The HealthRules Solution Suite


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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Gartner has named HealthEdge® as a Sample Vendor for HealthRules Payer in the 2022 Hype Cycle for 12 consecutive years

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KLAS Research named HealthRules® Payer its 2023 “Best in KLAS” payer claims and administration platform

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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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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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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.


Why We’re Different

Data Warehouse

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

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

“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

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.

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.


Additional Offerings

HealthRules Promote

Our Configuration and Promotion application enables your organization to benefit from increased automation, greater accuracy, a simplified process and lower costs.

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.