The HealthEdge GuidingCare Solution Suite
GuidingCare® Rules Designer
Health plans today face dynamic and complex challenges. To adapt quickly to regulatory shifts, competitive demands, and evolving member needs, automation and flexibility are essential. That’s why the GuidingCare solution suite has an embedded best-in-class rules engine that goes beyond a traditional rules engine to offer health plans complete control and customization of their business rules.
With the GuidingCare Rules Designer, customers can independently create, manage, and deploy business rules to automate workflows, enhance care coordination, and make data-driven decisions effortlessly.
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GuidingCare Achieves AA Certification for HEDIS Measures Subset
GuidingCare Platform & Mobile Clinician App Earn CA Veracode Verified Status
GuidingCare Achieves NCQA Population Health Management Prevalidation
GuidingCare Platform Achieves HITRUST Certification
Features
User-Friendly Rule Customization
Simplify the creation of rule conditions and actions with an intuitive drag-and-drop interface. Pre-built templates and decision modeling make even complex configurations accessible, enabling users to deploy rule changes easily.
Integrated Testing for Accuracy
Built-in comparison and verification queries allow for testing multiple rule versions, ensuring logical consistency and validity. This integrated testing capability minimizes errors and ensures seamless rule deployment across environments.
Flexible Environment Deployment
Gain full control over where and how rules are deployed. Whether in QA or pre-production environments, GuidingCare Rules Designer provides flexibility to test, validate, and refine rules before implementation, reducing risks and enhancing performance.
Flexible Deployment
Control rule deployment to various lower environments, such as QA or Pre-Production, and further test and validate the rules once deployed.
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Our best-in-class, highly configurable rules engine automates business processes and workflows, empowering customers to efficiently manage complex member care.
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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
The GuidingCare Solution Suite
GuidingCare®
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.
LEARN MOREGuidingCare Care Management
Our Care Management workflow software provides tools that help you operationalize an evidence-based, person-centered care management strategy for your populations.
LEARN MOREGuidingCare Utilization Management
Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.
LEARN MOREGuidingCare 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.
Learn MoreGuidingCare Business Intelligence
Our Reporting & Business Intelligence module provides more than 50 standard reports to make ad hoc report-building and analysis simple and actionable.
Learn MoreGuidingCare 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.
Learn MoreGuidingCare 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.
Learn MoreAdditional 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.
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 health care payers and providers.
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