HealthRules® for Health Plans With Home and Host Processing

Core Administrative Processing System (CAPS)

If your organization is like many health plans with home and host capabilities, you have a growing need for greater agility – to quickly launch new products and Lines of Business (LOBs) and reduce total cost of ownership. HealthRules Payer provides that agility, offering integrated, real-time capabilities that support programs, allowing members obtaining healthcare services from a host plan to receive all the same benefits as their contracted home plan. It supports all core administrative operations and assures that all home and host functionality works seamlessly with the breadth of the HealthRules Payer functions and enhancements. Plus, using the highest standard of hosting services enables you to reduce the time to go-live, achieve successful implementation with lower risk, and make a smooth transition to HealthRules Payer.

Features

Seamless Integration

HealthRules Payer has built-in capabilities to support aspects of the home and host program. Home and host solutions reduce complexity and eliminate unnecessary duplication of provider data.

APIC3 Service

The home solution utilizes APIC3, a more efficient and streamlined service for Pricing and Disposition Format build.

Submission Format Configuration

The host solution allows configuration of the Submission Format data elements, enabling faster implementation of changes.

ITS Access

By providing hosting services and shared solutions for home and host health plans, HealthRules accesses the software components and databases of Inter-Plan Teleprocessing Services (ITS) via a shared platform and utilizes batch file transfers or message-oriented middleware for communications.

Private Connection Integration

HealthRules Payer is integrated with your home and host health plan through a private connection. This enables customers to access the standard, reliable services offered by the hosting services while ensuring faster implementation of claims processing and changes.

Association-Mandated Web Application Integration

HealthRules Payer is also fully integrated with an association-mandated web application, giving home and host customers the convenience of sending and receiving adjustment messages directly from within HealthRules Payer.