Our Solutions


Health plans serving Medicaid members must provide high-quality care and keep costs under control while ensuring compliance with changing state regulations.

Case Study
Bringing Innovation to a Local Population

Read the case study describing how University of Maryland Medical Systems (formerly Riverside Health Plan) benefited from HealthRules solutions. A start-up health plan born from the Affordable Care Act (ACA), UMMS serves primarily Medicare and Medicaid members.

HealthEdge’s HealthRules product suite enables health plans serving Medicaid markets to improve operations and outcomes including:

  • Enroll and reconcile members efficiently and accurately
  • Lower administrative costs significantly by automating critical  business processes
  • Identify and provide care to high-risk populations and members with high utilization
  • Achieve and maintain regulatory compliance as new rules emerge in each state
  • Track and report on critical quality and compliance measures
  • Deliver transparency of information for increased member engagement and superior customer experience
  • Leverage key data sources with seamless integration
  • Coordinate individuals’ healthcare and support services effectively
Real-World Examples: Medica

Kimberly Branson, Vice President of Business Architecture and Strategy at Medica, a Minnesota-based health plan, shares the journey that Medica took to transform its technology infrastructure in order to meet its business goals. 

Medicaid businesses strive to achieve maximum efficiency while remaining compliant with each state’s specific regulations. These companies recognize the importance of having the latest technology platform. HealthEdge Medicaid customers achieve greater levels of operational efficiency, lower costs, and deliver enhanced levels of transparency and customer service while providing  compliant and high-quality care with the HealthRules product suite.