HealthEdge Payer
The industry's leading next-gen core administrative processing system.
Overview
HealthRules Payer is a modern core system that enables health plans to automate and streamline their operations, including claims administration. It is designed to handle complex benefit designs, support value-based care models, and provide real-time data for decision-making, leading to greater accuracy, efficiency, and agility.
✨ Key Features
- Real-time claims adjudication
- Automated workflow and processing
- Support for value-based care reimbursement
- Flexible benefit plan configuration
- Real-time data and analytics
- Scalable and secure cloud-based architecture
- Integrated financial management
🎯 Key Differentiators
- Next-generation, real-time architecture
- Strong support for value-based care models
- Language-based, easily configurable benefit rules
Unique Value: Provides health plans with a modern, agile core system that automates claims processing in real-time and easily adapts to new payment models and benefit designs, unlike restrictive legacy platforms.
🎯 Use Cases (4)
✅ Best For
- Modernizing core systems for health insurance payers to improve automation and support new care models.
💡 Check With Vendor
Verify these considerations match your specific requirements:
- Property & Casualty insurance.
- Small TPAs or businesses not operating as a health plan.
🏆 Alternatives
Offers a more modern, flexible, and real-time processing architecture compared to older, batch-based legacy core administrative systems.
💻 Platforms
🔌 Integrations
🛟 Support Options
- ✓ Email Support
- ✓ Phone Support
- ✓ Dedicated Support (All tier)
🔒 Compliance & Security
💰 Pricing
🔄 Similar Tools in Claims Adjudication
Claimable
A web-based claims management platform that facilitates communication with claimants and efficient p...
FileHandler Enterprise
A comprehensive claims administration system for TPAs, insurance carriers, risk pools, and self-insu...
Origami Risk
A highly configurable, integrated SaaS platform for insurance, risk, safety, and compliance manageme...
Sapiens ClaimsPro for P&C
A cloud-native solution that streamlines end-to-end claims processing for all personal and commercia...
Majesco Claims for L&A and Group
A comprehensive claims management solution for Life, Annuity, and Group benefits insurance....
TPA Stream
An insurtech software company that provides solutions for Third-Party Administrators (TPAs) and heal...