The HealthRules Solution Suite

HealthRules®
Promote

Configuration and Promotion Application

Every time you launch a new line of business or develop a new product or benefit plan, your business analysts have to first promote configuration changes to test and QA environments. HealthRules Promote is a standalone, browser-based application that enables your analysts to promote and test those configuration changes in minutes.

With HealthRules Promote, your organization benefits from increased automation, greater accuracy, a simplified process – and lower costs.

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KLAS Research named HealthRules® Payer its 2022 “Best in KLAS” payer claims and administration platform

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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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Features

User-Friendly Interface

No technical resources are required. Business analysts can move and promote configurations without IT support, ensuring maximum operational efficiency.

Advanced Search

Users can search a HealthRules instance for configuration by a variety of filter criteria. This makes it easy to find, organize and evaluate configuration entities for potential promotion with improved quality of adds and edits. A controlled workflow ensures quick creation and promotion of new configuration sets.

Mock Settings and Line-by-Line Comparisons

HealthRules Promote saves you valuable time by enabling your team to trial configuration changes in mock settings before promotion. They can troubleshoot and take corrective actions – with line-by-line comparisons to identify differences between specific source and target HealthRules environments.

Comprehensive Audit Trail

A comprehensive audit trail tracks every action that changes a configuration set or invokes a promotion. This reduces the need to independently track configuration migrations while increasing transparency across the end-to-end configuration process.

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Get the agility you need to freely update validation policies, modify fee schedules, restructure benefit plans and launch new lines of business.

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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
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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.

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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.

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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

HealthRules Promote

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

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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.

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