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 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.

HealthRules® Payor, named “Best in KLAS” by KLAS Research for claims administrative processing system (CAPS).

The HealthRules Advantage

HealthRules Payor helps transform health plans looking to grow, innovate and compete beyond any other core system today


HealthRules Differentiator
Business Advantage
Keep up with the latest competitive pressures, regulatory shifts, opportunities for expansion and more to be successful
Drive new levels of speed, automation, and accuracy. HealthEdge customers regularly achieve auto-adjudication rates over 90 percent with at least 99 percent accuracy
Quickly and accurately configure virtually any benefit plan, provider contract, or other core business processes using the HealthRules Language
Provide robust, comprehensive, and actionable data in real-time to key stakeholders in the healthcare continuum
Seamlessly integrate with key applications within your ecosystem in real-time via APIs and integration technologies
Swiftly configure new provider contracts and launch new benefit plans
Take advantage of the latest innovations and technology with ease, incorporating standard new functionality frequently


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Product Demo
HealthRules Payor Introduction

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.

HealthRules Payor Introduction

Customer Spotlight: NeuGen: Aligning IT and the Business

Data Sheet
HealthRules Payor

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.

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