Skip to main content
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 administrative processing 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.
HealthRules Payor is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information.
Gartner cited HealthEdge as a Sample Vendor for its next-generation core administration system in its August 2020 Hype Cycle for U.S. Healthcare Payers Report, 2020 for the 10th consecutive year
HealthRules Payor helps transform health plans looking to grow, innovate and compete beyond any other core system today
Legacy core administrative processing solutions cannot meet healthcare payer demands for a modern range of delivery models, implementation options, payment arrangements and IT system integrations. CIOs must use this research to advance their organizations to next-generation CAPS capabilities
Gartner, U.S. Healthcare Payer CIOs Must Pursue Next-Generation Core Administrative Processing Solutions, by Mandi Bishop, June 11, 2020. ID# G00729469
This video provides a short introduction to the HealthRules product suite, views of the HealthRules Payor user interface, and description of how our products work together. We recommend watching this video before any of the other in the series.
Customer Spotlight: NeuGen: Aligning IT and the Business
This data sheet gives an overview of HealthRules Payor, explores HealthRules Payor's seven differentiators, gives a comparison to legacy CAPS systems, and more.
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.