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What is HealthRules Payer?

HealthRules® Payer is a state-of-the-art core administrative processing framework that delivers transformative capabilities for health plans of all shapes and sizes. For more than ten years, health plans that have adopted HealthRules Payer have successfully seized market opportunities and sustained a competitive advantage. What distinguishes HealthRules Payer from other core administrative systems is its unique utilization of the patented HealthRules Language™, which closely resembles English and introduces an innovative approach to configuration, claims management, and transparency of information. This exceptional system empowers health plans to grow, innovate, and excel beyond their competitors more efficiently than any other core solution currently available. Consequently, HealthRules Payer not only enhances operational efficiency but also cultivates a culture of adaptability and responsiveness within health organizations, ultimately leading to improved patient care and satisfaction. By integrating advanced tools and methodologies, HealthRules Payer positions health plans to thrive in an ever-evolving healthcare landscape.

What is Enterprise Health Solution?

HM Health Solutions provides a detailed end-to-end service tailored specifically for health plans. By utilizing the Enterprise Health Solution, you gain access to essential support, enabling you to reach your business objectives through a unified, all-in-one health plan administration platform. This comprehensive suite encompasses various functionalities, which include sales, enrollment, billing, claims processing, provider management, clinical oversight, and customer support. What sets the Enterprise Health Solution (EHS) apart is its designation as the only verified end-to-end system that guarantees a seamless experience for members, guiding them from the enrollment process right through to claims payment. Although other providers may claim to offer a fully integrated solution, they often neglect to mention that achieving genuine integration typically involves the stepwise acquisition of multiple modules. In contrast, the Enterprise Health Solution is singularly dedicated to health plan administration, showcasing our unparalleled expertise in the payer landscape. Therefore, selecting EHS means you are choosing a platform that is committed to addressing the specific requirements and enhancing the operational efficiency of your health plan. This dedication ensures that your organization can navigate the complexities of health plan management with confidence and ease.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

Has API

API Availability

Has API

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

HealthEdge Software

Company Website

www.healthedge.com

Company Facts

Organization Name

HM Health Solutions

Date Founded

2014

Company Location

United States

Company Website

www.hmhs.com

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

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