Our Solutions


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

The latest technology platform is critical to meet the challenges created by changing regulations, new consumer expectations and the need to engage with members. HealthRules provides health plans with the agility to quickly adapt and offer new products, helps you deliver value to your customers while reducing overall risk.

HealthEdge’s HealthRules product suite enables health plans with commercial business to successfully tackle critical imperatives including:

  • Configure new products in hours and rapidly launch new lines of business in response to market opportunities
  • Embrace new payment reform models, including value-based reimbursements and benefits
  • Reduce administrative costs significantly by automating key processes
  • Save significant cost with automatic adjustment of claims based on retroactive changes
  • Lower medical costs and comply with Medical Loss Ratio requirements
  • Boost the quality of care and clinical outcomes, resulting in improved metrics and higher reimbursements
  • Deliver superior customer service, providing critical information in real-time to all stakeholders
  • Leverage key data sources with seamless integration
  • Ensure regulatory compliance
  • Rapid response to regulatory changes

HealthEdge customers achieve greater levels of operational efficiency, lower costs, and deliver enhanced levels of transparency and customer service with the HealthRules product suite. Just watch John Janney, Senior Vice President of Health Care Reform Implementation & Transformation, as he describes how AmeriHealth Administrators accomplished this impressive feat with HealthRules solutions.

The HealthRules platform is the only modern, enterprise-class software suite for all types of health and specialty insurers. Regular software updates deliver new capabilities, ensuring continued compliance with industry standards, allowing health insurers to stay current and competitive with the latest market developments, and drastically reduce both IT and operational costs.