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.

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?

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.

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.