The GuidingCare Solution Suite

GuidingSigns® Analytics

GuidingSigns Analytics is a Care Management clinical analytics solution that transforms data into actionable insights for healthcare payers and providers. GuidingSigns combines predictive risk scoring, stratification and grouping with gaps-in-care analytics to identify evidence-based health improvement opportunities across hundreds of clinical care and behavioral health indicators.

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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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Align Care Management With Resource Requirements

Modify risk scoring, weighting and more based on program requirements and available resources to ensure the right strategy for care management is deployed to the right members at the right time.

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Seamlessly Link Analytics With Care Plans

GuidingSigns is extensively integrated with our Care Management application. Analytics output – including risk scores, condition-based risk groupings, gaps in care, and corresponding service and education interventions directly populate relevant fields and automate patient-specific care plans.

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Fine-Tune Risk Assignment

GuidingSigns can incorporate additional sources of risk based on availability of data. For example, social determinants can be derived from the available health risk assessment tools. Each source of risk can be weighted to fine-tune its impact on the overall risk score for a population.

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Built-In CDPS+Rx Risk Model

Embedded within GuidingSigns is the Chronic Illness and Disability Payment System (CDPS), a predictive risk model that analyzes diagnostic and pharmacy data to identify and group populations into more than 60 risk categories. Available exclusively for commercial use within GuidingCare.

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See how GuidingSigns Analytics can help to identify evidence-based health improvement opportunities across hundreds of clinical care and behavioral health indicators.

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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.

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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.