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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: Health Plan for Large Metropolitan Area Transforms Care and Operations with HealthEdge® Solutions

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Case Study: Health Plan for Large Metropolitan Area Transforms Care and Operations with HealthEdge® Solutions

2024 HealthEdge Consumer Survey Key Trends

Case Study: Modernizing with HealthEdge® to Drive Expansion

Case Study: Modernizing Care Management and Operations with HealthEdge® Solutions

Case Study: Empowering Innovative Healthcare with Integrated HealthEdge® Solution

Case Study: Digital Health Improves Care Transitions For Members With Multimorbidities

Demonstrating the value of digital health with a new methodology

A large Blues plan uses Wellframe Digital Health Management to Drive Care Management Capacity and Member Engagement

Report: Digital Care Management can help lower blood pressure by more than 9%

Report: Digital Care Management can help lower blood sugar by more than 25%

HealthEdge’s Provider Data Management

Infographic: 2024 HealthEdge Annual Payer Market Survey

Data Sheet: HealthRules® Payer Named “Best in KLAS®” Three Years in a Row

Infographic: The History of HealthEdge Source™ The Payment Accountability® Platform

2024 HealthEdge Annual Payer Market Report

Infographic: A Member Journey After the No Surprises Act

Data Sheet: Integrated Secondary Editing Solution Now Available to HealthRules® Payer Clients

Data Sheet: Navigating the No Surprises Act - The Right Tools for Health Plan Success

Infographic: Future-Proof Claims Editing for Real Savings with Source Editing

Case Study: VillageCare

Data Sheet: HealthEdge Source - Medicare Reimbursement