The GuidingCare Solution Suite

Pediatric Population

The GuidingCare® Pediatric Population Health care management module offers standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid. Health plans using this module can be assured they are compliant with quality measures for assessing developmental milestones, screening and diagnosing health issues, and meeting vaccination schedules. GuidingCare’s Pediatric Population Health care management module also accommodates state-specific assessments, such as those for screening lead levels.

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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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Address Compliance for Quality Measures

Health plans can be assured they are compliant with quality measures, including state-specific assessments, such as those for lead screening. Quality measures include those in well-care visits, immunizations, access to primary care practitioners and dental visits.

Gain Transparency and Quality Reporting

Easy-to-understand and timely reports simplify and speed state and federal quality reporting. Health plans gain greater data transparency at the member and population levels as they reduce downstream expenses through proactive care. Primary care practitioners can also monitor and perform compliance downloads for pediatric plan members.

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Streamline Task Interface and Performance

One-click access into member-specific, easy-to-use dashboards that display past visits and those applicable in the future.

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Improve Workflow and Satisfaction

Enjoy greater efficiency by reducing error-prone, manual tasks and free up staff for higher-value work. This module helps health plans strengthen provider relationships and offers insights into value-based care arrangements with providers, reducing plan costs for analytics.

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Find out how to leverage GuidingCare’s tracking and reporting to stay compliant.

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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.