HealthEdge launches Benefit Predictor enterprise-class software platform

Oct 28 2009

HealthEdge, provider of the only modern, enterprise-class software platform for healthcare payors, today announced the availability of Benefit Predictor, a revolutionary new capability that is now a standard part of its HealthRules Payor application. This new functionality provides HealthEdge clients with a significant competitive advantage related to both transparency and customer service, as it enables them to quickly and easily answer the most complex benefit questions from their members and providers.

“With Benefit Predictor, the payor’s customer service team has an important new tool at their disposal,” said Ray Desrochers, COO of HealthEdge. “Now, when a member calls asking about their coverage for a certain procedure or event, the customer service representative (CSR) doesn’t need to search through benefit summary documents and external knowledge bases hoping to find the right answer. Using HealthRules, the CSR can now, with just a few keystrokes, instantly answer any benefit question. The HealthRules system presents them with an easy-to-read set of results that are specific to the particular member, their benefits, their provider network, their health conditions, their compliance with any care management programs, and the current state of their deductibles, limits, and out-of-pocket maximums.”

“Benefit Predictor leverages the unique capabilities of the HealthRules platform,” Desrochers continued, “to enable payors using our software to compete more effectively in the emerging, consumer-centric healthcare marketplace. HealthEdge provides the only product on the market that is able to leverage the power of the patented, English-like HealthRules language. This one-of-a-kind technology allows payors to quickly configure any benefit plan or provider contract, process claims with a stunning level of accuracy, and easily provide answers to customer and partner questions that are guaranteed to be correct the first time, every time. This is another example of how HealthEdge is leveraging next-generation technology to enable our customers to be successful in the rapidly evolving world of 21^st-century healthcare.”

HealthRules brings a new level of agility to organizations pursuing a competitive position in the emerging healthcare marketplace. Using HealthRules, payors are able to quickly design and implement any type of benefit plan or provider contract, regardless of complexity, in only hours or days, not the weeks or months that are normally required with other systems. They are also able to immediately take advantage of new market opportunities, automate all of their existing lines of business, and address emerging standards such as ICD-10. HealthRules allows payors of all types and sizes to compete like never before, using the only solution that was truly built to address the needs of the new healthcare economy.