HealthRules Payer Description
HealthRules® Payer represents a cutting-edge core administrative processing system that offers transformative features for health plans across various types and sizes. For over a decade, health plans utilizing HealthRules Payer have effectively capitalized on market opportunities, maintaining a competitive edge. What sets HealthRules Payer apart from other core administrative solutions is its innovative application of the patented HealthRules Language™, which resembles English and introduces a groundbreaking methodology for configuration, claims management, and information transparency. This system empowers health plans by enabling them to expand, innovate, and outperform their peers more effectively than any other core system available today. As a result, HealthRules Payer not only streamlines operations but also fosters a culture of agility and responsiveness within health organizations.
HealthRules Payer Alternatives
Service Center by Office Ally is trusted by more than 80,000 healthcare providers and health services organizations to help them take complete control of their revenue cycle. Service Center can verify patient eligibility and benefits, submit, correct, and check claims status online, and receive remittance advice. Accepting standard ANSI formats, data entry, and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers.
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RouteGenie is non-emergency medical transportation software for operations running 25 to 500+ vehicles. It combines NEMT scheduling software and route optimization with native multiload, real-time NEMT dispatch software, Medicaid and broker billing with CMS 1500 and claim scrubbing, and fleet compliance in one single-tenant platform. Multi-site operators run every location in one instance with role-based access and a full audit trail on every trip change. ImportGenie automates trip intake and status return across 28 live broker and payer integrations, including ModivCare, MTM, Veyo, Verida, SafeRide Health, Alivi, New York MAS, Uber Health and transit authorities. Subcontractor vehicles are visible on the same live map as owned fleet. SAML2 SSO (Entra ID, Okta, OneLogin, Google Workspace), SOC 2 Type 1, open REST API, iOS and Android driver apps, passenger app, and a payer and facility portal. Flat per-vehicle pricing with unlimited trips and unlimited users. 600+ fleets, 20,000+ vehicles, ~50,000 trips daily.
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PlanXpand
PlanXpand™ is the specialized transaction processing engine developed by Acero, which serves as the backbone for all products aimed at health benefits administrators. With this innovative engine, clients have the flexibility to implement Acero’s offerings either all at once or gradually over time. Beyond simply selecting from our standard range of products, administrators have the option to harness PlanXpand™ to create tailored solutions that enhance their current system functionalities. Acero’s distinctive, integrated solutions utilize a Service-Oriented Architecture, enabling health benefits administrators and insurers to augment their existing adjudication platforms with new features and capabilities. Furthermore, our advanced design and engineering facilitate real-time adjudication for all claim types, directly interacting with the core claims system, which leads to improved processing accuracy, increased customer satisfaction, and a reduced necessity for claims adjustments. This adaptability and precision in processing claims ultimately positions Acero as a leader in the health benefits administration sector.
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NextAgency for Health & Life Insurance
NextAgency is insurance agency management software built specifically for agencies selling health insurance, employee benefits, Medicare, and life insurance. Unlike agency management systems built for property and casualty insurance agencies, NextAgency is designed for the CRM needs, workflows, compliance requirements, and day-to-day operations of life and health insurance agencies.
NextAgency combines a life and health insurance agency CRM with agency management, marketing, automation, reporting, compliance, and optional insurance commission tracking in a single system. Agencies selling health, benefits, senior, and life policies across the country use NextAgency to organize client information, automate routine work, and manage their entire book of business.
Key capabilities include:
• Life and health insurance agency CRM for leads, prospects, clients, policies, renewals, relationships, and customer service
• Marketing automation with email campaigns, drip marketing, text messaging, renewal reminders, and client communications
• Automated insurance agency workflows, task management, dashboards, business analytics, and operational reporting
• Compliance and disclosure management with document storage, e-signatures, and required insurance documentation
• Optional insurance commission tracking with carrier statement imports, reconciliation, producer reporting, and sub-agent management
• Easy customization so the software adapts to your agency instead of forcing your agency to adapt to the software
• Transparent pricing, a 30-day free trial, no long-term contract required, free Android and iPhone apps, and top-rated customer support
• Integrates with Employee Navigator, BerniePortal, Intulse, GReminders, Zapier, and other software insurance agencies use
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Integrations
No Integrations at this time
Company Details
Company:
HealthEdge Software
Website:
www.healthedge.com
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Product Details
Platforms
Web-Based
Customer Support
Business Hours
Online Support
HealthRules Payer Features and Options
Claims Processing Software
Payor Management
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