Optimal HealthRules Payer Implementation

Professionals in the HealthTech Resources network can implement and integrate your HealthEdge HealthRules application according to industry best practices and your established workflows and processes. Because of our extensive leadership experience and unparalleled expertise in healthcare payor applications, we can provide unsurpassed support every step of the way—including to provide your staff with outstanding training.

To augment your healthcare IT staff, often as quickly as in 48 hours, please contact us today by either filling out the contact form below or calling us at (602) 903-7961.

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Hire HealthEdge Specialists In Any Module

The HealthEdge suite of applications, including the HealthRules Payer solution, provides users with a far more intuitive experience than traditional legacy systems.

This allows organizations to:

  • Respond to industry changes in hours rather than weeks.
  • Reduce costs and increase efficiency.
  • Gain an edge over the competition with the latest technology.
  • Provide members with quick and responsive customer service.
  • Achieve higher auto-adjudication rates.

In 2022, HealthRules Payer was named the “Best in KLAS” by KLAS Research—and top professionals in our network will collaborate closely with your in-house team to maximize the impact of your HealthRules implementation and to efficiently and cost effectively help you to achieve return on investment.

Client Testimonials

“I have worked with Larry Hodge, president & CEO of HealthTECH, and his team for almost my entire career. He takes time to hire only the best candidates and it shows in their tenure and quality of talent. Unlike larger providers who throw numbers and hope for the right fit, HealthTECH brings a much more customer-focused approach to finding resources and ensuring successful engagement. I will continue to partner with HealthTECH no matter where my career takes me.”

Jim Berlinger

Sr. Manager of Application Development

Healthfirst Florida

“HealthTECH is a detail oriented company that understands that hiring the right candidate for a career position for your organization is the most important factor for success. They will provide you outstanding service, qualified candidates with industry experience and ongoing communication to ensure you are extremely satisfied.”

Joe Gallo

VP, Health Plan

CVS Health

We Support These HealthEdge Products and Services Through Supplemented Staff:


HealthRules Language

HealthRules CareManager


HealthRules Portal Integration Kit


HealthRules Payer Implementation and Integration

As you build your IT team to implement and integrate HealthRules into your organization’s technology, it isn’t unusual to discover staffing gaps. After all, choosing and implementing a new payor system isn’t something that IT professionals do every day. When you can optimally fill in those gaps with experienced professionals with niche specialties, you can reach goals for the new software more quickly and efficiently while staying within your project’s scope and budget.

As you analyze your current staffing, take your IT teams’ current projects into account. How many people can be taken off current initiatives without harming their momentum? Is that acceptable? What project starts might be delayed? Is that advisable? If you’d like help with this analysis, contact the healthcare IT staffing experts at HealthTECH to receive guidance on right-sizing your HealthEdge HealthRules implementation and integration team.

HealthRules Payer Optimization

As you implement and integrate your HealthEdge HealthRules Payer system, you will have decisions to make to most effectively dovetail this application with your organization’s processes and workflows. When you make the most savvy decisions, then you’re automatically optimizing the software’s implementation and integration. Augmented professional staff provided by HealthTECH Resources can help your in-house team to analyze both internal and external factors to most efficiently and effectively implement your new payor system.

Stated another way, the optimization process will involve the selection of ways to most effectively leverage HealthRules Payer’s power to allow your facilities to compete in today’s world. Professionals from our network will help you to identify optimization opportunities to streamline processing, reduce risks, lower costs, reduce the number of processes handled manually, improve provider and patient satisfaction, enable change management, and enhance your overall payor system.

HealthRules Payer Consulting

HealthRules consultants provide insights gleaned from deep knowledge and expertise to healthcare organizations like yours. When you reach out to us for HealthEdge consultants, it can help us to receive specifics about what you need to accomplish. Do you, for example, want to have a deeper understanding of your new application’s technical capacity? To analyze the differences among each HealthRules module? To establish and fully leverage best practices to transform your healthcare organization?

In some cases, healthcare organizations have niche needs that need to be filled in by specialists. In other situations, a HealthEdge consultant with broad project management experience or change management expertise will suit your needs. Whatever you require, just let us know. The HealthTECH network has professionals with a wide range of HealthEdge HealthRules specialties.

HealthRules Payer Training

The best application that’s optimally implemented is only as good as the end users’ ability to efficiently use its workflows. To help, HealthTECH provides outstanding consultants who create and provide training services to prepare end users to confidently use HealthRules modules. Experienced trainers can create customized programs to efficiently and effectively meet the unique needs of end user groups in your healthcare facilities.

Training professionals can also create process documentation for your healthcare organization. Your teams can use this material as training guides; to onboard new employees; to serve as references at facility workstations; and to refresh the knowledge of your staff.

Choose HealthTech Resources For HealthRules Consultants

HealthTECH Resources specializes in just one niche—the healthcare IT space—and our boutique-style agency provides staff augmentation services for HealthEdge HealthRules system professionals with professionals of unsurpassed quality. We have more than 20 years in the industry, which makes us extremely well connected and gives us incredible depth and breadth in our knowledge, experience, and professional networks. We rapidly fill in staffing gaps, often as quickly as 48 hours, even with the most stringent requests.

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HealthEdge HealthRules Payer FAQs

What is HealthRules?

HealthRules is an integrated suite of administrative, financial, and clinical solutions with each of the products working independently or as a comprehensive platform for the healthcare delivery system. Benefits of HealthRules include the ability for organizations to efficiently control costs (administrative and healthcare-related) while maximizing opportunities for revenue. This allows facilities to coordinate functionalities to improve the quality of patient care and their outcomes in ways that are efficient and cost effective.

More specifically, then, what is HealthRules Payer?

You can think of this application as a core administrative processing system available for use with all kinds and sizes of health plans. It’s a module within the HealthRules overall suite of technologies. Organizations that use HealthRules can advance in the competitive market because of their ability to efficiently benefit from market opportunities. Numerous aspects of this technology make it stand out with HealthRules Language being at its heart. This patented application harnesses the power of the English language to streamline claims processes.

How does HealthRules Language benefit healthcare organizations?

HealthRules Language is an intuitive way of engaging with and administering health plans with business logic that’s clear to employees across departments. This means that health plan rules and terms can be understood and updated by virtually any user, not just those with IT experience—which in turn facilitates rapid innovation and the ability to more seamlessly navigate change. This application also provides healthcare organizations with transparent insights that you can transform into actions.

Is HealthRules Payer suitable for small and large healthcare payer organizations?

Yes, it is. HealthEdge HealthRules Payer is a robust yet flexible next-generation core administrative processing system (CAPS) that can transform health plans of all types and sizes. Its intuitive structure will be appreciated by healthcare payer organizations of all sizes as well.

What key features does HealthRules Payer offer?

Here are six of them:

  • HealthRules Language: HealthRules software uses easily understood conversational vernacular.
  • HealthRules Answers: Your organization can make informed real-time decisions as you seamlessly access operational data.
  • HealthRules Connector: Gain batch access to data and functionality in real-time and integrate third-party platforms.
  • HealthRules Promote: Benefit from enhanced automation as you streamline processes, reduce costs, and improve data accuracy.
  • HealthRules Home & Host Processing: Built-in capabilities reduce complexity levels and eliminate provider data duplication.
  • HealthEdge Source: Benefit from advanced secondary claims editing to lower inappropriate claims numbers before they’re paid.
Can HealthRules Payer support value-based care initiatives?

Absolutely! This is, in fact, one of the key benefits of the HealthRules software. Ways in which HealthEdge HealthRules Payer enables value-based care include how your healthcare organization can:

  • Define quality of care
  • Obtain accurate, real-time data
  • Benefit from the HealthRules software’s configurability, which is unmatched in the industry
  • Participate in health incentive programs
  • Automate results of the benefit or pricing based on member status in the compliance program
  • And more

As HealthEdge itself notes, “HealthEdge is enabling our customers through a best-in-class, MVP ecosystem for value-based care. Our accurate, real-time data warehouse powers determining compliance, provider quality level, reimbursement level, capitation versus fee-for-service, and more.”

Is HealthRules Payer compliant with healthcare regulations and standards?

Yes! Healthcare organizations like yours choose HealthEdge HealthRules Payer to ensure compliance with evolving regulations surrounding Medicare, Medicaid, Duals, and. The flexibility of the HealthRules software empowers these organizations to efficiently collect and store data, enabling seamless fulfillment of regulatory compliance requirements.

How does the implementation process of HealthRules Payer work?

The implementation process of HealthRules Payer starts with an initial assessment of the organization’s needs, custom configurations, integration planning, and identifying staffing gaps to fulfill these essential steps. The expert team at HealthTECH Resources excels in successful HealthRules implementations, we can ensure a tailored and efficient deployment of these healthcare solutions. Contact us online or call (602) 903-7961 to get started!

What sets HealthEdge HealthRules Payer apart from other payer software solutions?

Benefits of HealthEdge HealthRules Payer include its operational efficiency that virtually eliminates human error and allows healthcare organizations using the HealthRules software to remain resilient to change. Costs are significantly reduced when implementing a benefit plan and with maintenance and testing; integration flexibility exists; and your healthcare organization can gain actionable insights.

Can HealthRules Payer integrate with other healthcare systems and data sources?

Thanks to the HealthRules Connector, the answer is a resounding “yes.” This is an enterprise-class integration layer that allows your organization to smoothly integrate the HealthRules software with third-party vendors and other platforms.