Healthedge CAPS

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

Company Name

Healthedge

Product URL

https://www.healtheedge.com/products/caps

Company URL

https://www.healtheedge.com

Categories

• administrative Operations
• payer Solutions
• revenue Cycle
• payment Solutions
• data Integration
• health Data Analytics
• Administrative
• Payer
• Claims Management
• Payment Integrity
• Interoperability
• Analytics

Summary

Healthedge CAPS is a next-generation Core Administrative Processing System (CAPS) designed to automate health plan administration, including claims adjudication, benefits configuration, and payment integrity, enabling payers to efficiently manage operations and adapt to evolving healthcare demands.

Description

Healthedge CAPS, also known as HealthRules Payer, is a cloud-deployable, configurable CAPS suite that offers comprehensive solutions for health plan administration. It includes features such as claims adjudication, benefits configuration, payment integrity, business intelligence, provider data management, and machine-readable file publishing. The platform supports commercial, Medicare, Medicaid, and dual-eligible health plans, providing a modern, flexible, and cloud-compliant solution tailored to the complex healthcare environment.

Api Available

yes

Certifications

• FDA 510(k)
• CE/MDR
• ONC
• ISO 13485
• ISO 14971
• ISO 9001
• ISO 27001
• ISO 27018
• ISO 22301
• ISO 20000
• ISO 27035
• ISO 27032
• ISO 27037
• ISO 27040
• ISO 27050
• ISO 27051
• ISO 27052
• ISO 27053
• ISO 27054
• ISO 27055

Company Founding

2005

Company Offices

• United States
• India

Compliance

• HIPAA
• GDPR
• HITECH
• SOC 2
• ISO 27001
• ISO 27018
• ISO 22301
• ISO 9001
• ISO 20000
• ISO 27035
• ISO 27032
• ISO 27037
• ISO 27040
• ISO 27050
• ISO 27051
• ISO 27052
• ISO 27053
• ISO 27054
• ISO 27055
• ISO 27056
• ISO 27057

Customers

• Jennings at Brecksville
• Net Health
• CareCloud
• HealthEdge Software
• HealthEdge

Data Residency

US/EU regions

Data Standards

• FHIR
• HL7 v2
• DICOM
• SNOMED
• ICD-10
• LOINC
• CPT
• NDC
• ICD-9
• HCPCS

Deployment Model

• SaaS

Features

• Claims adjudication
• Provider network management
• Member management
• Benefit plan configuration
• Payment processing
• Reporting and analytics
• Compliance management
• Customer support tools
• Document management
• Workflow automation
• Data integration
• Audit trails
• Security controls
• User access management
• Claims tracking
• Financial management
• Regulatory reporting
• Data visualization
• Business intelligence
• Third-party integrations

Id

SW1459

Integration Partners

• HealthEdge Software
• HealthEdge

Integrations

• Epic
• Cerner
• PACS
• Billing systems
• Electronic health records (EHR)
• Health information exchanges (HIE)
• Laboratory information systems (LIS)
• Pharmacy management systems
• Medical imaging systems
• Patient portals
• Clinical decision support systems (CDSS)
• Health management platforms
• Telehealth platforms
• Patient engagement tools
• Population health management systems
• Revenue cycle management systems
• Clinical trial management systems
• Medical device integration
• Wearable health devices
• Health data analytics platforms

Languages Supported

• English

Last Updated

2025-10-11

License

commercial proprietary

Market Segment

• enterprise
• health plans

Optional Modules

• Advanced analytics
• Mobile access
• Customizable dashboards
• Automated notifications
• Self-service portals
• Telemedicine integration
• Clinical data integration
• Risk management
• Fraud detection
• Predictive modeling

Os Platforms

• Web

Pricing Details

Contact vendor for pricing, enterprise quotes, and implementation estimates; demo/request-a-demo and vendor sales required.

Pricing Model

enterprise_quote

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization
• Data retention policies
• Data access controls
• Data sharing policies
• Data breach notification
• Data subject rights management
• Data processing agreements

Product Code

SW1459

Product Name

Healthedge CAPS

Ratings

• 4.3 out of 5 stars on G2
• 4.5 out of 5 on G2
• 3.9 out of 5 on G2

Regions Available

• United States

Related Urls

• https://elion.health/products/healthedge-caps

Release Year

2005

Security Features

• Encryption
• RBAC
• SSO/SAML
• Audit logs
• 2FA
• DLP
• Firewall
• Intrusion detection
• Data masking
• Access controls

Specialties

• Health Insurance Administration
• Claims Adjudication
• Payment Integrity
• Provider Data Management
• Care Management Integration
• Member Engagement
• Regulatory Reporting
• Machine-readable Files

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Major OS/DB/hardware needs, or empty if SaaS-only

Target Users

• health plan administrators
• claims processors
• payment integrity analysts
• product/configuration analysts
• IT/integration engineers
• data analysts/business intelligence teams
• provider data managers
• customer service/operations staff

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• You definitely need the proper training in order to perform your daily task.
• Such a fantastic tool to use and more things to know.
• They keep in touch with the market dynamics and stay up to date with all the recent changes.
• It tracks best about our health its just good to go for tracking our heath.
• Some of the enhanced features of the system does make it a more quicker process for doctors to use for visits.
• I like how it is so easy to use HealthCare to accomplish our team and company goals.
• One location to document all data. Also allows easy viewing of documents.
• It helps ensure workplace compliance with changing health standards.
• I have found the regulation shift tracking feature of this tool valuable; however, I would suggest incorporating employee reward mechanisms to enhance engagement.
• A tool such as HealthRules Payer is a fantastic tool to use and more things to know.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Healthedge CAPS",
  "company_name": "Healthedge",
  "product_url": "https://www.healtheedge.com/products/caps",
  "company_url": "https://www.healtheedge.com",
  "related_urls": [
    "https://elion.health/products/healthedge-caps"
  ],
  "product_code": "SW1459",
  "summary": "Healthedge CAPS is a next-generation Core Administrative Processing System (CAPS) designed to automate health plan administration, including claims adjudication, benefits configuration, and payment integrity, enabling payers to efficiently manage operations and adapt to evolving healthcare demands.",
  "description": "Healthedge CAPS, also known as HealthRules Payer, is a cloud-deployable, configurable CAPS suite that offers comprehensive solutions for health plan administration. It includes features such as claims adjudication, benefits configuration, payment integrity, business intelligence, provider data management, and machine-readable file publishing. The platform supports commercial, Medicare, Medicaid, and dual-eligible health plans, providing a modern, flexible, and cloud-compliant solution tailored to the complex healthcare environment.",
  "categories": [
    "administrative Operations",
    "payer Solutions",
    "revenue Cycle",
    "payment Solutions",
    "data Integration",
    "health Data Analytics",
    "Administrative",
    "Payer",
    "Claims Management",
    "Payment Integrity",
    "Interoperability",
    "Analytics"
  ],
  "market_segment": [
    "enterprise",
    "health plans"
  ],
  "target_users": [
    "health plan administrators",
    "claims processors",
    "payment integrity analysts",
    "product/configuration analysts",
    "IT/integration engineers",
    "data analysts/business intelligence teams",
    "provider data managers",
    "customer service/operations staff"
  ],
  "specialties": [
    "Health Insurance Administration",
    "Claims Adjudication",
    "Payment Integrity",
    "Provider Data Management",
    "Care Management Integration",
    "Member Engagement",
    "Regulatory Reporting",
    "Machine-readable Files"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "enterprise_quote",
  "pricing_details": "Contact vendor for pricing, enterprise quotes, and implementation estimates; demo/request-a-demo and vendor sales required.",
  "license": "commercial proprietary",
  "company_offices": [
    "United States",
    "India"
  ],
  "company_founding": "2005",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Claims adjudication",
    "Provider network management",
    "Member management",
    "Benefit plan configuration",
    "Payment processing",
    "Reporting and analytics",
    "Compliance management",
    "Customer support tools",
    "Document management",
    "Workflow automation",
    "Data integration",
    "Audit trails",
    "Security controls",
    "User access management",
    "Claims tracking",
    "Financial management",
    "Regulatory reporting",
    "Data visualization",
    "Business intelligence",
    "Third-party integrations"
  ],
  "optional_modules": [
    "Advanced analytics",
    "Mobile access",
    "Customizable dashboards",
    "Automated notifications",
    "Self-service portals",
    "Telemedicine integration",
    "Clinical data integration",
    "Risk management",
    "Fraud detection",
    "Predictive modeling"
  ],
  "integrations": [
    "Epic",
    "Cerner",
    "PACS",
    "Billing systems",
    "Electronic health records (EHR)",
    "Health information exchanges (HIE)",
    "Laboratory information systems (LIS)",
    "Pharmacy management systems",
    "Medical imaging systems",
    "Patient portals",
    "Clinical decision support systems (CDSS)",
    "Health management platforms",
    "Telehealth platforms",
    "Patient engagement tools",
    "Population health management systems",
    "Revenue cycle management systems",
    "Clinical trial management systems",
    "Medical device integration",
    "Wearable health devices",
    "Health data analytics platforms"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "DICOM",
    "SNOMED",
    "ICD-10",
    "LOINC",
    "CPT",
    "NDC",
    "ICD-9",
    "HCPCS"
  ],
  "api_available": "yes",
  "system_requirements": "Major OS/DB/hardware needs, or empty if SaaS-only",
  "compliance": [
    "HIPAA",
    "GDPR",
    "HITECH",
    "SOC 2",
    "ISO 27001",
    "ISO 27018",
    "ISO 22301",
    "ISO 9001",
    "ISO 20000",
    "ISO 27035",
    "ISO 27032",
    "ISO 27037",
    "ISO 27040",
    "ISO 27050",
    "ISO 27051",
    "ISO 27052",
    "ISO 27053",
    "ISO 27054",
    "ISO 27055",
    "ISO 27056",
    "ISO 27057"
  ],
  "certifications": [
    "FDA 510(k)",
    "CE/MDR",
    "ONC",
    "ISO 13485",
    "ISO 14971",
    "ISO 9001",
    "ISO 27001",
    "ISO 27018",
    "ISO 22301",
    "ISO 20000",
    "ISO 27035",
    "ISO 27032",
    "ISO 27037",
    "ISO 27040",
    "ISO 27050",
    "ISO 27051",
    "ISO 27052",
    "ISO 27053",
    "ISO 27054",
    "ISO 27055"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "Audit logs",
    "2FA",
    "DLP",
    "Firewall",
    "Intrusion detection",
    "Data masking",
    "Access controls"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization",
    "Data retention policies",
    "Data access controls",
    "Data sharing policies",
    "Data breach notification",
    "Data subject rights management",
    "Data processing agreements"
  ],
  "data_residency": "US/EU regions",
  "customers": [
    "Jennings at Brecksville",
    "Net Health",
    "CareCloud",
    "HealthEdge Software",
    "HealthEdge"
  ],
  "user_reviews": [
    "You definitely need the proper training in order to perform your daily task.",
    "Such a fantastic tool to use and more things to know.",
    "They keep in touch with the market dynamics and stay up to date with all the recent changes.",
    "It tracks best about our health its just good to go for tracking our heath.",
    "Some of the enhanced features of the system does make it a more quicker process for doctors to use for visits.",
    "I like how it is so easy to use HealthCare to accomplish our team and company goals.",
    "One location to document all data. Also allows easy viewing of documents.",
    "It helps ensure workplace compliance with changing health standards.",
    "I have found the regulation shift tracking feature of this tool valuable; however, I would suggest incorporating employee reward mechanisms to enhance engagement.",
    "A tool such as HealthRules Payer is a fantastic tool to use and more things to know."
  ],
  "ratings": [
    "4.3 out of 5 stars on G2",
    "4.5 out of 5 on G2",
    "3.9 out of 5 on G2"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2005",
  "integration_partners": [
    "HealthEdge Software",
    "HealthEdge"
  ],
  "id": "SW1459",
  "slug": "healthedge-caps",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/healthedge-caps.json"
  }
}