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. 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.

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.

Gartner cited HealthEdge as a Sample Vendor for its next-generation core administration system in its July 2018 Hype Cycle for U.S. Healthcare Payers Report, 2018 for the 2nd consecutive year.


Are you resilient to change?
Business Advantage Delivered
Unique Capability
Respond rapidly to market changes and size 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
Market Brief
Core Administration

Industry changes are creating an imperative for health plans to transform the way they do business. Are you looking to join the growing ranks of leading health plans transforming their place in the dynamic healthcare marketplace?

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.

*Gartner Disclaimer: Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.