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Future-proof your business with next-generation core administration and care coordination for transformative health plans.

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HealthRules® Payor, named “Best in KLAS” by KLAS Research for claims administrative processing system (CAPS).

Gartner named HealthEdge as a Sample Vendor for its next-generation core administrative system in its July 2021 Hype Cycle for U.S. Healthcare Payers Report, 2021 for the 11th consecutive year.*

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Important Customer Update

The international COVID-19 outbreak has introduced unforeseen changes and uncertainty to all parts of our lives. During this time, HealthEdge wants you to know that we are here for you and committed to helping you continue running your business as you work with your providers and members. 

COVID-19 Customer Update
Featured Business Opportunity
Embrace Value-Based Reimbursement

The move to value-based care and value-based reimbursement is gaining momentum in healthcare and will only increase over time. Is your organization equipped to succeed in this new world?

Embrace Value-Based Reimbursement
EBOOK
Value-Based Reimbursement: How we got here, what’s working, and who’s doing it well

Payers, providers, the U.S. government, and other entities have made initial investments in value-based reimbursement. And while these initial investments have, in some cases, made great strides in the march toward quality-based care, costs are still increasing, payers and providers are no closer to a trust-based relationship, and fee-for-service is still a large part of reimbursement.

Value-Based Reimbursement
White Paper
Medicare Lines of Business and the Challenges Payers Face

There are significant market forces impacting Medicare, both today and in the future. The rise of value-based reimbursement models along with innovative pilot demos is forcing a different awareness for providers and a changed reality for payers. Read how regulatory reform continues to provide a layer of uncertainty that directly impacts the ability for payers to plan ahead.

*Gartner, Hype Cycle for U.S. Healthcare Payers, 2021, Bryan Cole, Jeff Cribbs, Mandi Bishop, 13 July 2021

Gartner and Hype Cycle are registered trademarks of Gartner, Inc. and/or its affiliates in the U.S. and internationally and is used herein with permission. All rights reserved. Gartner does not endorse any vendor, product, or service depicted in its research publications and does not advise technology users to select only those vendors within the highest ratings or other designation. Gartner's research publications consist of the opinions of Gartner's research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

Press Releases

August 04, 2022
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Industry Veteran Alan Stein Joins HealthEdge as Chief Commercial Officer
June 01, 2022
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New Sales Leadership Joins HealthEdge to Accelerate Growth and Support the Expansion of Digital Health Platform
May 05, 2022
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A Health Plan Story: The Impact of Effective Care Management on the D-SNP Population

News

Empowered Patient Podcast August 01, 2022
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Payment Integrity Means Getting to the Root Causes of Errors in Healthcare Claims with Ryan Mooney HealthEdge
Electronic Health Reporter July 27, 2022
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Payment Integrity In The U.S.: Uncover the “Why”
BenefitsPRO July 05, 2022
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3 value-based care considerations to prioritize in a health plan

Events

Webinar August 16, 2022
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Source Medicaid Survey Insights

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