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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: Easing Healthcare Preauthorizations - Priority Health

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New from HealthEdge

3 Functional Areas That are Ripe for immediate Operational Efficiency Games

Case Study: Easing Healthcare Preauthorizations - Priority Health

Case Study: Modernizing with HealthEdge® to Drive Expansion

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

Case Study: Health Plan for Large Metropolitan Area Transforms Care 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%

Case Study: Improving Maternal Health Outcomes Through Digital Engagement

HealthRules Payer Case Study with Presbyterian

Case Study: VillageCare

Case Study: Managing Payment Complexity to Improve Operational Efficiency

Case Study: Regional Non-Profit - Leveraging Source for Efficient Claims Audit & Inquiry

Case Study: Denver Health Medical Plan Customer Spotlight

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

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

Case Study: Non Profit Midwestern Health Plan

Case Study: AmeriHealth Administrators

Case Study: Large Southeast Payer