HealthEdge™ Announces Availability of HealthRules® Payor 2.0
Waltham, MA, June 1, 2006 – HealthEdge announced today the availability of HEALTHRULES PAYOR™
2.0 – a revolutionary claims and benefit administration application that completely redefines the way that
health insurers and benefit administrators design and deliver health benefits. Based upon an advanced,
patent-pending technology platform, HEALTHRULES PAYOR enables a level of flexibility in the development
of consumer-focused healthcare benefit products that is unachievable with other technologies. In addition,
with HEALTHRULES PAYOR new products can be delivered in a fraction of the time required by other
systems, resulting in drastically improved time-to-market for new and competitive offerings.
HEALTHRULES PAYOR was designed from the ground up to be a core engine for today’s consumer-
directed and personalized benefit plans. For the first time, payors can offer health insurance benefits
tailored to the specific chronic conditions of their members and incent those members to modify their
lifestyles and behaviors. The unlimited flexibility of HEALTHRULES PAYOR lets payors customize their
offerings based on disease burden, age, geography, or any combination of characteristics that meets the
payor’s business objectives. HEALTHRULES PAYOR uses true member-level benefit design to personalize
benefit plans according to the unique needs of each member; even allowing individual family members to
participate in unique benefit plans.
HEALTHRULES PAYOR is built on an advanced processing platform and is coupled with a patent-pending,
English-based rules authoring language – the HealthRules™ Language. The HealthRules Language
allows administrators to move business from idea to implementation in one step without the need to
translate into complex and indecipherable codes and tables. Payors can now bring new products and
services to market in hours or days, not the weeks or months required by existing systems. In addition to
benefit definitions, the HEALTHRULES Language is used to configure provider contracts, fee schedules,
and utilization / care management requirements.
“Health benefit plans are entering a new era of consumerism and customization. In response, payors’
enterprise software systems will be required to provide a higher level of information and content to the
key participants in the system – payors, providers and members – to allow for intelligent decision-making.
We believe that HEALTHRULES PAYOR 2.0 achieves this goal while making it possible for payors to effectively meet their financial and business objectives,” said Dr. Albert Waxman, HealthEdge Chairman and Managing Member of Psilos Group Partners.
HEALTHRULES PAYOR provides all the functionality that payors expect in a comprehensive benefit
administration system It consists of four primary components: HEALTHRULES DESIGNER – the visual,
rules-based design environment for healthcare benefits, network contracting and reimbursement
schedules; HEALTHRULES MANAGER – the workflow and administration environment for management of
groups, enrollment, providers, claims, CDHP accounting and all other key business information;
HEALTHRULES CONNECTOR – the XML web service and application integrator; and HEALTHRULES Server –
the advanced claims processing engine.
HEALTHRULES PAYOR is built on the J2EE and Microsoft .NET platforms and is designed to scale with the
growth of the organization. All interactions between the components of HEALTHRULES PAYOR are handled
through its Service-Oriented Architecture (SOA) and industry-standard XML web services. HEALTHRULES
PAYOR augments existing IT infrastructures without disrupting health plan operations.
“The product we are introducing today will enable health plans and benefit administrators to meet the
changing needs of consumers, now and in the future. No other product offers the promise of
accommodating currently unknown future market requirements with the speed and flexibility of
HEALTHRULES PAYOR,” said Rob Gillette, CEO of HealthEdge.
About HealthEdge Software, Inc.
HealthEdge Software, Inc. is an agile and innovative software company that provides a business-
transforming technology platform for benefits and claim administration. Headquartered in Waltham,
Massachusetts, HealthEdge can be contacted at 781-285-1326, or visit our
website at www.healthedge.com for more information.