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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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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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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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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