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Stay Compliant With Regulatory Changes

Government programs have unique requirements that mandate that health plans stay current with.


Expensive sanctions or even total shutdowns can result from non-compliance. It is imperative that technology systems not only support but fully enable rapid and reliable changes in response to changing regulations, whether they originate from CMS or state-regulated Medicaid programs. With today’s uncertainty regarding overall healthcare reform, the ability to modify underlying rules, produce auditable information and deliver reports is mandatory. All this while enabling the highest quality of care at the lowest price for the best member experience. And health plans must react quickly, always staying within compliance time windows.

HealthEdge customers with Medicare, Medicaid and Duals memberships rely on HealthRules solutions to remain compliant in the face of ever-changing regulations. HealthRules®  Payor provides the flexibility to make necessary system changes. The result is attainment of the highest revenue, with high ratings not only from the government, but from members as well.

Resiliency to Change

HealthRules enables health plans to confidently react to the latest regulatory shifts, competitive pressures, and opportunities for expansion and more to be successful.