Technical, Operational and Clinical Expertise for HealthRules

The payer landscape continues to change, and you need a partner who understands your business’s challenges and opportunities, as well as the technology tools available to help you meet your goals. Our skilled consultants have the technical knowledge and operational expertise to help you take full advantage of the benefits of the HealthRules product suite and to maximize the value of your investment.

We recognize that each healthcare organization’s requirements are unique. We listen to our clients’ specific needs and meet them where they are with objective guidance and support services to help them achieve their goals.

Expert Services and Support for the HealthEdge HealthRules Product Suite

A leader in advisory, implementation, optimization and outsourcing services, Tegria’s Payer Division has been a HealthEdge partner since 2008. We have a history of successfully leading HealthRules implementations, integrations and various projects for health plans, government agencies and payer organizations nationwide. We offer a variety of services to support the HealthRules product suite.

Implementation

Our consultants are certified in the HealthRules suite of products and have a deep knowledge of HealthEdge Agile Implementation Methodology. We will leverage our technical expertise to assist your organization in preparing for go-live.

As a first step, we will help you gather high-level requirements and other information required by HealthEdge for implementation. Throughout the project, Tegria will provide cost-effective support for various configuration and technical sprints to ensure success in meeting project milestones.

Data Conversion

We fully understand the HealthRules data conversion process and can assist you with data analysis/staging, mapping, testing, and remediation of conversion issues.

Testing and Quality Assurance

Tegria can help in building and executing testing scenarios to meet the acceptance criteria set by your business areas. We have consultants who specialize in QA and testing and know how to apply those skills in HealthRules implementations.

Integration and Reporting

You can leverage our in-depth knowledge of the HealthRules data warehouse to assist your health plan with custom reporting and data extraction for specific integrations. Tegria is proficient in Crystal Reports, a tool used to deploy custom reports in HealthRules Answers.

If your health plan has unique business requirements that extend beyond what is supported by the standard HealthRules integration points, Tegria can assist in the design, development and testing needed to meet those requirements. Our consultants are well-versed in the HealthRules Connector suite of tools and integration options. We have broad experience in healthcare electronic data interchange (EDI), having worked with most of the X12 transactions mandated by HIPAA in both the 4010A and 5010 transaction sets. We also have experience with many legacy EDI formats superseded by HIPAA (but still in use) and with healthcare transactions in areas that are not addressed or only partially addressed by HIPAA.

Training

Tegria consultants have significant experience developing and delivering training to meet specific health plan needs. We can provide training for all aspects and phases of the HealthRules implementation, including system configuration, technical/data warehouse, and end user training.

System Management and Support

Tegria has the knowledge and experience to help you manage and support your HealthRules platform. If your health plan is a self-hosted HealthEdge client, we can assist in managing the upgrade and periodic “rebuild” efforts across various HealthRules environments. We are familiar with the process employed by HealthEdge whereby configuration data is maintained in a pristine environment and periodically deployed to the development and testing areas in scheduled “rebuilds.”

Module Expertise

Tegria has extensive experience and deep product knowledge with a variety of HealthRule modules, including:

• HealthRules Designer for system configuration
• HealthRules Manager for health plan operational activities
• HealthRules Connector for integration
• HealthRules Admin Console for system security
• HealthRules Answer and the data warehouse for reporting
• HealthRules Portal for connecting all members of the healthcare delivery cycle
• Various integrated, third-party tools to support pricing, utilization/case management, fraud detection/claim bundling, and correspondence

We can help your organization implement, optimize and support your core claims and benefits administration systems.