The GuidingCare Solution Suite

Care Management

Next-Generation Care Management Platform

The GuidingCare® solution suite provides easy-to-use, next-generation data integration and workflow management tools that help you operationalize an evidence-based, person-centered Care Management strategy for your populations. Its sophisticated data analytics, workflow management, care coordination, and reporting capabilities enable your organization to better serve targeted populations and maintain compliance every step of the way.

With GuidingCare, you can streamline coordination across the care spectrum, seamlessly manage clinical and behavioral health needs, automate care and service planning, and identify and target your high-risk populations.


GuidingCare Achieves AA Certification for HEDIS Measures Subset

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GuidingCare Platform & Mobile Clinician App Earn CA Veracode Verified Status

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GuidingCare Achieves NCQA Population Health Management Prevalidation

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GuidingCare Platform Achieves HITRUST Certification



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Whole-Person Care

As an integrated care and disease management platform, Care Management incorporates clinically valid care planning content for more than 30 common and atypical health conditions.

Automated Care Planning

Powerful automation tools leverage a broad range of patient data, including assessments, to proactively build and sustain a comprehensive care plan for each member.

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Community Referrals

Integrated with leading social services platforms to seamlessly connect members to social services in their community, track progress and measure outcomes.

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Mobile Clinician

Enable effective care management in the field, including assessments, care planning, and activities even in an offline mode.

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Integrated Platform

All member information is consolidated into a single, comprehensive care record shared across the solution suite for streamlined care coordination.

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The GuidingCare® Care Management solution provides mission-critical workflow solutions to health plans that drive superior outcomes in a value-based, patient-centric ecosystem.


Why We’re Different

Deep Clinical Expertise

Our seasoned clinical team has a deep understanding of clinical operations, regulatory compliance and technical aspects of the business, bridging the clinical and technical.

Leading in Innovation

Designed to enable the most complex clinical models today, with significant investment and growth toward composable digital health solutions.

Ease of Integration

Lower costs and improve member outcomes through interoperability. Easily connect your vendor ecosystem with GuidingCare’s out-of-the-box integration suite.

Operational Efficiency

Leverage GuidingCare’s advanced rules engine to automate business processes and take advantage of user-friendly workflows and features to streamline operations.

Reimagined Implementations & Upgrades

Take advantage of the latest technology innovations at low cost and with ease, incorporating standard new functionality and innovation frequently.

Resiliency to Change

Embrace change, stay competitive and take advantage of opportunities created by a variety of market dynamics with highly configurable features and workflows.

Actionable Insights

Arm your leaders with near-real-time business intelligence to inform key operational and clinical decisions.

Regulatory & Compliance

Leverage robust enterprise compliance and security safeguards, reinforced by HITRUST certification.

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Care-Payer Integration

HealthRules Payer is even more powerful when combined with GuidingCare®. Our unique Care-Payer Data Exchange solution provides the API-based integration that enables the continuous management of member care and core administrative processes.

Care-Payer provides a range of vital capabilities, including:

  • Standardized core data delivery from HealthRules Payer to GuidingCare
  • Authorization entry workflow improvement, including single-case agreement and referral category enhancement
  • Near-real-time authorization delivery from GuidingCare to HealthRules Payer

Most notably, Care-Payer includes Benefit Predictor integration. This unique feature enables GuidingCare users to quickly and easily answer complex benefit questions prospectively from members and providers.

This Benefit Predictor integration is incorporated into several key workflows, giving Utilization Management staff and care managers unparalleled access to near-real-time benefits information.

Care-Payer Data Exchange delivers significant benefits to your organization, including:

  • Smooth implementation through HealthEdge expertise and standardized processes
  • Synchronized data sets between HealthRules Payer and GuidingCare
  • New levels of operational efficiency in authorization entry and medical management
  • Improved payment integrity
  • Certified data exchange
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The GuidingCare Solution Suite


GuidingCare is a comprehensive solution for whole-person, patient-centered care, offering easy-to-use, next-generation data integration and workflow management solutions and tools. Our feature-rich solution suite is easy to integrate with existing systems and is highly configurable.

GuidingCare Care Management

Our Care Management workflow software provides tools that help you operationalize an evidence-based, person-centered care management strategy for your populations.

GuidingCare Utilization Management

Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.

GuidingCare Authorization Portal

This intuitive and comprehensive electronic tool eases the preauthorization, appeals and messaging process for your Utilization Management staff and the providers who interface with your plan.

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GuidingCare Business Intelligence

Our Reporting & Business Intelligence module provides more than 50 standard reports to make ad hoc report-building and analysis simple and actionable.

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GuidingCare Population Health

Our web-based care coordination application for provider partners incorporates gaps-in-care analytics that enables clinical staff to identify high-risk patients and potential health improvement opportunities.

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GuidingCare Appeals & Grievances

Our Appeals & Grievances module streamlines and consolidates the entire appeals management process to help you meet regulatory demands for timely resolution and correspondence.

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Additional Offerings

GuidingCare Medication Therapy Management

Enable pharmacists with a central location in which they can manage member medications and intervene to prevent potentially harmful outcomes.

GuidingCare Pediatric Population Health

Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.

GuidingSigns® Analytics

A clinical decision support system that transforms data into actionable insights for health care payers and providers.