Optimizing HealthRules Payer Implementation: Enhancing Efficiency and Compliance in Managed Care IT Systems

The National Library of Medicine notes how optimal healthcare IT systems improve “health outcomes, quality of care, and the healthcare experience of patients.”

• Reducing administrative costs
• Improving operational efficiency
• Enabling rapid adaptation to regulatory changes
• Supporting value-based care models
• Enhancing member and provider experiences

To get the most value from HealthRules for your healthcare system and patients alike, it’s important the system is properly implemented and configured the system—which is where Managed Care IT consulting companies like HealthTECH Resources come in.

Role of Managed Care IT Consulting Companies in HealthRules Payer Implementation

HealthRules continually drives innovation and modern technology architecture forward, expanding from a single-product company to a comprehensive healthcare IT solutions provider through a combination of organic growth and key acquisitions.

HealthEdge’s umbrella goal was to create a next generation core administrative processing system (CAPS) that would boost accuracy and efficiency, allow health plans to smoothly innovate, and swiftly bring new lines of business to market. They’ve achieved that in HealthRules, the next generation CAPS solution listed in Gartner’s market guide for thirteen consecutive years to date. KLAS, meanwhile, has dubbed HealthRules Payer as “Best in KLAS” for claims and administrative platforms for three years running, including in 2024—and Forrester Wave acknowledges this innovative system in their healthcare technology reports.

HealthEdge deserves applause for its innovations with HealthRules. To ensure HealthRules can adapt to a broad spectrum of healthcare systems, it is highly configurable. This means that each healthcare system has the opportunity to mesh the application with its own processes, procedures, and workflows. This, in turn, means that it’s crucial for HealthRules to be implemented and configured for the specific healthcare system—which highlights the importance of having the right experts on your side, including healthcare IT consulting firms like HealthTECH Resources.

Our expert HealthRules consultants will leverage their deep knowledge and expertise to help clients accomplish goals: from understanding the technical capacity of your new application to analyzing individual modules and their differences, establishing best practices, and more. Our deep and wide network contains professionals who can seamlessly implement, optimize, and integrate HealthRules, train end users in engaging and memorable ways, create process documentation materials, provide ongoing support, and much more.

Strategic Staffing Solutions for HealthRules Payer Implementation

HealthTECH Resources thoroughly understands the intricacies of claims processing, benefit configurations, and payer operations, thanks to more than two hundred successful placements in payer system projects. Our experience ranges from large health systems (like Trinity Health and Mount Sinai Health System) to regional hospitals, specialty care centers, and managed care organizations. This broad and diverse exposure allows us to bring a wealth of industry insights to your HealthRules project.

Here’s more about how it works behind the scenes:

• Adaptable Talent Pool: We leverage a broad and wide pool of more than one thousand active consultants who are experienced in payer platforms and can flawlessly and rapidly adapt to HealthRules Payer’s unique requirements.

• Strategic Staffing Approach: Our exceptional leadership team listens carefully to the specific needs of the IT directors and CIOs involved in the project, aligning our staffing solutions with professionals with the right technical expertise who can also provide strategic value to the implementation.

• Rapid Deployment: HealthTECH Resources recognizes that, when you’ve decided to implement HealthRules, you’ll want to recognize its benefits sooner rather than later. So, we focus on rapid deployments, and our average time-to-fill for specialized roles is two to three weeks, which is crucial for maintaining project timelines in fast-paced implementations.

• Quality Assurance and Ensuring Compliance: Our rigorous vetting process ensures that all consultants are well-versed in healthcare regulations like HIPAA and ACA. We provide comprehensive support for regulatory compliance, helping clients meet critical deadlines and optimize HealthRules for full regulatory adherence.

• Flexible and Scalable Solutions: Our healthcare IT company offers a range of engagement models, able to quickly scale teams up or down based on project phases and needs.

• Innovation Focus: Just like HealthEdge’s HealthRules Pay, we maintain a strong focus on innovation, actively tracking technologies like HealthRules, building relationships with experienced professionals, and upskilling our base of Managed Care IT consulting professionals.

• Partnership Approach: We see ourselves as true partners throughout your implementation journey, focusing on your long-term success and going beyond simply filling positions for your healthcare organization.

• Industry Recognitions: Our healthcare IT company has received endorsements from leaders in organizations like Healthfirst Florida and CVS Health for our customer-focused approach and high-quality talent.

• Comprehensive Support: From the start of planning to post-implementation optimization, you can count on end-to-end support for your HealthRules Payer project.

To chat about how we can ensure a successful HealthRules Payer implementation, reach out today, our team is standing by.

Technical Proficiency in HealthRules Configuration

Our HealthRules consultants bring:

• Cross-Platform Expertise: Our Managed Care IT consulting professionals possess deep knowledge of multiple payer platforms, including Facets, QNXT, and others. This multi-system experience enables our experts to quickly grasp new technologies, understanding both the commonalities and unique features of each system.

• Core Payer Processes: Fundamental processes inherent in payer operations remain consistent across platforms. This means that our professionals already have a robust understanding of the following functions:
  • Claims processing and adjudication
  • Member enrollment and eligibility management
  • Provider network management and contracting
  • Benefit plan design and configuration
  • Regulatory compliance and reporting

• Technical Skill Transferability: Technical skills possessed by our network of experts are directly applicable to HealthRules implementations, including these:
  • Database management and optimization
  • API integration and web services
  • Business rules engine configuration
  • Performance tuning and scalability planning
  • Data conversion and migration strategies

• Healthcare Industry Knowledge: Our consulting professionals bring deep industry-specific knowledge that transcends any particular software platform, including the following:
  • Understanding of healthcare regulations (e.g., HIPAA, ACA)
  • Familiarity with healthcare data standards (e.g., HL7, FHIR)
  • Knowledge of value-based care models and their IT requirements
  • Insight into evolving trends like interoperability and population health management

• Agile and Waterfall Methodologies: Our professionals are well-versed in both Agile and Waterfall project management methodologies, allowing them to adapt to the preferred approach for HealthRules implementations.

• Rapid Learning and Knowledge Transfer: We have a proven track record of quickly ramping up on new technologies. Our consultants are adept at:
  • Leveraging existing knowledge to accelerate learning curves
  • Participating in focused training programs to gain platform-specific expertise
  • Collaborating with system vendors and client SMEs to bridge knowledge gaps

• Integration Expertise: Understanding how core administrative systems interact with other healthcare IT components is vital (and our skilled Managed Care IT consulting professionals do), including with:
  • Electronic health records (EHR) systems
  • Customer relationship management (CRM) platforms
  • Business intelligence and analytics tools
  • External regulatory and partner systems

Contact HealthTECH Resources for Your HealthRules Needs

The benefits of using the services of managed care IT consulting companies are clear—and so are the advantages of choosing HealthTECH Resources as your staffing partner. If you’re ready to efficiently implement HealthRules Payer in ways that are optimal for your healthcare organization and fully in compliance, please connect with us for an expert consultation. We look forward to meeting your unique needs!