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

A dynamic solution that simplifies contract configuration and provides accurate modeling.

Our web-based care coordination application for provider partners incorporates gaps-in-care analytics that enables clinical staff to identify high-risk patients and potential health improvement opportunities.

Independently create, manage, and deploy business rules into your GuidingCare instances to automate workflows and decision-making.

The integration between HealthRules Payer® and Source creates a new level of operational efficiency and accuracy in claims pricing and editing.

Our Business Intelligence capabilities enable enterprise-wide decision support for setting medical policy, renegotiating provider contracts, and identifying and remediating billing and utilization trends within your provider network.

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.

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

HealthRules Payer provides transformational capabilities to health plans of all types and sizes with features that align with your business processes and functional areas.

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 Configuration and Promotion application enables your organization to benefit from increased automation, greater accuracy, a simplified process and lower costs.

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.

Pay Medicaid claims accurately, quickly and comprehensively – the first time.

Incorporate third-party solutions and their data into a cohesive workflow for true interoperability of normally disjointed solutions.

Enabling payers to gain control of their IT ecosystem through radical transparency.

Our Source experts are stewards of our solution, with a mission to equip your internal teams with the knowledge and support required to optimize your business.

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

A clinical decision support system that transforms data into actionable insights for healthcare payers and providers.

Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.

Comprehensive support to handle complex policies automatically across all lines of business.

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.

Delivers, manages and maintains CMS pricing data for comprehensive payment accuracy.

HealthRules Payer offers built-in capabilities to support all aspects of the home and host program, reducing complexity and eliminating unnecessary duplication of provider data.

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 HealthRules Answers business intelligence solution transforms the way you see and use data in real time, helping to reduce costs, identify market opportunities, validate new product offerings, and support next-generation business models.

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

HealthRules Connector is a robust integration layer that links HealthRules seamlessly with other systems, partner networks and exchanges so you can share critical healthcare information quickly, easily and securely.

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