Hidden Gems

Network Design

With HealthRules Payor, network design options are highly flexible to support the easy and rapid configuration of narrow networks, direct hospital networks, regional networks, broad networks, affiliation networks, external re-pricers, and more. The unique HealthRules Payor data model approach to providers eliminates duplicate entries that most legacy systems require. This functionality steers the member to preferred providers based on quality and improved patient care, improving healthcare outcomes and lowering costs at the same time. In addition to extensive first-class fields in the provider and member data models, unlimited User Defined Terms can be used as criteria to drive value-based pricing rules. This allows our clients to administer value-based programs based on their unique analyses and benchmarks.

The 'Edge Report
Inefficient Processes Stifle Creativity and Continuous Improvements

To remain competitive in today’s market, health plans must have the ability to stand up new lines of business and benefit plans quickly and efficiently.

Independent Health Value-Based Payments: Getting from Here to There

Read the case study to learn how Independent Health is realizing achieving high levels of customer satisfaction and transparency for both members and providers resulting from the use of HealthRules Payor.

Other Hidden Gems
Agility & Go-To-Market

HealthRules Payor allows health plans to design and implement any type of benefit plan or provider contract

Benefit & Contract Modeling

HealthRules Payor empowers health plans to model benefit plans and provider contracts