The GuidingCare Solution Suite
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, providing whole-person care.
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
Mission-Critical Clinical Workflow Solutions
Drive superior outcomes in a value-based, patient-centric and fully-integrated ecosystem
Streamline clinical workflows & care coordination
Effectively manage the authorization lifecycle
Appeals & Grievances
Meet regulatory demands & ensure compliance
Streamline workflows & communication with providers
Evaluate, track and measure outcomes; manage operations and stay compliant
Engage care teams to drive population outcomes
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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.
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.
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.
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 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 More
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.LEARN MORE
GuidingCare Utilization Management
Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.LEARN MORE
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.LEARN MORE
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.LEARN MORE
GuidingCare Population Health
Our web-based care coordination application for provider partners incorporates gaps-in-care analytics that enable clinical staff to identify high-risk patients and potential health improvement opportunities.LEARN MORE
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.LEARN MORE
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 MORE
GuidingCare Pediatric Population Health
Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.Learn More
A clinical decision support system that transforms data into actionable insights for health care payers and providers.LEARN MORE