Case Study: Presbyterian Health Plan boosts claims efficiency with HealthEdge HealthRules Payer

Presbyterian Health Plan - Customer Case Study

Presbyterian Health Plan, a New Mexico-based health insurer covering 725,000 lives, was experiencing rapid growth that its legacy core administrative processing system could not support. The organization needed a more flexible and configurable system to automate claims operations, improve accuracy, and quickly adapt to competitive market demands. To address this challenge, they partnered with vendor HealthEdge and implemented their HealthRules Payer solution.

By implementing HealthEdge's HealthRules Payer, Presbyterian Health Plan transformed its claims operations and achieved significant measurable results. The configurable system led to a 40% improvement in benefits configuration efficiency, a 25% increase in auto-adjudication rates, and staff productivity increases of up to 30%. The solution also enabled faster adaptation to market changes, such as rapidly configuring for new COVID-19 requirements, and helped the health plan achieve a first-call resolution rate greater than 90%.

Presbyterian Health Plan