Health plans serving Medicaid members must provide high quality care and keep costs under control while ensuring compliance with changing state regulations.

HealthEdge’s HealthRules product suite enables health plans serving Medicaid markets to tackle critical imperatives including:

  • Enroll and reconcile members efficiently and accurately
  • Lower administrative costs significantly by automating key business processes
  • Identify and provide care to high-risk populations and members with high utilization
  • Achieve and maintain regulatory compliance as new rules emerge in each state
  • Track and report on critical quality and compliance measures
  • Deliver transparency of information for superior customer experience and increased member engagement
  • Leverage key data sources with seamless integration
  • Coordinate individuals’ healthcare and support services effectively

Medicaid businesses strive to achieve maximum efficiency while remaining compliant with each state’s specific regulations. These businesses recognize the importance of having the latest technology platform. HealthEdge Medicaid 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.