Clinical Edge Rules Designer
Rules Designer, part of Clinical Edge, is an intuitive rules engine that helps health plans create, manage, and deploy business rules independently while adapting to changing requirements with concurrent editing, testing, and decision modeling.
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Enhanced User Experience
Technical users get a simple, easy-to-use interface for creating rules, including a drag-and-drop graph editor that displays rule logic visually, so your team can build and update rules faster.
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Intuitive rules interface
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Faster changes
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Lower risk
Superior Performance & Control
Rules Designer supports concurrent editing with built-in versioning and workspace controls, so teams stay in sync without slowing down.
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Concurrent multi-user support
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Fine-grained versioning
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Full control
Testing & Decision Modeling
Rules Designer lets teams test, compare, and validate rules before deployment to catch errors early and model complex decisions clearly.
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Version management
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Scenario testing
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Pre-release validation
Clinical Edge Suite
Care
Management
Streamlined workflows and centralized member data help care teams deliver personalized, evidence-based, whole-person care.
Utilization
Management
Clinically sound, workflow-driven tools with intelligent automation optimize the authorization lifecycle and support compliance.
Appeals
and Grievances
An intuitive, end-to-end solution consolidates appeals, supports regulatory compliance, and delivers one-click packet creation.
Authorization
Portal
End-to-end workflows, automated approvals, and real-time provider communications boost operational agility across your plan.
Mobile
Clinician
Secure mobile access lets field staff run assessments, build care plans, capture consent, and start referrals online or offline.
Member
Engagement
A scalable digital platform pairs omnichannel communication with advanced tools to deliver measurable health outcomes.
Population
Health
Real-time analytics and effective stratification identify at-risk populations and help your teams close care gaps faster.
Quality 360
NCQA-certified quality management links HEDIS gap identification to care workflows, streamlining closure and reducing manual work.
Precision in Care Management
Rules Engine automates care management using rules driven by your data, member events, and assessments, so your teams can deliver whole-person care in real time.