The HealthRules Solution Suite


Enterprise Integration Layer

HealthRules Connector enables you to share critical healthcare information – within and beyond your organization – quickly, easily and securely. Providing real-time and batch access to all HealthRules data and functionality from other applications and portals, HealthRules Connector enables you to easily integrate HealthRules with other systems, partner networks, and exchanges. The results are faster implementations, dramatically lower integration costs, and shorter time to market.

With HealthRules Connector, you can readily support new business models and leverage the power of HealthRules beyond traditional boundaries. At the same time, the HealthRules EDI Gateway ensures that you meet HIPAA transaction requirements with a tightly integrated, highly configurable application.

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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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See for yourself how HealthRules Payer enables you to react swiftly to change, pursue new ideas, and gain vital business insights.


Care-Payer Integration

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HealthRules Payer is even more powerful when combined with GuidingCare®. Our unique Care-Payer Data Exchange solution provides the API-based integration that enables the continuous management of member care and core administrative processes.


Care-Payer provides a range of vital capabilities, including:

  • Standardized core data delivery from HealthRules Payer to GuidingCare
  • Authorization entry workflow improvement, including single-case agreement and referral category enhancement
  • Near-real-time authorization delivery from GuidingCare to HealthRules Payer


Most notably, Care-Payer includes Benefit Predictor integration. This unique feature enables GuidingCare users to quickly and easily answer complex benefit questions prospectively from members and providers. This Benefit Predictor integration is incorporated into several key workflows, giving Utilization Management staff and care managers unparalleled access to near-real-time benefits information.


Care-Payer Data Exchange delivers significant benefits to your organization, including:

  • Smooth implementation through HealthEdge® expertise and standardized processes
  • Synchronized data sets between HealthRules Payer and GuidingCare
  • New levels of operational efficiency in authorization entry and medical management
  • Improved payment integrity
  • Certified data exchange

Payer-Source Integration

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The integration between HealthRules Payer and Source creates a new level of operational efficiency and accuracy in claims pricing and editing. With the continuous management of payment integrity and core administrative processes between platforms, the Payer-Source integration enables:

  • A single source of truth
  • Increased accuracy
  • Organization-wide IT lift
  • Improved payment integrity
  • Streamlined support model

The increased transparency gained from the Payer-Source integration improves payer-provider relations and member satisfaction.


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.

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

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.