HealthEdge™ Introduces HealthRules Payor™ 2.2
Burlington, MA, February 15, 2007 — HealthEdge Software, Inc., a pioneering healthcare software company, today unveiled HealthRules Payor 2.2, a revolutionary application that sets new standards for flexibility and ease-of-use in managing the business of healthcare. Based on a six-year, over $100 million, state-of-the-art development effort, Payor 2.2 offers a unique combination of enterprise-class scalability and reliability with the flexibility and functionality to support payors of all sizes as they deploy new business models in the increasingly consumer-driven healthcare industry.
“The consumerism bell can’t be unrung and health plans now face an increasingly complex and competitive market,” said Rob Gillette, CEO of HealthEdge. “Payors will either choose to ignore the imminent challenges, and hope that their existing legacy systems will be able to handle the industry’s shifting dynamics, or they can choose to innovate and be ready to adapt with new business models for the consumer-driven future. Agility will be the critical success factor for handling the rapid changes required around benefit and contract design. HealthRules offers unparalleled capabilities to deliver the required agility.”
Payor 2.2 is a uniquely flexible and scalable administration platform based on a service-oriented architecture (SOA) that provides unprecedented levels of automation and seamless transactions between payors and their provider and member constituencies. The system fully integrates benefit and provider contract design and claims processing. Its ability to support multiple lines of business helps organizations to deliver cost-effective, quality healthcare benefits with products designed to meet the widest range of market requirements. Payor 2.2 is designed for business users, allowing them to design and deploy new products and contracts without the need for specialized technical support.
Payor 2.2 offers innovative billing and financial capabilities, giving payors much greater flexibility in constructing and administering plan benefits and provider contracts. For example, with traditional systems, delayed contract negotiations would result in a manual, labor-intensive and often inaccurate process of retroactively reconciling already processed claims. Payor 2.2 offers the industry’s only intelligent claims re-processor, which allows payors to automatically reprocess historic claims and either report on or pay them based on the re-adjudication. It even allows healthcare professionals to exempt individual categories of claims from the reprocessing.
Using HealthRules Language (HRL) – an English-based rules authoring tool that translates complex codes into easy-to-use business language – Payor 2.2 provides all the functionality that payors expect in a comprehensive benefit administration system. Core components include:
- A visual, rules-based design environment for healthcare benefits, network contracting and reimbursement
- A workflow and administrative environment for managing groups, enrollment, providers, claims, CDHP accounting, and all other key business information
- An XML-based web service and application integrator to handle connections among multiple systems
- An advanced claims processing engine
HealthEdge Software, Inc. is an agile and innovative software company serving payor organizations and benefit administrators seeking to innovate in a rapidly changing industry. Health plans, TPAs, PPOs, insurance companies and employer groups improve business performance and beat their competitors to market with new business models using HealthEdge products. HealthEdge provides HealthRulesTM, the only health plan administration software in the market today built to address the challenges of the consumer-driven healthcare industry using the best in modern enterprise technology. For more information, visit our website at www.healthedge.com.