healthedge

JSON twin: https://www.healthaidb.com/software/healthedge.json

Company Name

HealthEdge

Product URL

https://healthedge.com/solutions/

Company URL

https://healthedge.com/

Categories

Summary

HealthEdge provides a cloud-native SaaS platform of payer-focused solutions (core administration, payment integrity, care management, provider data, and member engagement) to modernize health plan operations and enable AI-driven automation.

Description

HealthEdge offers an integrated suite (HealthRules® core administration, HealthEdge Source for prospective payment integrity, GuidingCare® for care management, Wellframe for member engagement, and provider data management) delivered as standalone SaaS modules or an integrated platform. The platform emphasizes touchless claims processing, payment accuracy, care-payer integration, and AI-driven analytics to support health plans, Medicare/Medicaid lines, and value-based care initiatives. Services include professional services, implementation, and customer success.

Api Available

yes

Certifications

Company Founding

2005

Company Offices

Compliance

Customers

Data Residency

Data Standards

Deployment Model

Features

Id

P0703

Integration Partners

Integrations

Languages Supported

Last Updated

2025-09-07

License

proprietary commercial

Links

Market Segment

Optional Modules

Os Platforms

Pricing Details

Contact vendor for pricing; enterprise subscription with professional services and implementation (trial/contact for demo).

Pricing Model

enterprise_quote

Privacy Features

Ratings

Regions Available

Release Year

2005

Security Features

Specialties

Support Channels

System Requirements

Target Users

Training Options

Type

product

User Reviews

Version

1.0

Canonical JSON

{
  "company_name": "HealthEdge",
  "company_url": "https://healthedge.com/",
  "company_offices": [
    "United States",
    "India"
  ],
  "company_founding": "2005",
  "product_url": "https://healthedge.com/solutions/",
  "categories": [
    "administrative",
    "payer",
    "care management",
    "payment integrity",
    "provider data management",
    "member engagement",
    "analytics",
    "AI"
  ],
  "market_segment": [
    "enterprise"
  ],
  "links": [
    "https://healthedge.com/",
    "https://healthedge.com/about-us/",
    "https://healthedge.com/solutions/",
    "https://healthedge.com/solutions/core-administrative-processing-systems/healthrules-home-and-host-capabilities/",
    "https://healthedge.com/resources/data-sheets/healthedge-source-product-overview",
    "https://healthedge.com/solutions/care-management-workflow/guidingcare-care-management/",
    "https://healthedge.com/solutions/provider-data-management/",
    "https://healthedge.com/about-us/careers/us-offices/",
    "https://healthedge.com/resources/press-releases/",
    "https://healthedge.com/healthedge-products-recognized-by-klas/"
  ],
  "summary": "HealthEdge provides a cloud-native SaaS platform of payer-focused solutions (core administration, payment integrity, care management, provider data, and member engagement) to modernize health plan operations and enable AI-driven automation.",
  "description": "HealthEdge offers an integrated suite (HealthRules® core administration, HealthEdge Source for prospective payment integrity, GuidingCare® for care management, Wellframe for member engagement, and provider data management) delivered as standalone SaaS modules or an integrated platform. The platform emphasizes touchless claims processing, payment accuracy, care-payer integration, and AI-driven analytics to support health plans, Medicare/Medicaid lines, and value-based care initiatives. Services include professional services, implementation, and customer success.",
  "target_users": [
    "health plan administrators",
    "payers",
    "care managers",
    "payment integrity teams",
    "provider network managers",
    "IT/analytics teams",
    "customer service/admin staff"
  ],
  "specialties": [
    "payer administration",
    "claims processing",
    "payment integrity",
    "care management",
    "provider data management",
    "member engagement",
    "value-based care",
    "population health",
    "AI-driven analytics"
  ],
  "regions_available": [
    "United States",
    "India (support/offices)"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "enterprise_quote",
  "pricing_details": "Contact vendor for pricing; enterprise subscription with professional services and implementation (trial/contact for demo).",
  "license": "proprietary commercial",
  "deployment_model": [
    "SaaS",
    "cloud",
    "on_prem",
    "hybrid"
  ],
  "os_platforms": [
    "Web",
    "iOS",
    "Android"
  ],
  "features": [
    "Claims administration and adjudication (HealthRules Payer)",
    "Prospective payment integrity, claims pricing and editing (HealthEdge Source)",
    "Provider data management (cloud-based provider data platform)",
    "Care management workflow and care coordination (GuidingCare)",
    "Digital member engagement and mobile programs (Wellframe)",
    "API-based care-payer integration (Care-Payer Data Exchange)",
    "Benefit predictor for near-real-time benefits queries",
    "Authorization and utilization management workflows",
    "Analytics and business intelligence for care and payment integrity",
    "Provider authorization portal",
    "Auto-adjudication and configuration-driven plan setup",
    "Population health / gaps-in-care tracking",
    "Audit trails and reporting",
    "Integration connectors to third-party systems and EHRs",
    "AI/GenAI-enabled data querying and automation",
    "Continuous regulatory/content updates (CMS/Medicaid)"
  ],
  "optional_modules": [
    "HealthEdge Source (Payment Integrity suite)",
    "GuidingCare (Care Management suite)",
    "Wellframe (Member Engagement suite)",
    "Provider Data Management suite",
    "Benefit Predictor",
    "Care-Payer Integration (API connectors)",
    "Payer-Source integration",
    "HealthEdge Platform add-ons",
    "Professional Services (implementation/optimization)"
  ],
  "integrations": [
    "Wellframe (member engagement integration)",
    "GuidingCare (care management integration)",
    "HealthRules Payer (core administrative integration)",
    "HealthEdge Source (payment integrity integration)",
    "Care-Payer API-based integration (health plan ↔ care apps)",
    "Payer-Source integration (HealthRules ↔ Source)",
    "Third-party systems and EHRs (generic connectors)"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "RESTful APIs"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "HITRUST"
  ],
  "certifications": [
    "HITRUST"
  ],
  "security_features": [
    "Encryption (at-rest/in-transit)",
    "Role-based access control (RBAC)",
    "SSO/SAML support",
    "Audit logging"
  ],
  "privacy_features": [
    "Business Associate Agreement (BAA) available",
    "Consent management",
    "Data anonymization/data minimization"
  ],
  "data_residency": "",
  "customers": [
    "SummaCare",
    "Medica"
  ],
  "user_reviews": [
    "Responsive and willing to adapt based on customer feedback.",
    "Modern and flexible platform that improved payer operations and automation."
  ],
  "ratings": [
    "Best in KLAS — HealthRules Payer, Claims & Administration Platforms (KLAS Research) — multi-year winner (2022-2024)"
  ],
  "support_channels": [
    "email",
    "phone",
    "ticketing",
    "community"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite"
  ],
  "release_year": "2005",
  "integration_partners": [
    "Edifecs",
    "Gynisus"
  ],
  "id": "P0703",
  "slug": "healthedge",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-09-07",
  "links_json": {
    "self": "https://www.healthaidb.com/software/healthedge.json"
  }
}