Commercial

With about 20% of health plan members disenrolling every year1, health plans with commercial business are under greater pressure to reduce turnover, invest in enrollment and maintain affordability while growing their business in a competitive and dynamic marketplace.

It takes next-generation healthcare commercial plans software to handle the specific requirements of a commercial line of business while giving you the scalability and flexibility to react quickly to shifting market conditions. The HealthEdge® integrated solution suite gives you the agility to master change, offer new products, lower administrative costs and deliver value and a satisfying experience to keep enrollment numbers up.

Commercial overview

How HealthEdge
Can Help

HealthRules® Payer

Gain the ability to expand into new markets and quickly stand up and grow all lines of business. The platform's reusable configuration capabilities drastically reduce IT and administrative costs and improve operational efficiency.

Source

Choose the only prospective payment integrity solution that natively delivers up-to-date regulatory data, claims pricing and editing, and real-time analytics tools in a single IT ecosystem. With higher visibility into the overall payment management process, you can strategically grow your commercial line of business.

GuidingCare®

Turn to the nation's largest and most widely adopted platform for care management and population health to address care coordination, medical management workflow and regulatory compliance to serve any member.

Wellframe

Gain insights between clinical encounters and provide more consistent support. Wellframe Digital Care Management extends the reach of your staff to engage more fully with your high-risk members.

Source

Choose the only prospective payment integrity solution that natively delivers up-to-date regulatory data, claims pricing and editing, and real-time analytics tools in a single IT ecosystem. With higher visibility into the overall payment management process, you can strategically grow your commercial line of business.

GuidingCare®

Turn to the nation's largest and most widely adopted platform for care management and population health to address care coordination, medical management workflow and regulatory compliance to serve any member.

Wellframe

Gain insights between clinical encounters and provide more consistent support. Wellframe Digital Care Management extends the reach of your staff to engage more fully with your high-risk members.

HealthRules® Payer

Gain the ability to expand into new markets and quickly stand up and grow all lines of business. The platform's reusable configuration capabilities drastically reduce IT and administrative costs and improve operational efficiency.