You already know what your health plan needs to maintain a competitive advantage and grow:
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.Learn More
The HealthRules® Solution Suite
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 PRODUCT
Our 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 product
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.explore product
Our Configuration and Promotion application enables your organization to benefit from increased automation, greater accuracy, a simplified process and lower costs.explore product
HealthRules Home & Host Processing
HealthRules 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 product
What is HealthRules Payer?
HealthRules Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes.
What is the HealthRules Connector?
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.
What is a core administrative processing systems?
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.
What is auto adjudication?
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.”