Case Study: AmeriHealth Administrators boosts claims accuracy and agility with HealthEdge HealthRules Payer

AmeriHealth Administrators - Customer Case Study

AmeriHealth Administrators (AHA), a subsidiary of Independence Blue Cross, faced the industry-wide challenge of needing greater agility and flexibility to respond to healthcare reform and rising consumer expectations. Their legacy systems were ill-equipped to support the rapid launch of new products and flexible benefit designs required by their self-funded clients. To modernize its operations, AHA selected HealthEdge and implemented its HealthRules Payer platform.

By deploying HealthRules Payer, HealthEdge provided AHA with a rules-based engine that combined flexible benefit coding with reusable objects. This solution enabled AHA to drastically improve its claims auto-adjudication rate by over 30% and achieve 99.6% financial accuracy. The implementation also dramatically reduced the time to onboard new clients, exemplified by launching a customer with 300,000 members in just four months, showcasing the speed and agility provided by HealthEdge.

AmeriHealth Administrators

Michael Robak

Vice President of Service Operations Independence