Case Study: McLaren Health Plan boosts auto-adjudication and lowers costs with HealthEdge HealthRules Payer

McLaren Health Plan - Customer Case Study

McLaren Health Plan, a Michigan-based health maintenance organization, faced the challenge of operating on outdated 30-year-old technology that resulted in a 0% claims auto-adjudication rate and high administrative costs, threatening its ability to remain in business. To capture new business in a competitive landscape, McLaren partnered with HealthEdge to implement its HealthRules Payer solution, seeking a modern, scalable platform to replace its clunky and inefficient legacy system.

By implementing HealthEdge's HealthRules Payer, McLaren gained a flexible and efficient core administrative system. The solution delivered dramatic results, increasing the auto-adjudication rate to over 90%, speeding up claims processing, and eliminating the need to add claims staff as the company expanded. This improved efficiency and scalability allowed McLaren to lower administration costs, reallocate resources to innovation, and support significant business growth, including the successful acquisition and integration of MDwise. HealthEdge provided the technological edge that was crucial to McLaren's expansion and competitiveness.

McLaren Health Plan

Sara Mavredes

Vice President of Business Information and Operations