Our Solutions

Health insurers must act quickly to launch new offerings targeted at member populations in specific market segments. Whether a government program, commercial or individual product, or dental or TPA offering, HealthEdge works with transformative health plans to create and maintain competitive advantage.

Health plans must be able to rapidly and confidently respond to changing regulatory requirements. 

Momentum around innovative payment models, particularly value-based reimbursement, is making agility more important than ever.

Health plans of all types of and sizes use the HealthRules solution suite to successfully introduce new lines of business or bring unique products to market. If you are looking to lower administrative and medical costs, comply with new regulations, boost quality scores and outcomes, or effectively grow and expand your business, the transformational technology at the core of HealthRules allows you to leapfrog the competition.

Join the other HealthEdge customers who:

  • Successfully capture growth opportunities and rapidly launch new lines of business
  • Drastically lower costs with streamlined business processes and fully-automated workflows
  • Deliver essential, accurate information in real-time for a superior customer experience, with full transparency among members, providers and the health plan
  • Initiate targeted care coordination initiatives and optimize critical quality measures including HEDIS, Star Ratings, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and NCQA accreditation
  • Achieve and maintain compliance with the latest state and Federal regulations
  • Ensure the highest level of security with HITRUST certification
Explore Our Solutions
Commercial

Health plans with commercial business must transform to stay ahead in today’s competitive and dynamic marketplace

Individual

Keeping pace with the innovation of the exchanges is a key requirement for health plans serving the individual market

Medicare

Health plans that serve Medicare members must provide high-quality care while complying with government regulations

Medicaid

Health plans serving Medicaid members must provide high-quality, cost-effective care  while ensuring compliance with changing state regulations

Third Party Administrators

Third Party Administrators must have the agility to satisfy each of their customers’ unique requirements quickly and easily

Dental

Organizations serving the dental market have large member populations and fewer product variations, making high throughput and accuracy key