SOLUTIONS

Get an Enduring Edge

HealthEdge pairs HealthRules Edge—the industry's leading core administrative processing system—with one of two delivery models to match each health plan's operational reality. Software modules for payment integrity, risk adjustment, care management, and provider data can be layered on to build a coordinated operational foundation.

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HOW IT WORKS

One Path, Built to Fit
Your Organization

Step 1

Choose a Delivery Model

BPAAS DELIVERY MODEL

Enduring Edge

A performance partnership that integrates technology and managed operations to guarantee a lasting financial advantage. Reducing costs, managing risk, and strengthening margins over time.

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EPaaS DELIVERY MODEL

Integration Edge

An integrated operating environment for enterprise performance—connecting technology, workflows, and domain expertise to accelerate measurable improvement without requiring full operational support.

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Step 2

Learn about
HealthRules® Edge

HealthRules® Edge (formerly HealthRules® Payer) is our core claims engine. A cloud-native solution that powers accurate, efficient claims administration for health plans of every size. It embeds AI directly into claims workflows to deliver industry-leading auto-adjudication rates and stronger financial and operational performance.

  • Drive new levels of speed, automation, and accuracy with our innovative operating models and guaranteed PMPM savings with Enduring Edge BPaaS delivery model.
  • HealthRules Language allows business users to quickly and accurately configure virtually any benefit plan, provider contract, or other core business process, avoiding IT backlogs.
  • Fully integrated, robust analytics enable actionable insights to improve patient outcomes, lower costs, and increase transparency inside and outside the health plan.
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Step 3

HealthEdge Solutions

HealthEdge delivers the leading workflow system that modern payers need to compete in a complex and rapidly evolving market. Our end-to-end suite connects core administration, payment integrity, risk adjustment, quality, care management, and member engagement into a unified operational infrastructure. Instead of managing fragmented systems and disconnected vendors, payers gain a coordinated foundation where data, workflows, and performance are aligned across the enterprise. This integrated approach improves efficiency, reduces operational friction, and strengthens financial performance, creating the infrastructure required to compete and sustain an enduring financial edge.

Payment
Accuracy Edge Ensuring accurate payments for continuous cost containment through transformative payment integrity solutions. Revenue
Align Edge Enabling proactive management and stronger compliance across the payer enterprise, by giving payers a clear, data driven picture of risk. Clinical
Edge Improving care quality outcomes and managing costs through an integrated care management platform that streamlines workflows. Provider Atlas
Edge Reducing operational friction, compliance risk, and administrative risk through a single, reliable source of truth across the payer data ecosystem.
AI PLATFORM

Agentic AI Platform

HealthEdge's AI is built into the system of record, not bolted on top. Intelligent agents within the workflows automate decisions, improve accuracy, and help drive measurable financial outcomes.

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  • Optimization side icon Models are trained on governed health plan data to deliver accurate, defensible decisions—not generic outputs.
  • Insert side icon Humans stay in the loop, with the controls to review, approve, and override AI decisions.
  • Reorder side icon Every AI decision is explainable, so teams understand how and why an output was produced.