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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PLEXIS Payer Platforms
PLEXIS offers a comprehensive suite of top-tier applications designed to equip payers with the advanced capabilities required for contemporary core administrative systems. These applications encompass functionalities such as real-time benefit management, adjudication, automated EDI transmission, and self-service customer portals, ensuring that PLEXIS Business Apps meet all your needs. The Passport feature facilitates crucial connections between core administration and claims management systems, PLEXIS business applications, custom applications, and existing internal systems. Its adaptable API layer allows for real-time integration with various portals, automated workflow tools, and business applications, ensuring that connectivity knows no bounds. By employing this centralized, modern core administration and claims management platform, you can enhance workflows effectively. This approach enables the efficient processing of claims while simplifying the complexities associated with benefit administration, resulting in a swift return on investment and the ability to provide exceptional customer service. Ultimately, PLEXIS empowers organizations to thrive in an increasingly complex healthcare landscape.
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Evolent Health
Achieving significant advancements in both clinical and administrative outcomes, Evolent Care Partners, a healthcare system in the Midwest, has earned the distinction of being ranked third nationally for both total shared savings and the percentage of savings against benchmarks. By providing independent primary care physicians with essential capital and resources, Evolent Care Partners empowers them to engage in and thrive under two-sided payer contracts while mitigating their financial exposure. New Century Health enhances cost-effectiveness and quality of care in oncology and cardiology by leveraging clinical evidence to inform care decisions, a process that enjoys support from both payers and providers alike. Furthermore, Evolent Health Services streamlines health plan operations through a suite of comprehensive services backed by a modern, integrated platform and a genuine model of strategic partnership. Additionally, the organization encourages exploration of insights and news related to value-based care, population health, health plan administration, and various topics concerning the transformation of healthcare. Through these initiatives, Evolent aims to foster a more efficient and effective healthcare landscape.
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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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