List of HealthEdge GuidingCare Customers
HealthEdge
30 Corporate Dr Suite 150,
Burlington, 1803, MA,
United States
Burlington, 1803, MA,
United States
1 781-285-1300
Professional Services
2000
$473M
Since 2010, our global team of researchers has been studying HealthEdge GuidingCare customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased HealthEdge GuidingCare for Medical Care Management from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using HealthEdge GuidingCare for Medical Care Management include: Avera Health, a United States based Healthcare organisation with 22100 employees and revenues of $285.00 billion, Blue Cross Blue Shield of Illinois, a United States based Insurance organisation with 11000 employees and revenues of $7.00 billion, UCare, a United States based Insurance organisation with 1600 employees and revenues of $6.16 billion, Priority Health, a United States based Insurance organisation with 1600 employees and revenues of $5.80 billion, Colorado Access, a United States based Insurance organisation with 690 employees and revenues of $667.0 million and many others.
Contact us if you need a completed and verified list of companies using HealthEdge GuidingCare, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
The HealthEdge GuidingCare customer wins are being incorporated in our Enterprise Applications Buyer Insight and Technographics Customer Database which has over 100 data fields that detail company usage of software systems and their digital transformation initiatives. Apps Run The World wants to become your No. 1 technographic data source!
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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Avera Health | Healthcare | 22100 | $285.0B | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2021 | n/a |
In 2021, Avera Health implemented HealthEdge GuidingCare in the Medical Care Management category to modernize claims processing for Avera Health Plans. The move followed an RFP process that began in 2019, and Avera announced a new claims platform using HealthRules Payor offered by HealthEdge as the core administrative processing engine supporting the effort.
The implementation centered on core claims processing capabilities, with an emphasis on configurable claims adjudication, rules-based processing and improved transparency of information for providers and members. HealthEdge GuidingCare deployment leveraged HealthEdge’s approach to configuration and claims workflow to enable centralized configuration management and streamlined adjudication logic across plan products.
Operational scope was explicitly limited to Avera Health Plans, DAKOTACARE and DAKOTACARE Administrative Services remained unaffected by the change. Cutover was scheduled for September 1 2021, and communication and guidance for providers was distributed via a Provider View special issue, with the Provider Relations team designated as the primary contact for questions and updates, and dates noted as subject to change due to unforeseen circumstances.
Governance for the rollout emphasized provider readiness and operational guidance, with published recommendations and a commitment to deliver additional guide updates as needed. The stated objective of the HealthEdge GuidingCare implementation was to create a better experience for members and providers while centralizing claims processing and transparency of information for health plan operations.
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Blue Cross Blue Shield of Illinois | Insurance | 11000 | $7.0B | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2023 | n/a |
In 2023, Blue Cross Blue Shield of Illinois implemented HealthEdge GuidingCare as part of a Medical Care Management deployment focused on provider facing care coordination. The rollout targeted provider users who manage Illinois Blue Cross Community Health Plans members and Blue Cross Community MMAI members, enabling payer side visibility into care management workflows delivered to external provider organizations.
HealthEdge GuidingCare is delivered as a web based care management portal to monitor rendered services, activities, quality measures and care plans. The implementation centers on standard Medical Care Management capabilities including care plan management, service and activity tracking, and quality measure monitoring to support longitudinal care coordination workflows for providers.
The GuidingCare portal is accessible via Availity Essentials under Payer Spaces, with access assigned to existing Availity administrators and to designated users. Administrators are required to complete a secondary Availity enrollment process to provision GuidingCare access and all users must be registered with Availity Essentials, aligning access control with Availity's administrator model.
The implementation documentation references the Medicaid Care Management Information and Reporting User Guide for enrollment and operational procedures, and BCBSIL provides operational support through Government Programs contact channels. Availity is identified as a separate company providing electronic information exchange and administrative services to BCBSIL, and the GuidingCare portal is noted as provided by Altruista Health with BCBSIL making no endorsement of third party vendor services.
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Chorus Community Health Plans | Insurance | 200 | $449M | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2023 | n/a |
In 2023, Chorus Community Health Plans implemented HealthEdge GuidingCare, deploying the Medical Care Management application to centralize care coordination and clinical guidance across provider-facing channels. The 200 employee health insurer is using HealthEdge GuidingCare on its website to surface care protocols, utilization criteria, and referral workflows for provider access.
The HealthEdge GuidingCare implementation emphasized core Medical Care Management capabilities, configured to support care management plans, utilization management workflows, concurrent and retrospective review processes, and longitudinal care coordination. Configuration work focused on clinical rule sets, care plan templates, and role based access for care managers and provider users. The full application name HealthEdge GuidingCare is referenced in provider documentation and site navigation to link external clinicians directly into clinical guidance and authorization pathways.
Operational coverage centers on care management, utilization management, and provider relations teams, with governance organized around clinical policy owners and care management leads to maintain and update rule sets and templates. Workflows were restructured to route provider inquiries and authorization requests through the HealthEdge GuidingCare interface on the Chorus provider site, standardizing intake and clinical review steps. Integrations beyond the website surface are not specified in the source materials.
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Colorado Access | Insurance | 690 | $667M | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2014 | n/a |
In 2014 Colorado Access began upgrading and operationalizing HealthEdge GuidingCare as its core Medical Care Management platform. The initiative included coordinated version upgrades of HealthEdge GuidingCare from 4.9 to 8.13 and subsequently to 8.17, executed as a program of upgrades and operational validation.
Configuration and module work focused on claims processing and care management workflows, with HealthRules Payor data configured to surface correctly on the HealthEdge GuidingCare front-end and validated on back-end load processes. Functional streams included authorizations and grievances, utilization management, care management and CRM touchpoints, supported by documented test plans and test cases and hands-on testing.
Integrations were explicitly addressed, moving existing 3M/TREO claims extracts into a new Truven dimensional model to support internal systems and reporting, and coordinating claims feeds with the State. The implementation also incorporated Teradata Workflow & Collaboration Manager for marketing task automation, Zoho CRM and Zoho Creator forms for broker and partner relationship tracking, and management of Online Insight storefront portals under the same operational scope.
Governance and delivery followed a combined V-Shaped and Agile SDLC, with Colorado Access staff performing system administration, requirements gathering, quality assurance and JIRA-based issue tracking. The Senior Business Analyst served as primary analyst and as IT Project Manager for initiatives including the KP Payment Reform Project with Kaiser and the State, driving cross-team coordination with A&G, UM, CRM and CM team leads to promote upgrades and system enhancements.
Operational coverage centered on internal care management, utilization management, CRM and authorization functions, with continued responsibilities for troubleshooting configuration and user issues, entering service tickets, and documenting business, functional and non-functional requirements for subsequent projects. HealthEdge GuidingCare remained the principal Medical Care Management application for these integrated workflows and validations.
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Denver Health Medical Plan | Insurance | 150 | $437M | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2018 | n/a |
In 2018, Denver Health Medical Plan implemented HealthEdge GuidingCare for Medical Care Management to strengthen care management operations across its Medicaid-dominant membership. Denver Health Medical Plan is a nonprofit health plan embedded in a safety net hospital system managing a population exceeding 120,000 members with high chronic disease burden, behavioral health needs, and social determinants of health challenges, which shaped the deployment requirements for HealthEdge GuidingCare.
The deployment focused on configuring HealthEdge GuidingCare to support core care management workflows, creating more comprehensive patient profiles, and enabling multi-channel member engagement. Work included an environmental scan to identify tool gaps and targeted upgrades to better align GuidingCare functionality with care manager tasks, case assignment, and outreach orchestration consistent with Medical Care Management best practices.
Operational integration emphasized close collaboration with GuidingCare representatives through ride-along sessions to surface adoption gaps and optimize tool usage, and planning to extend capabilities by integrating HealthEdge Wellframe for remote engagement and longitudinal member touchpoints. The operational scope centered on the plan s care management teams, behavioral health coordination, and member engagement functions, reflecting a county-level safety net population focus rather than enterprise-scale regional rollouts.
Governance and process work prioritized continuous improvement cycles, ongoing upgrades, and workflow refinement to improve care manager efficiency and member experience within constrained resources. The program explicitly treated transformation as improving quality of care rather than reducing workload, and documented plans to incrementally expand HealthEdge GuidingCare usage while layering Wellframe for extended outreach and engagement.
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Insurance | 300 | $200M | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2022 | n/a |
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Healthcare | 2000 | $450M | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2015 | n/a |
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Insurance | 1600 | $5.8B | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2022 | n/a |
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Insurance | 1600 | $6.2B | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2018 | n/a |
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Healthcare | 1200 | $400M | United States | HealthEdge Software | HealthEdge GuidingCare | Medical Care Management | 2023 | n/a |
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Buyer Intent: Companies Evaluating HealthEdge GuidingCare
ARTW Buyer Intent uncovers actionable customer signals, identifying software buyers actively evaluating HealthEdge GuidingCare. Gain ongoing access to real-time prospects and uncover hidden opportunities. Companies Actively Evaluating HealthEdge GuidingCare for Medical Care Management include:
- LanceSoft, Inc, a United States based Professional Services organization with 5000 Employees
- The Fountain Group, a United States based Professional Services company with 50 Employees
- Tech Insurance Agency, a United States based Insurance organization with 40 Employees
Discover Software Buyers actively Evaluating Enterprise Applications
| Logo | Company | Industry | Employees | Revenue | Country | Evaluated | ||
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FAQ - APPS RUN THE WORLD HealthEdge GuidingCare Coverage
HealthEdge GuidingCare is a Medical Care Management solution from HealthEdge Software.
Companies worldwide use HealthEdge GuidingCare, from small firms to large enterprises across 21+ industries.
Organizations such as Avera Health, Blue Cross Blue Shield of Illinois, UCare, Priority Health and Colorado Access are recorded users of
HealthEdge GuidingCare for Medical Care Management.
Companies using HealthEdge GuidingCare are most concentrated in Healthcare and Insurance, with adoption spanning over 21 industries.
Companies using HealthEdge GuidingCare are most concentrated in United States, with adoption tracked across 195 countries worldwide. This global distribution highlights the popularity of HealthEdge GuidingCare across Americas, EMEA, and APAC.
Companies using HealthEdge GuidingCare range from small businesses with 0-100 employees - 9.09%, to mid-sized firms with 101-1,000 employees - 36.36%, large organizations with 1,001-10,000 employees - 36.36%, and global enterprises with 10,000+ employees - 18.18%.
Customers of HealthEdge GuidingCare include firms across all revenue levels — from $0-100M, to $101M-$1B, $1B-$10B, and $10B+ global corporations.
Contact APPS RUN THE WORLD to access the full verified HealthEdge GuidingCare customer database with detailed Firmographics such as industry, geography, revenue, and employee breakdowns as well as key decision makers in charge of Medical Care Management.