HealthRules® Payer is even more powerful when combined with GuidingCare®. Our unique Care-Payer Data Exchange solution provides the API-based integration that enables the continuous management of member care and core administrative processes.

Wellframe’s Digital Care Management solution reimagines the way care teams can support the clinical needs of high-risk members. By digitizing the Care Management offering, your health plan can shift support from episodic to continuous.

Clinical Advocacy can improve healthcare navigation by giving members access to health plan resources, making benefits information more accessible and actionable. Digitally enabled benefits navigation and member services empower health plan members to get the most out of their health benefits.

GuidingCare is a comprehensive solution for whole-person, patient-centered care, offering easy-to-use, next-generation data integration and workflow management solutions and tools. Our feature-rich solution suite is easy to integrate with existing systems and is highly configurable.

Our Appeals & Grievances module streamlines and consolidates the entire appeals management process to help you meet regulatory demands for timely resolution and correspondence.

This intuitive and comprehensive electronic tool eases the preauthorization, appeals and messaging process for your Utilization Management staff and the providers who interface with your plan.

Our Reporting & Business Intelligence module provides more than 50 standard reports to make ad hoc report-building and analysis simple and actionable.

Our Care Management workflow software provides tools that help you operationalize an evidence-based, person-centered care management strategy for your populations.

Enable pharmacists with a central location in which they can manage member medications and intervene to prevent potentially harmful outcomes.

Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.