HealthRules Connector

The Right Information, in the Right Place, at the Right Time

In today’s healthcare marketplace, data flows to more constituents than ever before. The need to share key healthcare information quickly, easily and securely is critical.

HealthRules Connector is a robust, enterprise-class integration layer that provides real-time and batch access to all HealthRules data and functionality, allowing HealthRules to easily integrate with a wide variety of other systems, partners and exchanges.

Built using a service-oriented architecture, HealthRules Connector enables customers to quickly and easily:

  • Interface HealthRules with other systems, partner networks and exchanges
  • Provide real-time access to HealthRules data and functionality from within other applications and portals
  • Support new business models and approaches
  • Leverage the power of HealthRules beyond the traditional walls of the payor organization
HealthRules Connector includes:

  • A channel orchestration tool that enables quick configuration of interface end-points and business logic
  • A business interface message layer that provides an easy-to-understand business concept-based data structure and a straightforward set of services for performing look-ups and other interface tasks
  • An analytics dashboard for monitoring performance and spotting trends
  • Standard HIPAA X12 XML-based channels for direct, real-time communications with clearinghouse and trading partners
  • Boundary layers that increase security and reliability, and support regulatory requirements

Optional HealthRules Connector modules include:

  • HealthRules EDI Gateway — The HealthRules EDI Gateway enables payors to meet all of their HIPAA transaction requirements with a tightly integrated, highly configurable application that will deliver:
  • Faster implementations
  • Dramatically lower integration costs
  • A decreased time to market
With the HealthRules EDI Gateway, business users can:

  • Experience faster implementations
  • Reduce integration costs
  • Increase trading partner satisfaction
  • Quickly address new EDI initiatives
  • HealthRules Medicare Eligibility Module – With the HealthRules Medicare Eligibility Module, payors can seamlessly enroll and track Medicare-eligible members, and enable reconciliation and variance management across their Medicare population. Combined with the rest of the HealthRules product suite, HealthRules Medicare Eligibility Module allows payors to:
    • Quickly meet the demands of the Medicare market
    • Reduce administrative costs
    • Increase operational efficiencies
HealthRules Medicare Eligibility Module features:

  • Request for information
  • Enrollment and pre-enrollment
  • Batch eligibility query
  • Late enrollment penalty
  • Low-income subsidy
  • Outbound enrollment verification process
  • Transaction reply reporting
  • Medicare plan benefit package change processing
  • Medicare out-of-area processing
  • End-stage renal disease review and maintenance
  • Medicare monthly review processing
  • Premium billing
  • Medicare secondary payor processing
  • Medicare correspondence
  • Payment reconciliation
  • Medicare Advantage and Part D plan configuration
  • CMS compliant member notification
  • Medicare claims pricing