Get an Enduring Financial Edge

Unlock a lasting financial advantage and long-term performance enhancements with integrated solutions and delivery models from HealthEdge®.

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Get an Integration Edge

Unlock risk-free implementation and reduce complexity across the payer ecosystem to enhance performance without requiring full operational support.

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Clearing the Path to Better Care Outcomes

Improve quality performance, outcomes, and cost management through an integrated care management platform that streamlines essential health plan workflows.

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HOW IT WORKS

One path, built to fit your organization

Built to match your operational needs with one AI-powered platform. Choose the delivery model that meets your operational need.

  • Enduring Edge (BPaaS)
  • Integration Edge (EPaaS)

HealthRules Edge is our core claims engine. A cloud-native solution that powers accurate, efficient claims administration for health plans of every size. It embeds AI directly into claims workflows to deliver industry-leading auto-adjudication rates and stronger financial and operational performance.

Combining an integrated technology platform across claims administration, payment integrity, care management and more, HealthEdge harnesses AI to drive measurable financial outcomes that compound over time.

One system of record operating off live structured data. Our cloud native architecture allows for continuous, compounding AI improvements automatically.

1. Delivery Models

Finding the right model for your plan

Enduring Edge (BPaaS)

A Performance Partnership that Guarantees a Lasting Financial Advantage

Integrate technology, software solutions, and managed operations to unlock an enduring financial edge. By combining our AI-powered platform with operational execution, we deliver sustained performance improvements: reducing costs, managing risk, and strengthening margins over time. This is a true performance partnership, designed to guarantee long-term financial resilience and a durable competitive edge for payers.

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INTEGRATION EDGE (EPaaS)

An Integrated Operating Environment for Enterprise Performance

Goes beyond software to provide a risk-free implementation of an integrated operating environment, connecting technology, workflows, and domain expertise. It reduces complexity across the payer ecosystem and accelerates measurable performance improvement without requiring full operational support.

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SOFTWARE SOLUTIONS

2. HealthRules® Edge

HealthRules Edge, formerly HealthRules® Payer, is our core claims engine: a cloud-native solution that powers accurate, efficient claims administration, delivers industry-leading auto-adjudication rates, and enables stronger financial and operational performance.

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3. Choose the add-ons

Payment
Accuracy Edge Clinical
Edge Revenue
Align Edge Provider
Atlas Edge

Find Your Enduring Edge

Discover how much your organization can save with Enduring Edge by answering our short questionnaire.

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How We Deliver

Integrated Ecosystem

Best-in-class integrated solutions and strategic partners for long-term scalability and performance.

Implementation

Dedicated implementation teams and strategic AI application accelerates adoption and reduces time to value.

Run/Operate

Flexible delivery models and integrated solutions give payers more options when covering lines of business.

See How HealthEdge Impacts Payer Operations

$1.6 million in savings by automating processes
99% accuracy in claims payment
95% decrease in pending claims
$20 million revenue increase
Case Study Elderplan uses HealthRules® Edge to Lower Administrative Costs

Elderplan, a not-for-profit health plan organization based in Brooklyn, New York, faced significant challenges in managing administrative costs and operational inefficiencies. Manually processing tens of thousands of claims each month strained resources and hindered the organization's ability to reinvest in crucial areas such as innovation, member satisfaction, and care coordination.

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