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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

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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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Data Sheet: HealthRules Payer for Plans with Home & Host Capabilities

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Data Sheet: HealthRules Payer for Plans with Home & Host Capabilities

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

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

Infographic: EDGEcelerate

Infographic: A Member Journey After the No Surprises Act

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

Video: Care-Payer

Data Sheet: Achieving Transparency Compliance Through HealthRules Payer

Data Sheet: Configuration as a Service Expedites Time-to-Value for Health Plans

Brochure: Value-Based Care - Health Plans With Home & Host Capabilities Are Market Leaders

Data Sheet: Member Travel Card & HealthRules Payer

Case Study: HealthRules® Promote Empowers Medica Health Plan to Streamline Processes

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

Data Sheet: SmartComm for HealthRules Payer

Case Study: Elderplan uses HealthRules® Payer to Lower Administrative Costs

Data Sheet: HealthRules Payer + Source Integration

Data Sheet: HealthRules Promote

Data Sheet: HealthRules Payer Best in KLAS Report

Data Sheet: HealthRules Payer Platform Overview

Data Sheet: HealthRules Answers

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