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Text Content
Skip to content Primary Menu * Become a Digital Payer * Solutions * * * SOLUTIONS * * * Core Administrative Processing System * The HealthRules® Solutions Suite includes the industry’s leading digital claims administration processing system – plus a host of additional value-added capabilities. * HealthRules Solution Suite * Care Management Workflow Solutions * GuidingCare®, our Care Management Workflow solutions, starts with the nation’s most widely adopted care management platform – and provides much more to improve quality of care. * GuidingCare Solution Suite * * Prospective Payment Integrity * Source is the preeminent digital prospective payment integrity solution, combining claim payment automation with proactive business intelligence. * Source Solution Suite * Member Experience * Wellframe Digital Care Management and Digital Customer Service solutions extend the reach of your staff to more fully engage and support members. * Wellframe Solution Suite * * Professional Services * Customer Success * Care-Payer Integration * Payer-Source Integration * Partners * Lines of Business * Commercial * Government * Medicare * Medicaid * Dual Eligibles * Plans With Home and Host Capabilities * Dental * Consultants * Resources * * * Blog * Brochures * Case Studies * Data Sheets * eBooks * Executive Summaries * * Infographics * Podcasts * Videos * White Papers * * Events * Newsroom * Company News * Press Releases * * NEW FROM HEALTHEDGE PRICING TRANSPARENCY & THE ONLINE SHOPPING/PRICE COMPARISON TOOL We are nearing the 1/1/23 requirement for health plans to provide online shopping/price comparison on health plan member portals for around 500 services. This is part of the Transparency in Coverage Rule. READ BLOG POST * About Us * Leadership * Careers * Life at HealthEdge * US Offices * India Offices * Employee Testimonials * Job Openings * Speak Up Hotline * Contact Us Generic selectors Exact matches only Exact matches only Search in title Search in title Search in content Search in content Search in excerpt Post Type Selectors Hidden Hidden CONNECT TO A COMPREHENSIVE DIGITAL TRANSFORMATION.A TRULY MEMBER-CENTRIC EXPERIENCE.MORE AUTOMATED OPERATIONS.THE NEXT GENERATION OF SERVICE.A COMPREHENSIVE DIGITAL TRANSFORMATION.A TRULY MEMBER-CENTRIC EXPERIENCE.MORE AUTOMATED OPERATIONS.THE NEXT GENERATION OF SERVICE.A COMPREHENSIVE DIGITAL TRANSFORMATION. HealthEdge® solutions – deployed as standalone next-generation SaaS or together as an integrated platform – help payers accelerate their digital transformation and position them for continuous success. Make the connection The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience The individual healthcare experience has three dimensions. Each dimension requires deep application focus and an integrated approach to applications and data. READ MORE HealthRules® Payer named “Best in KLAS®” HealthRules Payer has been named "Best in KLAS" by KLAS Research for Claims & Administration Platforms for the second year in a row. READ MORE Voice of the Market: 2022 Digital Transformation Survey HealthEdge Survey Highlights Growth Opportunities and Challenges for Health Plan Leaders READ MORE The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience The individual healthcare experience has three dimensions. Each dimension requires deep application focus and an integrated approach to applications and data. READ MORE HealthRules® Payer named “Best in KLAS®” HealthRules Payer has been named "Best in KLAS" by KLAS Research for Claims & Administration Platforms for the second year in a row. READ MORE Voice of the Market: 2022 Digital Transformation Survey HealthEdge Survey Highlights Growth Opportunities and Challenges for Health Plan Leaders READ MORE The Digital Payer Journey to Achieve a Coherent Individual Healthcare Experience The individual healthcare experience has three dimensions. Each dimension requires deep application focus and an integrated approach to applications and data. READ MORE * 1 * 2 * 3 HEALTHEDGE BY THE NUMBERS 76+ MILLION COVERED LIVES SERVED BY 4 SOLUTIONS See Our Solutions 120+ CUSTOMERS See Our Solutions 100+ INTEGRATIONS WITH THIRD-PARTY SOLUTIONS See Our Solutions 48+ STATES SUPPORTED WITH 23 MEDICARE ADVANTAGE CLIENTS See Our Solutions WHAT CAN HEALTHEDGE DO FOR YOU? Our healthcare SaaS software provides payers with a digital foundation that enables them to deliver a transparent and consumer-centric experience at lower cost while offering higher quality and higher service levels to their members, providers and partners. see our solutions X A TRULY CONNECTED ECOSYSTEM Whether connecting to our best-of-breed applications or other third-party systems, HealthEdge enables health plans to access data within and between systems for new digital member experiences. HealthEdge is on a digital journey with our customers to make it easy to exchange real-time data and streamline workflows across once-siloed functional areas and data. See Our Solutions HEALTHEDGE Digital Transformation in Healthcare HEALTHRULES PAYER Core Administration SOURCE Prospective Payment Integrity WELLFRAME Member Experience GUIDINGCARE Care Management ENABLING THE DIGITAL PAYER What does it mean to be a digital payer in today's highly complex and dynamic health insurance market? It means every aspect of your business is constantly improving. While working with hundreds of payers, we consistently see the following five attributes in our digital-first customers: Become a Digital Payer EVER-EVOLVING FOCUS ON THE MEMBER AND END-USER EXPERIENCE Modern technology and seamless exchange of real-time data facilitate a better experience EVER-DECLINING TRANSACTION COSTS Automating business processes based on accurate data drives down costs and drives up productivity EVER-IMPROVING QUALITY Accessing accurate insights from real-time data across lines of business and care provider networks results in better health outcomes EVER-INCREASING SERVICE LEVELS Empowering team members with modern technology and up-to-the-minute data results in better service EVER-IMPROVING BUSINESS TRANSPARENCY Greater visibility and robust analytical tools lead to more informed business decisions FURTHER RESOURCES * PROSPECTIVE PAYMENT INTEGRITY MOVING FROM PAY AND CHASE TO PREDICTIVE This Spotlight examines payer payment integrity platforms and how payers can aggressively apply analytics and coordinate workflows to move "left" from reactive postpay to proactive, predictive prepay. Read More * HEALTHRULES® PAYER NAMED “BEST IN KLAS®” Read More * HEALTHEDGE COMPANY BROCHURE Read More * ANNUAL MARKET SURVEY REPORT 2022 Read More READY FOR YOUR DIGITAL TRANSFORMATION? Meet with a transformational expert today to talk about how we can help you solve today’s challenges while setting you up for future success. SCHEDULE A CONSULTATION * Become a Digital Payer * Solutions * Lines of Business * Resources * Request a Demo * About Us * Contact Us * Speak Up Hotline * Customer Login Privacy Policy | EOO Statement ©2022 HealthEdge Software, Inc. | HealthEdge®, HealthRules®, The HealthRules Language™, GuidingCare®, and the Wellframe logo are registered trademarks of HealthEdge Software, Inc. All Rights Reserved.