Products & Services

HealthRules Payor

With healthcare dynamics changing at an increasingly rapid pace, health plans must employ the latest technology to help turn today’s challenges into tomorrow’s opportunities.

HealthRules Payor is a next generation core administration system that provides transformational capabilities to health plans of all types and sizes.

Business Advantage Delivered Unique Capability
Respond rapidly to market changes and seize new opportunities Build and launch new benefit plans to market quickly and with minimal development time
Lower administrative costs, maximize efficiency and use of valuable resources Increase claims adjudication and accuracy rates to unprecedented levels with advanced automation
Provide health plan staff with critical information at their fingertips for enhanced member experience Share real-time information with member-facing staff for streamlined communications and transparency with members
Stay compliant with regulatory changes Keep up with the latest Federal and state regulations
Embrace new business models and payment reform with value-based reimbursement Flexible and rapid configuration allows effective provider contract management changes
Enable members to make informed choices with special insight into financial liability Benefit predictor capability enables members to understand financial liability before electing services or providers
Real-World Examples: Zombie Health Plans

Kimberly Branson, Vice President of Business Architecture and Strategy at Medica, a Minnesota-based health plan, tells the remarkable story of how, in just two weeks time, Medica was able to quickly resurrect and bring to market more than 80 distinct benefit plans followings a sudden regulatory shift under the ACA.

HealthRules Payor features the patented HealthRules Language, a revolutionary approach to configuration, claims processing and transparency of information that leverages an English-like vernacular to enable health plans to quickly react to market changes and new opportunities. With HealthRules Payor, your organization can design and implement any benefit plan or provider contract in significantly less time and at less cost than typically required with other systems.

For more than ten years, health plans implementing HealthRules Payor have been able to quickly address market opportunities and stay in front of their competition. They have done this with high levels of customer satisfaction and transparency by providing accurate, real-time information to everyone involved in the care continuum. And those health plans have also significantly lowered administrative costs resulting in an enhanced bottom line by simultaneously automating their critical manual business processes.

Payers' Place in the Healthcare Ecosystem

The healthcare industry is changing, and the challenges for payers are increasing rapidly. Watch to learn how uncertainty and change stemming from reform, competitive pressures and the rise of consumerism are causing payers and providers to reevaluate all aspects of their businesses.

HealthEdge provides the only modern, enterprise class software platform for health plans. HealthRules is a Software as a Service (SaaS) solution, which means lower costs, faster implementations and upgrades for HealthEdge customers.  Regular software updates deliver valuable new capabilities, allowing health plans to stay current and competitive with the latest market developments, while drastically reducing both IT and operational costs. Our technology infrastructure and industry expertise enable HealthEdge to provide our customers with an ongoing competitive advantage, staying in front of market changes, whether they are of a regulatory or business nature.