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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 Evolent Health?
Evolent Care Partners, a healthcare provider based in the Midwest, has achieved notable progress in both clinical and administrative performance, securing the impressive position of third nationally for total shared savings and the percentage of savings relative to benchmarks. By equipping independent primary care physicians with vital resources and capital, Evolent Care Partners enables them to successfully navigate and flourish under two-sided payer contracts, thus reducing their financial risks. In the realm of oncology and cardiology, New Century Health improves cost-effectiveness and care quality by utilizing clinical evidence to guide treatment decisions, an approach that garners support from both payers and providers. Additionally, Evolent Health Services enhances the efficiency of health plan operations with a comprehensive suite of services built on a modern, integrated platform and a commitment to strategic partnership. The organization also promotes the exploration of insights and updates related to value-based care, population health, and health plan management, reflecting its dedication to healthcare transformation. Overall, through these collective efforts, Evolent aspires to create a more streamlined and effective healthcare environment for all stakeholders involved.
Integrations Supported
OpenPM
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
Evolent Health
Date Founded
2002
Company Location
United States
Company Website
www.evolenthealth.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
Benefits Administration
COBRA Administration
Claims Management
Deduction Management
Disability Insurance Administration
Employee Benefits Administration
FMLA Administration
FSA Administration
Flexible Spending Accounts
For Brokers
For Employers
HIPAA Compliant
Health Insurance Administration
Life Insurance Administration
Online Benefits Enrollment
Premium Billing
Provider Management
Retiree Administration
Retirement Plan Management
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