Case Study: Medica achieves claims processing agility and growth with HealthEdge HealthRules Payer

Medica’s Business Transformation Using NextGeneration Claims Technology as a Catalyst

Medica, a regional non-profit health plan, faced the challenge of modernizing its legacy claims processing system to keep up with shifting market dynamics. They needed a platform to maximize the value of their data and create an agile operational environment. To meet this challenge, they partnered with vendor HealthEdge to implement the HealthRules Payer administrative platform.

HealthEdge provided a solution that enabled Medica to automate and streamline its operations. The implementation delivered significant results, including the ability for a four-person team to configure 81 health plans in just 10 days during the ACA rollout. This agility allowed Medica to quickly capture new market share, eliminate costly manual processing, and provide superior customer service, ultimately enabling their continued growth.

Medica

Kimberly Branson

VP Business Transformation