List of HealthRules Payer 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 HealthRules Payer 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 HealthRules Payer for Core Admin Processing System 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 HealthRules Payer for Core Admin Processing System include: UnitedHealth Group, a United States based Insurance organisation with 400000 employees and revenues of $400.28 billion, CVS Health, a United States based Healthcare organisation with 219000 employees and revenues of $372.81 billion, Cigna Healthcare, a United States based Insurance organisation with 71295 employees and revenues of $244.38 billion, Aetna CVS Health, a United States based Insurance organisation with 50000 employees and revenues of $98.00 billion, Humana, a United States based Insurance organisation with 95500 employees and revenues of $83.06 billion and many others.
Contact us if you need a completed and verified list of companies using HealthRules Payer, 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 HealthRules Payer 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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Aetna CVS Health | Insurance | 50000 | $98.0B | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2012 | n/a |
In 2012 Aetna CVS Health deployed HealthRules Payer from HealthEdge Software as a Core Admin Processing System to provide core payer administration for enrollment, eligibility, benefits administration, claims adjudication, provider management and billing. The HealthRules Payer implementation was positioned to support a heterogeneous insurance portfolio including government Medicare and employee group insurances and to operate at very large scale with OLTP and supporting HRP data warehouse workloads.
The technical deployment centered on high availability Oracle infrastructure and large scale database management for HealthRules Payer. Operational signals include managing more than 50 Oracle databases and sustaining databases in excess of 100 TB, OLTP processing for HealthRules Payer and an HRP data warehouse. Platform engineering activities recorded include conversion to RAC One Node with Data Guard Standby, Oracle Grid Infrastructure and ASM configuration, Exadata proof of concept benchmarking, and Linux operating system upgrades from RHEL7 to RHEL8.
Data movement and continuity workstreams were explicit in the implementation. The team used GoldenGate replication to support a 100 TB database migration and to minimize downtime while rehoming tables from regular tablespaces to BigFile tablespaces on target systems. Database lifecycle practices included RMAN backup and recovery strategy development and testing, patching and upgrades, and ongoing tablespace and index management to accommodate rapid data growth.
Operational governance and runbook practices were implemented across DBA, performance engineering and development teams. Performance tuning workflows used Oracle diagnostics such as AWR, ASH, TFA and Oracle Enterprise Manager, combined with SQL Profiles and baselines to stabilize OLTP response. Automation of routine DBA tasks and integration with agile application delivery practices were applied to support production readiness, compliance and recovery planning for the HealthRules Payer Core Admin Processing System.
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AmeriHealth | Insurance | 610 | $181M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2022 | n/a |
In 2022 AmeriHealth implemented HealthRules Payer as its Core Admin Processing System, initiating a transition of core business operations to a common next generation operating platform across all lines of business except Medicaid. The initiative follows a multi year technology strategy in which AmeriHealth insourced member, provider, and broker portals and its customer service platform, positioning HealthRules Payer as the central processing engine for claims administration and policy operations.
HealthRules Payer was configured to support category aligned capabilities such as claims adjudication, enrollment and eligibility workflows, policy administration, and premium billing operations, reflecting typical Core Admin Processing System functional modules. The deployment emphasizes integrated processing across adjudication and client servicing workflows, and HealthRules Payer is described as fully integrated within Independence Health Group third party administrator lines of business where the platform already supports 385 clients and 800,000 members.
Operational coverage for the HealthRules Payer rollout centers on core administration, claims operations, client account management, provider relations, and broker servicing teams, while digital touchpoints including member and provider portals will remain stable before and after the transition to minimize member disruption. The implementation applies across AmeriHealth New Jersey lines of business within the Independence Health Group footprint, explicitly excluding Medicaid, and leverages existing insourced customer service tooling to maintain continuity.
Governance for the transition to HealthRules Payer is led by AmeriHealth New Jersey senior leadership and is planned as a staged multi year rollout to ensure controlled migration and client communication. AmeriHealth states the platform will provide greater flexibility and agility for clients and members, support faster speed to market and improved capabilities, and deliver scale and operational efficiency for client servicing, with detailed timing and client transition plans to be communicated in the subsequent year.
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AmeriHealth Administrators | Insurance | 500 | $250M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2015 | n/a |
In 2015, AmeriHealth Administrators implemented HealthRules Payer as its Core Admin Processing System. The deployment established HealthRules Payer from HealthEdge Software as the enterprise-grade payer platform supporting configuration and benefits administration for the companys insurance operations.
The program was led through a Testing Center of Excellence that spearheaded the entire QAT Delivery organization and owned testing deliverables at the enterprise level. The team implemented a structured test strategy for HealthRules Payer configuration and benefits testing, formalizing test planning, environment management, and repeatable validation cycles to align configuration with product and benefits rules.
Governance was coordinated with the Plan CIO for strategic, operational, and staffing alignment of the program to the enterprise vision. Financial and operational oversight included tracking and reporting on performance against budget, staff compensation, and cost metrics tied to operating profit goals, with the QAT organization reporting into centralized program governance.
Operational scope extended across enterprise IT, QA, product configuration, and benefits operations, with the Testing Center of Excellence providing thought leadership on testing standards and release readiness for HealthRules Payer. The work prioritized configuration fidelity and benefits rule validation as core functional capabilities of the Core Admin Processing System.
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ATRIO Health Plans | Insurance | 140 | $25M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2021 | n/a |
In 2021, ATRIO Health Plans implemented HealthRules Payer as its Core Admin Processing System. The deployment is positioned to support ATRIO as a US-based insurer with 140 employees, and it underpins administration for 24 Medicare Advantage clients operating across 48 states and the District of Columbia, covering more than 4 million covered lives.
HealthRules Payer was configured to deliver core payer workflows consistent with a Core Admin Processing System, including member enrollment and lifecycle management, claims adjudication and payment processing, premium billing and invoicing, and product and benefits configuration for Medicare Advantage plans. The implementation emphasized policy-driven claim adjudication and centralized product modeling to maintain consistent benefit rules across multiple MA lines of business.
Operational coverage extends across claims operations, enrollment and eligibility, finance and premium billing, provider operations, and care management teams, with the platform acting as the system of record for plan administration across ATRIOs MA book. The implementation narrative indicates health plan scale by client account rather than a single-plan deployment, requiring multi-client configuration and tenant-aware plan mapping within HealthRules Payer.
Governance was structured to centralize plan configuration and rule governance, standardize onboarding processes for new Medicare Advantage client accounts, and rationalize workflows for policy changes and benefit updates. The program focused on creating repeatable configuration templates and governance checkpoints to support ongoing management of Medicare Advantage product sets within HealthRules Payer.
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Avera Health Plans | Insurance | 150 | $20M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2010 | n/a |
In 2010, Avera Health Plans deployed HealthRules Payer as its Core Admin Processing System. The deployment was centered in Sioux Falls, South Dakota and focused on operationalizing benefits configuration and claims adjudication across the payer organization. The implementation targeted benefits administration and claims processing functions that span medical and pharmacy business areas.
Configuration work was executed using HealthRules Manager and HealthRules Designer, with Benefit Plan Wizard used to amend and create benefit plans inside HealthRules Payer. The Senior Configurations Analyst role performed analysis, gathering, build and test cycles using source of truth documents to drive benefit plan configuration, Service Categories, Benefit Plan Components, Value Lists and Templates, aimed at maximizing auto adjudication accuracy. Functional capabilities emphasized benefit setup, rules configuration, templating and automated adjudication workflows.
Operational integrations and coverage included participation on the EPIC implementation team for Tapestry Benefits and direct collaboration with medical and pharmacy staff to align benefit configuration with clinical and pharmacy policy on a quarterly cadence. The team conducted quarterly reviews of CPT, HCPC and ICD 10 codes for service category placement and reviewed the USPSTF site to align preventative benefit coverage with A and B requirements for compliance. Daily operational support included review of Jira tickets for updates and troubleshooting related to inaccurate claims adjudication, and extensive claims testing to identify configuration errors and software defects that affect claims processing.
Governance and documentation were embedded into the rollout, with preparation and maintenance of technical manuals, systems configuration documents and work instructions to onboard and guide configuration staff. Implementation participation covered requirements gathering, definition and configuration of system workflows, and quality audits of benefit configuration set ups to ensure configuration controls and repeatable deployment practices.
Ongoing operational practices centered on continuous configuration quality assurance and claims validation, with structured review cycles and documented configuration standards to support the payer s benefits administration and claims adjudication processes using HealthRules Payer as the Core Admin Processing System.
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Insurance | 650 | $150M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2022 | n/a |
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Insurance | 600 | $850M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2021 | n/a |
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Healthcare | 57000 | $16.4B | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2020 | n/a |
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Insurance | 220 | $100M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2020 | n/a |
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Insurance | 1600 | $720M | United States | HealthEdge Software | HealthRules Payer | Core Admin Processing System | 2019 | TEKsystems |
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Showing 1 to 10 of 78 entries
Buyer Intent: Companies Evaluating HealthRules Payer
ARTW Buyer Intent uncovers actionable customer signals, identifying software buyers actively evaluating HealthRules Payer. Gain ongoing access to real-time prospects and uncover hidden opportunities. Companies Actively Evaluating HealthRules Payer for Core Admin Processing System include:
- Capital Rx, a United States based Healthcare organization with 800 Employees
- Sohu.com Limited, a China based Professional Services company with 4900 Employees
- UCare, a United States based Insurance organization with 1600 Employees
Discover Software Buyers actively Evaluating Enterprise Applications
| Logo | Company | Industry | Employees | Revenue | Country | Evaluated |
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Capital Rx | Healthcare | 800 | $310M | United States | 2026-03-26 |
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Medica Health Plans | Insurance | 3000 | $5.0B | United States | 2026-01-06 |
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Sohu.com Limited | Professional Services | 4900 | $836M | China | 2025-12-18 |
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Insurance | 1600 | $6.2B | United States | 2025-12-06 |
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Education | 5009 | $3.9B | United States | 2025-10-08 |
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Insurance | 2100 | $4.0B | United States | 2025-08-04 |
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Professional Services | 10000 | $1.0B | Germany | 2025-07-31 |
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Banking and Financial Services | 10 | $3M | United States | 2025-07-09 |
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Healthcare | 100 | $16M | United States | 2025-06-24 |
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Professional Services | 132 | $12M | United States | 2025-05-22 |
FAQ - APPS RUN THE WORLD HealthRules Payer Coverage
HealthRules Payer is a Core Admin Processing System solution from HealthEdge Software.
Companies worldwide use HealthRules Payer, from small firms to large enterprises across 21+ industries.
Organizations such as UnitedHealth Group, CVS Health, Cigna Healthcare, Aetna CVS Health and Humana are recorded users of
HealthRules Payer for Core Admin Processing System.
Companies using HealthRules Payer are most concentrated in Insurance and Healthcare, with adoption spanning over 21 industries.
Companies using HealthRules Payer are most concentrated in United States, with adoption tracked across 195 countries worldwide. This global distribution highlights the popularity of HealthRules Payer across Americas, EMEA, and APAC.
Companies using HealthRules Payer range from small businesses with 0-100 employees - 5.13%, to mid-sized firms with 101-1,000 employees - 43.59%, large organizations with 1,001-10,000 employees - 24.36%, and global enterprises with 10,000+ employees - 26.92%.
Customers of HealthRules Payer 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 HealthRules Payer customer database with detailed Firmographics such as industry, geography, revenue, and employee breakdowns as well as key decision makers in charge of Core Admin Processing System.