Case Study: Community Health Options improves claims operations and member satisfaction with HealthEdge HealthRules Payer

Leveraging next-generation technology to optimize operationsand delight members and providers

Community Health Options (CHO) is a provider-owned, not-for-profit health plan based in Maine. Facing a critical need to bring its core administrative operations in-house after rapid growth, CHO required a stable and integrated platform to manage claims, benefits, and provider contracts. To overcome this challenge, they partnered with HealthEdge and implemented its HealthRules Payer solution.

By leveraging HealthEdge's HealthRules Payer, CHO gained a highly configurable system that provided seamless data integration and real-time reporting capabilities. This solution enabled them to achieve a 91% group retention rate, high broker satisfaction scores, and 99% average member satisfaction scores, making the organization more nimble and efficient in a competitive market.

Community Health Options

Kevin Lewis

Chief Executive Officer