The integration of Claims and Care Management through Care-Payer by HealthEdge® offers a revolutionary approach for health plans. By leveraging the synergy between HealthRules® Payer and GuidingCare®, this solution provides seamless connectivity that enhances efficiency and reduces costs.

Key Features

• Real-time Data Access: Ensures immediate availability of member demographics, provider information, claims data, and benefit details.
• Streamlined Workflows: Facilitates the exchange of data between HealthRules Payer and GuidingCare, improving accuracy and eliminating the need for duplicate entries.
• Enhanced Payment Integrity: Improves claims matching and auto-adjudication rates, reducing manual intervention.
• Cost Reduction: Minimizes the development effort required to maintain third-party integrations.
• Improved Outcomes: Increases transparency and data access, leading to better care planning and patient outcomes.

Benefits

• Increased Transparency: Provides key stakeholders with up-to-date, accurate information.
• Improved Care Planning: Enhances patient outcomes by optimizing care management processes.
• Workflow Efficiency: Reduces errors and frustration by connecting core administrative processes with care management platforms.

How It Works

• HealthRules Payer: Offers standardized benefit information for real-time access in GuidingCare.
• GuidingCare: Shares information with HealthRules Payer to streamline claims management and improve accuracy. The Care-Payer solution is a game-changer for health plans, breaking down silos and creating efficient, connected workflows.