Strategic investments in improving the member experience, strengthening care coordination, and launching new lines of business and other innovations. But increasing administrative costs, tighter margins and regulatory changes limit your ability to act.
An advanced Core Administrative Processing System (CAPS) can provide you with the efficiency, flexibility, insights and agility necessary to control costs, embrace change and move quickly to take advantage of new opportunities.
HealthRules Payer provides transformational capabilities to health plans of all types and sizes with features that align with your business processes and functional areas.
EXPLORE PRODUCTOur HealthRules Answers business intelligence solution transforms the way you see and use data in real time, helping to reduce costs, identify market opportunities, validate new product offerings, and support next-generation business models.
explore productHealthRules Connector is a robust integration layer that links HealthRules seamlessly with other systems, partner networks and exchanges so you can share critical healthcare information quickly, easily and securely.
explore productOur Configuration and Promotion application enables your organization to benefit from increased automation, greater accuracy, a simplified process and lower costs.
explore productHealthRules Payer offers built-in capabilities to support all aspects of the home and host program, reducing complexity and eliminating unnecessary duplication of provider data.
explore productHealthRules Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes.
HealthRules Connector is a robust integration layer that links HealthRules seamlessly with other systems, partner networks and exchanges so you can share critical healthcare information quickly, easily and securely.
CAPS is a critical tool for U.S. healthcare payer business enablement, consisting of software and services that support health insurance administration and transaction processing. These solutions historically reside at the center of payer architecture, serving as the system of record for claims and, in many cases, for member enrollment, premium billing and provider fee schedules as well.
Auto-adjudication is the automatic process of adjudicating a medical claim between a provider or healthcare system and a health plan. A claim must go through a 20+ step process to be adjudication, auto-adjudication ensures this happens automatically without manual intervention.
“We wouldn’t be in business if we didn’t make a change. Not only was our legacy solution extremely clunky and hard to configure, but only a couple of people understood it, as it was not user-friendly, and it certainly wasn’t scalable.”