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HealthRules® Answers
The HealthRules Solution Suite

HealthRules®
Answers

Real-Time Business Intelligence Solution

HealthRules Answers provides the insights you need to better understand your business and drive operational efficiency – helping you reduce costs, identify market opportunities, validate new product offerings and support next-generation business models.

Easy to deploy and infinitely scalable, HealthRules Answers enables you to analyze key drivers of business performance, understand the impact of important market changes, and answer “what-if” questions to drive greater innovation, efficiency and agility.

And your organization isn’t the only beneficiary. HealthRules Answers also provides actionable business information to your members, providers and partners – giving everyone the real-time insights it takes to be successful and grow.

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Image of male and female healthcare professionals in an office looking at a tablet screen.

Integrating into HealthRules Payer and their replicated data warehouse was the cherry on top. We can go in, get real-time data or historical data, and feed it up into informational management dashboards to make sure that everything’s running as expected. It’s really powerful and the antithesis of how we operated in prior years. The level of transparency we have in operations has allowed us to be much more nimble as an organization.

— Robert Hillman, SVP and COO Community Health Options

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HealthRules Payer works well. The transparency, level of customization with benefits and contracts is great. The ability to capture all necessary data and process claims consistently is key to our business and Payer does that well.

— Health Plan Executive, 2025

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Features

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Real-Time Data Warehouse

The data warehouse offers a real-time repository of claims, financial, membership and provider data that payers can analyze to monitor any operational parameter. English-like HealthRules LanguageTM statements allow greater insight into the relationships between benefit plans and provider contracts and their financial outcomes.

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Reporting

A straightforward custom reporting tool designed for reporting team members to develop comprehensive libraries of internal and external reports, graphs, dashboards, etc. Extensive control over data selection, rich visualizations, drill-down, scheduling and email capabilities.

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Dashboards

The HealthRules Answers dashboard includes interactive charts that work together to display key operational data associated with core functions, such as claims, utilization management, membership, and revenue management. Users can explore multiple views to highlight the most relevant aspects.

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Discover how your organization can analyze key drivers of business performance, understand the impact of important market changes, and answer “what-if” questions.

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Why We’re Different

Data Warehouse

A comprehensive data warehouse that provides flexibility and agility not possible with other solutions

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Real-Time Updates

Critical updates on key business performance measures via operational reports and dashboards
Capabilities to spot trends, correlations and root causes within key data

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“What-If” Modeling

Answers to “what-if” questions that can be used to make key business decisions
The ability to identify new market opportunities and validate new products

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The HealthRules Solution Suite

HealthRules Payer

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
HealthRules Answers

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.

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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.

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Additional Offerings

Machine Readable Files

The HealthRules Machine Readable Files Suite 3.x is a cloud-deployed SaaS application that improves health plans’ processes for publishing Machine-Readable Files (MRF) of their negotiated rates and allowed amounts, making meeting regulatory requirements easier, faster, and more accurate than ever.

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Provider Data Management

HealthEdge Provider Data Management creates a single source of truth for provider data. Natively integrated with Core Administrative Processing System, Provider Data Management streamlines ingestion and enrichment using a Generitive AI-powered framework and distributes cleansed data through a configurable, event-based, realtime API architecture. This enables real-time accurate data to flow across the HealthEdge solution suite and the broader heath plan ecosystem.

Explore Provider Data Management:
HealthRules Promote

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 and 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