Our Solutions

Medicare

Health plans that serve Medicare members must provide high-quality care while complying with government regulations.

The combination of HealthRules® Payor, Burgess Source®, and GuidingCare® is the first-of-its-kind integrated solution suite featuring three next-generation, cloud-based applications that can help Medicare and Medicare Advantage businesses stay ahead in today's competitive market.

The industry shift to value-based care requires health insurers to have the flexibility and agility to adapt quickly. With HealthRules Payor, plans with Medicare and Medicare Advantage lines of business lower costs with greater levels of operational efficiency, and deliver enhanced levels of transparency and customer service while providing compliant and high-quality care.

Story Sheet
6 Ways to make a Medicare Advantage Plan Successful

With the growing popularity of Medicare Advantage, health plans must strive to differentiate in an increasingly competitive market. HealthEdge customer, UCare,® has offered MA plans for more than 20 years and is the trusted MA plan in its market. With more than 100,000 individuals in Minnesota and Wisconsin enrolled in the UCare MA plan, they have realized 96 percent retention rates. Click here to learn about the six key factors that make UCare's MA plan successful.

Medicare Advantage Active Members Medicare Compliance Solutions

Medicare undergoes major quarterly updates, policy adjustments, and retroactive changes,  with fee schedules requiring constant maintenance, research, and manual updates. Burgess Source automates these processes with cloud-based delivery and gives plans the flexibility to customize contracts and focus on innovation, growth, and customer satisfaction.

Case Study
Large National Health Insurer

A large national health plan with more than six million covered lives knew they needed to automate their claims reimbursement process to grow their government business. Initial success with their Medicare Advantage business led to millions of dollars in savings. Download the case study to learn how.

Case Study image for Medicare complaine solutions

To remain competitive in the Medicare and Medicare Advantage markets, health plans need a software technology platform for end-to-end care management and population health. With GuidingCare, health plans increase collaboration between all stakeholders for maximum coordination and member engagement, leading to improved STAR ratings, better health outcomes, and increased member satisfaction.

Fewer Gaps. Better Care.
eBook
Next-Generation Technology Solutions for Health Plans Serving Government Lines of Business

Download this eBook to read real-life examples and testimonials from HealthEdge customers across all three products with government lines of business successfully tackle critical imperatives using our integrated solution suite.

Next-Generation Technology Solutions for Medicare

Working together, HealthRules, Burgess Source, and GuidingCare enable health plans serving Medicare and Medicare Advantage markets to tackle critical imperatives including:

  • Enroll and reconcile members efficiently and accurately
  • Identify and provide care to high-risk populations and members with high utilization
  • Track and report on critical quality and compliance measures
  • Receive the highest STAR ratings for quality of care and clinical outcomes, raising reimbursements
  • Achieve and maintain regulatory compliance as new rules emerge
  • Deliver transparency of information for superior customer experience
  • Lower administrative costs
  • Coordinate individuals' healthcare and support services effectively
  • Innovate new product lines