HealthRules Payer Commentary
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Boyd Stewart
VP of Payer/Provider Collaboration
KLAS VP of Payer/Provider Collaboration - Boyd Stewart
 
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User Commentary

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Analyst/Coordinator

Value

My likelihood to recommend HealthRules Payer rates high. The solution is highly configurable. It...

Apr 2025
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Analyst/Coordinator

Operations, Product

HealthEdge has user notes for training. They aren't anything spectacular. Also, there aren't any AI...

Apr 2025
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VP/Other Executive

Loyalty, Product

I don't know what new technology I'm missing yet. AI is an example. It might prove to be pretty...

Mar 2025
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VP/Other Executive

Product, Value

I have been around for a long time and in this industry for decades. HealthRules Payer is the best...

Mar 2025
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VP/Other Executive

Operations

Our last upgrade was years ago, but we have a very intense implementation routine. We have built...

Mar 2025
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VP/Other Executive

Relationship

From the service end, if I have a problem, I have to write an internal ticket, and the problem is...

Mar 2025
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CIO

Relationship, Product

HealthEdge could improve HealthRules Payer's technical performance. There is still slowness in the system....

Nov 2024
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CIO

Value

Even though the vendor is not nickel-and-diming us, I am concerned that HealthEdge is starting to...

Nov 2024
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CIO

Product

Besides the high degree of auto-adjudication with HealthRules Payer, it is very easy to integrate...

Nov 2024
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Director

Product

HealthRules Payer may perform better in certain cases, but from a purely financial and integration...

Nov 2024
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Director

Operations

The last time I got training from HealthEdge was a few years back, and it went well. The vendor had...

Nov 2024
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Director

Product

There is no interoperability capability currently that HealthEdge is giving to me except for the...

Nov 2024
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Director

Loyalty

We are implementing HealthEdge’s provider data management platform, and there is quite a bit of...

Nov 2024
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Director

Relationship

HealthEdge has been a great partner, and we are in a really good space today. We have good...

Nov 2024
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Director

Loyalty

There is virtually zero AI in HealthRules Payer, and maybe the vendor focused more on the other...

Nov 2024
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VP/Other Executive

Product

We are really happy with HealthRules Payer. We do reference calls all the time. All we do is use the...

Nov 2024
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VP/Other Executive

Relationship, Operations

HealthEdge's support is pretty good. The last time we upgraded, HealthEdge's implementation services...

Nov 2024
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VP/Other Executive

Loyalty, Relationship, Product

I think the vendor is making efforts to modernize our system. They can at least talk the talk....

Nov 2024
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Director

Relationship

The vendor needs to work on their issue resolution. They don't have enough resources on the support...

Nov 2024
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Director

Product, Value

The vendor has helped us get a big increase in 834 enrollment processing. Automatic payment...

Nov 2024
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Director

Product

The vendor's new strategic engagement with Edifecs could be a game changer. Right now, for EDI...

Nov 2024
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Director

Relationship

HealthEdge's strength is their commitment to the customer. They have a private-equity investment,...

Nov 2024
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Director

Loyalty

We attended HealthEdge's leadership conference, and if they can meet the direction that they are...

Nov 2024
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Director

Loyalty, Product

HealthEdge has a promotion system that we will put on. The vendor is trying to get end-user tasks...

Nov 2024
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VP/Other Executive

Relationship, Product

In the last year, the vendor created a known-issue spreadsheet that we can go out and download. I...

Sep 2024
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VP/Other Executive

Value

From a claims processing perspective, we are running a high percentage automatic adjudication rate,...

Sep 2024
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VP/Other Executive

Relationship, Product

The vendor seems a little behind on how fast they get any of the new technology. There is no AI in...

Sep 2024
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VP/Other Executive

Product

We really haven't had significant downtime with the system. It has been reliable in that regard. The...

Sep 2024
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VP/Other Executive

Loyalty, Product

The functionality we have is different than all of the functionality that now exists, and that is...

Sep 2024
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VP/Other Executive

Relationship, Operations

The vendor's people are always willing to get on the phone regardless of their level. They do that...

Sep 2024
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VP/Other Executive

Loyalty

I would buy this solution again. One vendor has come a long way since we got HealthRules Payer, so...

Sep 2024
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VP/Other Executive

Operations

In terms of implementation services, we can subscribe to a white-glove service, or we can do things...

Sep 2024
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VP/Other Executive

Product

The product doesn't always integrate well. It integrates with our authorization module, our EDW, and...

Sep 2024
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VP/Other Executive

Operations, Value

The vendor doesn't train us on anything. Originally, we bought some of their training packages, and...

Sep 2024
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VP/Other Executive

Culture, Value

The vendor avoids charging for every little thing as long as we have a contract. If we don't have a...

Sep 2024
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VP/Other Executive

Relationship, Operations

HealthEdge struggles to keep their promises. They tend to focus on bigger fish. We are a small fish,...

Sep 2024
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VP/Other Executive

Value

We have to give the vendor a little credit in terms of technology. Since we went live, there have...

Sep 2024
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VP/Other Executive

Relationship

The vendor's support has gotten better. We don't have the spreadsheets of things that haven't been...

Sep 2024
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VP/Other Executive

Value

If we were to recommend the solution to somebody, I would likely tell that person right off the bat...

Sep 2024
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VP/Other Executive

Value

HealthEdge, over the long haul, has avoided charging us for every little thing. However, their...

Sep 2024
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VP/Other Executive

Relationship

For the most part, HealthEdge has been a very good vendor. Their support is really good, and we have...

Sep 2024
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VP/Other Executive

Product, Value

We have a really high automatic adjudication rate. That has allowed us to automate the bulk of our...

Sep 2024
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VP/Other Executive

Product, Value

HealthRules Payer is an excellent system. I have worked on other systems, and HealthRules Payer is...

Sep 2024
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VP/Other Executive

Product

The system is really good, but there are some things in it that are lacking, like some workflow...

Sep 2024
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VP/Other Executive

Relationship

HealthEdge has an opportunity to share upgrade lessons learned across their client base. When a plan...

Sep 2024
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Director

Relationship

The ongoing operations and support from HealthEdge have improved significantly, along with the...

Sep 2024
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Director

Culture, Relationship

I really like the HealthRules Payer system, but HealthEdge could do a better job by listening to...

Sep 2024
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Director

Operations

HealthEdge needs a program that has the right people helping to deliver new functionality for new...

Sep 2024
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Director

Product

The HealthRules Payer system being a real-time system is great. We know the end result of a claim,...

Sep 2024
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Director

Operations, Product

HealthRules Payer is a really good system, but we could have been much further along if everything...

Sep 2024
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COO

Loyalty, Product

HealthRules Payer is a core processing system but not a billing system, so we have had to go to...

Sep 2024
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COO

Relationship

We have had an excellent hands-on experience with the people at HealthEdge. We meet with them...

Sep 2024
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COO

Loyalty

We have seen significant improvement over the last year in the proactiveness of HealthEdge. Their...

Sep 2024
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COO

Loyalty, Relationship

The executives at HealthEdge have a vision around AI, and they are mandating that all their leaders...

Sep 2024
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Director

Operations, Product

We haven't had any problems with HealthRules Payer upgrades. The solution is extremely stable with...

Sep 2024
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Director

Product

I like the familiarity with HealthRules Payer. The configurability is nice, and so is the ability to...

Sep 2024
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Director

Product

HealthRules Payer doesn’t meet all our needs, and part of this is our fault. The way that we do...

Sep 2024
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Director

Product

We haven't really adopted additional functionality in HealthRules Payer, but when we do have...

Sep 2024
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VP/Other Executive

Product

HealthEdge has done a good job of improving the quality of their products, but we get into...

Sep 2024
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VP/Other Executive

Relationship

We are working on getting upgrades, and HealthEdge is working with us as a customer to really...

Sep 2024
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Director

Relationship

I'm able to get anything I need with my account team with HealthEdge. I can call them on their cell...

Sep 2024
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VP/Other Executive

Product, Value

We are experiencing a high automatic adjudication rate with HealthRules Payer. With the way the...

Sep 2024
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VP/Other Executive

Relationship

HealthEdge is still a relatively young company, and they have been doing a lot of acquisitions. As...

Sep 2024
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VP/Other Executive

Relationship

HealthEdge is getting better at being proactive. We have a really good day-to-day resource that we...

Sep 2024
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COO

Relationship, Product

The front-end users love HealthRules Payer; it is easy to configure, and the functionality is great....

Sep 2024
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VP/Other Executive

Product

The inherent core of HealthRules Payer is automation. I wouldn't say it is AI. The system is a...

Sep 2024
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VP/Other Executive

Relationship

HealthEdge's customer support is inconsistent. If we can get the right people, they will kill it. If...

Sep 2024
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VP/Other Executive

Value

HealthEdge is better than most at not nickel-and-diming, but there are still times when they do. I...

Sep 2024
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VP/Other Executive

Product

When it comes to the system, HealthEdge is far ahead of anyone else in terms of intuitiveness,...

Sep 2024
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VP/Other Executive

Operations, Product

I usually tell my people to just log into the system and try a transaction. They can do 70%–80% of...

Sep 2024
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VP/Other Executive

Relationship, Product

We have been working with HealthEdge on scorecards and results. The system shows the metrics around...

Sep 2024
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VP/Other Executive

Operations

We don't do a lot of training with HealthEdge, so we aren't utilizing their training services, but...

Sep 2024
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VP/Other Executive

Relationship, Operations

We have had very successful implementations with HealthRules Payer. We have had some bumps in the...

Sep 2024
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Director

Value

The cost of HealthRules Payer is fair with market value. Naturally, HealthEdge is a for-profit...

Sep 2024
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Director

Loyalty, Product

I haven't gone to RFP. I inherited HealthRules Payer, and there are other systems out there. We are...

Sep 2024
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Director

Product

HealthRules Payer has an outdated UI. It is a little cluttered. The vendor could definitely take...

Sep 2024
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CEO/President

Loyalty

HealthRules Payer is clearly a superior technology to legacy technologies. Moving to HealthRules...

Sep 2024
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CEO/President

Operations

Implementations are difficult and costly. That is a drawback. However, we are live now, and we are...

Sep 2024
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CEO/President

Relationship, Product, Value

The system is very configurable, and the vendor is supportive of us reaching our targeted automatic...

Sep 2024
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CEO/President

Relationship

HealthEdge's work with APIs and interoperability is strong. HealthEdge has supported us in...

Sep 2024
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Director

Operations, Value

It would have been cool to do this survey after meeting with HealthEdge because then I would know...

Sep 2024
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CIO

Relationship

We have invested in other HealthEdge products, like Source. The vendor is really strong with clean...

Aug 2024
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CIO

Relationship

HealthEdge doesn’t do very well at being proactive on the service side. We constantly have to...

Aug 2024
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CIO

Value

HealthEdge is fair about charging, and there are no significant charges as we have seen with other vendors....

Aug 2024
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CIO

Product

HealthRules Payer is a pretty good product for a midsize payer plan. It is pretty intuitive. We...

Aug 2024
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CIO

Operations

Implementations and upgrades are sometimes part of HealthEdge’s downfall. Sometimes in their...

Aug 2024
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CIO

Relationship, Product

Interoperability is what HealthRules Payer lacks. The vendor has an API connector, but it is...

Aug 2024
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VP/Other Executive

Product, Value

The operational efficiency improvements from HealthRules Payer really come in terms of the...

May 2024
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VP/Other Executive

Loyalty, Product, Value

There are files that are required for the transparency in coverage rule, and they are...

May 2024
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VP/Other Executive

Relationship

HealthEdge has really stepped up their executive involvement. However, I think everything comes down...

May 2024
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VP/Other Executive

Relationship, Operations

One area where we face challenges with HealthEdge is communication. HealthEdge created a new...

May 2024
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VP/Other Executive

Product

HealthEdge’s product is decent, but we had a bad upgrade that had a lot of issues, and that reduced...

Apr 2024
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VP/Other Executive

Product, Value

HealthRules Payer doesn't have a robust reporting system. We had to take the reporting offline. We...

Apr 2024
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VP/Other Executive

Product

HealthEdge is good on the Medicare commercial side. Medicaid is a bit of a weak area, and we had to...

Apr 2024
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VP/Other Executive

Value

HealthRules Payer is an expensive system that takes a lot to support and run. On the back end, it is...

Apr 2024
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VP/Other Executive

Operations

Regarding implementations, HealthEdge misses the mark in terms of quality and timeliness. Sometimes,...

Apr 2024
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VP/Other Executive

Product

Ease of use is probably one of HealthEdge’s strengths. HealthRules Payer is a modern system that...

Apr 2024
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VP/Other Executive

Relationship

HealthEdge is reactive. They could improve their testing processes and general promptness in...

Apr 2024
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VP/Other Executive

Loyalty

Sometimes, the vendor's plans get squashed. For example, HealthEdge said they were going to have a...

Apr 2024
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VP/Other Executive

Relationship

We have been with HealthEdge a long time, so the support might be a little bit better We have been...

Apr 2024
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VP/Other Executive

Loyalty

HealthEdge has a product called Care-Payer. We are upgrading our other HealthEdge products to make...

Apr 2024
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Manager

Product, Value

We can configure our stuff into a ton of manual processes with HealthRules Payer, and HealthEdge...

Apr 2024
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