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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

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

“Operating margin improvement is a top three critical outcome for digital investments in 2024 for 67% of U.S. healthcare payers.”

– Gartner®, Three Operational Excellence Best Practices to Optimize Costs for U.S. Healthcare Payers, 1 November 2023, Mandi Bishop 1

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Case Study: AmeriHealth Administrators

November 2, 2022

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Case Study: AmeriHealth Administrators

Video: Leading with Clinical Expertise

Infographic: GuidingCare Clinical Expertise

Data Sheet: HealthRules® Payer named “Best in KLAS” in 2023 Research Report (PDF)

Cloud-Based Data Delivery in Healthcare: Point-of-Service Payment Success Path

Data Sheet: Point-of-Service (POS) Payment Success in Healthcare - Process Automation & Intelligent Workflows

Video: Source Medicare Reimbursement

Data Sheet: Source 3rd Party Integrations Partnerships

Infographic: Top 9 Reasons More Payers Choose GuidingCare Than Any Other Care Management System

Case Study: SummaCare - Value of editing & pricing in Source

Data Sheet: Automatically Manage Retroactive Policy and Pricing Changes

Case Study: Easing Healthcare Preauthorizations - Priority Health

Webinar: Navigating Value-Based Care Through Technology and Automation

Case Study: Large Southeast Payer

Data Sheet: What Sets Us Apart - Operational Efficiency

Case Study: McLaren Health Plan

Data Sheet: HealthRules Payer Platform Overview

Data Sheet: Cloud-Based Pricing and Editing Content for Effortless Upgrades

Stop Recurring Post-Payment Issues with an Open Book Approach to Payment Integrity

Gartner Reports Next-Gen CAPS Technology Will Be Standard By 2024

Why Prospective Payment Integrity Solutions Are Must-Have Tech for Health Plans