Our Solutions

Commercial

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

You need next-generation technology that can handle the specific requirements of a commercial line of business with the scalability and flexibility to react quickly to shifting market dynamics. HealthEdge's integrated solution suite provides health plans with the agility to quickly adapt and offer new products, lower administrative costs with improved operational efficiency, and deliver value and a delightful experience to your customers.

HealthRules® Payor gives health plans the ability to expand into new markets as well as quickly stand up and grow all lines of business. The platform's English-like, reusable configuration capabilities enable health insurers to create a variety of benefit plans without needing to make manual updates in multiple locations, drastically reducing both IT and administrative costs and improving operational efficiency.

Burgess Source® is the only prospective payment integrity solution that natively brings together up-to-date regulatory data, claims pricing and editing, and real-time analytics tools into a single IT ecosystem. With higher visibility into the overall payment management process, plans can strategically grow their commercial lines of business. Burgess Source removes rework to uncover savings, scales quickly and easily, and enables transparency and flexibility.

EBOOK
7 Reasons to Choose an Integrated Ecosystem

Health plans can save over $27 per patient encounter by improving workflow automation. The seven unique features in Burgess Source offer health plans the opportunity to modernize claims processing in an agile, streamlined ecosystem that delivers significant savings. Download the eBook to learn more.

eBook commercial health plan software for payment integrity and automation

GuidingCare® is the nation's largest and most widely adopted platform for care management and population health. It addresses care coordination, medical management workflow, and regulatory compliance to serve any member. GuidingCare meets rigorous standards in security and quality, and its next-generation architecture flexes to evolving value-based models and integration needs. 

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GuidingCare is a comprehensive solution for patient-centered care, offering next-generation data integration and workflow management solutions and tools. Our feature-rich platform is easy to integrate with existing systems and is highly configurable.

Workflow image for commercial health plan software

Working together, HealthRules, Burgess Source, and GuidingCare enable health plans with commercial business to successfully tackle critical imperatives including:

  • Configure new products in hours to capture new membership in response to market opportunities
  • Embrace new payment models, including value-based reimbursements and benefits
  • Gain administrative efficiencies through automating processes
  • Boost the quality of care and clinical outcomes, also 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