports that address ODAG, CDAG, and Part C/D requirements.
LEARN MOREGuidingCare Population Health Management
Leverage advanced gaps-in-care analytics to identify high-risk members, prioritize interventions, and optimize health outcomes. Empower care teams with SDOH and analytics to address risk factors and inequities for more effective care.
LEARN MOREGuidingCare Member Engagement
Our scalable digital member engagement platform incorporates omnichannel communications to equip health plans with tools to deliver personalized support, streamline operations, and achieve measurable health outcomes across diverse member populations.
Member EngagementAdditional Offerings
GuidingCare University
Empower your team with our self-service digital training platform offering on-demand, video-based learning to optimize user interaction with the GuidingCare Solution Suite.
LEARN MOREGuidingCare Rules Designer
Independently create, manage, and deploy business rules into your GuidingCare instances to automate workflows and decision-making.
Learn MoreGuidingCare Pediatric Population Health
Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.
Learn MoreGuidingSigns® Analytics
A clinical decision support system that transforms data into actionable insights for healthcare payers and providers.
Learn MoreFAQ
What is a care management system?
A care management system or software is a type of software technology that helps care managers, providers, and care teams work more efficiently and effectively. This technology pulls data from disparate systems or areas - such as claims, EHR, pharmacy, or others, into one platform to help users with workflow management and care coordination. Robust care management software systems also offer services for areas such as utilization management, provider authorizations, appeals and grievances, population health, business intellgience and analytics, and more.
What makes GuidingCare unique?
Whole-Person Care
GuidingCare combines clinical, social, behavioral, and economic insights into a comprehensive system that empowers care teams to provide customized, person-centered care.
AI That Works for You
Built to align with your operational goals, our AI tools drive efficiency, predict and address trends, and improve workflows to achieve meaningful outcomes for your members.
Seamless Interoperability
Unified under FHIR interoperability standards, GuidingCare seamlessly integrates with existing systems, ensuring real-time coordination and optimized performance.
Scalability Beyond Expectations
GuidingCare is built to grow with you. Whether you're a regional plan or a national payer, our platform's multi-tenant architecture ensures adaptability for millions of users while maintaining exceptional performance and reliability.
Regulatory Confidence
Ensure your operations stay ahead by proactively adapting to regulatory shifts and maintaining seamless alignment with NCQA and CMS standards. With certifications like AA Certification for HEDIS Measures Subset and HITRUST Certification, GuidingCare enables compliance, quality, and confidence in healthcare management.
Hear from Our Customers
“Elderplan specializes in intense, complex care management of our membership, and GuidingCare has done a fantastic job helping us support those care management goals as well as compliance goals.”
Craig Azoff, Senior Vice President of Health Plan Information Systems
READ CASE STUDY"We're trying to walk that fine line. We recognize the providers are on the front lines of delivering high-quality care to our members, and we value that partnership with our providers. We wanted to help solve that problem, reduce that burden and make their lives better"
Ann Donnelly, Vice President, Care and Utilization Management
Read Case Study"HealthEdge is a valued partner helping us put the member at the center of their care journey, powered by platforms that communicate with each other seamlessly."