Markets

Medicare

Health plans that serve Medicare members must provide high quality care while complying with government regulations. HealthEdge’s HealthRules suite enables health plans serving Medicare and Medicare Advantage markets to tackle critical imperatives including:

  • Enroll and reconcile members efficiently and accurately
  • Identify and provide care to high-risk populations and members with high utilization
  • Receive the highest STAR ratings for quality of care and clinical outcomes, raising reimbursements
  • Achieve and maintain regulatory compliance as new rules emerge
  • Track and report on critical quality and compliance measures
  • Deliver transparency of information for superior customer experience
  • Lower administrative costs significantly by automating everything
  • Leverage key data sources with seamless integration
  • Coordinate individuals’ healthcare and support services effectively

Medicare and Medicare Advantage businesses striving to stay ahead in today’s competitive and dynamic marketplace recognize the importance of having the latest technology platform. HealthEdge Medicare customers achieve greater levels of operational efficiency, lower costs, and deliver enhanced levels of transparency and customer service while delivering compliant and high quality care with the HealthRules product suite.

The HealthRules platform is the only modern, enterprise-class software suite for all types of health and specialty insurers. Regular software updates deliver new capabilities, ensuring continued compliance with industry standards, allowing health insurers to stay current and competitive with the latest market developments, and drastically reduce both IT and operational costs.