Your Opportunities

Lower Administrative & Healthcare Costs


What if you could leverage administrative and care management insights together?

What seemed impossible is now possible.Your claims system and care management application can work together as one, each informing the other for greater accuracy, efficiency and improved patient outcomes. It is possible to lower administrative costs and healthcare costs with one set of integrated information. In the HealthRules suite of solutions, information between HealthRules Payor and HealthRules CareManager is always in sync because HealthRules Payor is the single source of truth. This information flows from one product to another. Nurses don’t have to key demographic information since they receive it from HealthRules Payor and prior authorizations are visible in HealthRules Payor by a call center rep. There is no need to move between systems.

Other examples include:

  • 360 degree view of the member is provided by HealthRules Payor and HealthRules CareManager so you can see all information pertaining to the member on one screen.  This eliminates what would otherwise be the manual process of searching through claims data

  • The ease of usability and “basic English language” of HealthRules Payor means that a nurse can look up a claim and easily understand how it was processed. This provides accurate decision making for a clinician, which ensures an improved outcome and lower healthcare cost