To comply with the modularity standards put forth by the U.S. Department of Health and Human Services Centers for Medicare and Med- icaid Services, many states have implemented architectures that leverage an enterprise service bus to integrate separate modules for claims and adjudication, provider management, vendor management, care management and more. Within this architecture, each […]
According to the Center for Disease Control and Prevention, chronic diseases —such as heart disease, stroke, cancer, diabetes, and arthritis—are among the most common, costly, and preventable of all health problems in the U.S. Healthcare insurers in the public and private sector are seeking to improve health outcomes and lower costs by better managing chronic […]
Roughly 9.8 billion medical claim transactions took place in the US in 2015. This number represents only the commercial side; government-related medical claim transactions may have accounted for as much as 720 million more. We can safely assume that number of transactions has increased since 2015 and will continue to do so in the coming […]
The shift to population health management in the healthcare industry today dramatically escalates the requirements for situational awareness and proactive care programs. As disparate data that has traditionally been siloed becomes interrelated, it creates the need for a system that can detect and identify abnormalities across data sets and raise an alert to signify a […]
Uppsala Vatten (Water) and Avfall (Waste) AB operate in one of Sweden’s strongest growth regions. Te Uppsala municipality is continuing to expand, and as new areas emerge and new workplaces take shape, a functioning infrastructure, secured capacity, and sustainable management of natural resources and facilities are required. With more than 220 employees, Uppsala Vatten and […]
For developers and architects working for insurance organizations, business analysts’ requests for “quick” or “simple” changes to claims adjudication calculations can set off a huge ripple effect that begins with lost time and productivity and often ends with frustration. From sifting through large application code repositories for a single calculation that needs to be modified, […]
InRule® is the premier .NET Business Rules Management System (BRMS) for authoring, managing and executing business rules across an organization. Organizations of all sizes and across all industries can benefit from using InRule, especially if their applications require frequent changes to decision-making logic due to changing regulations, prices or policies set by business users. InRule […]
Business rules for rating and underwriting pose a consistent challenge to commercial insurance organizations. As underwriters, actuaries, and other business users request changes to the rating and underwriting logic that powers the business, IT teams often require weeks to code, test, approve, and push them out to the appropriate applications. This costs the business not […]
Artificial intelligence, and more specifically machine learning, is everywhere these days. We hear about applications for facial recognition, product recommendations, fraud detection, hedge fund trading, airline pricing, natural language processing, medical diagnosis, health monitoring – you name it. It seems like it is the solution to every kind of problem out there. Machine learning holds […]
The purpose of this paper is to provide a framework to quantify the value of the InRule® Decision Platform. While every project is different, and every organization has unique priorities, we have attempted to provide common examples and use cases for InRule that highlight cost and time savings and increased revenue – priorities for most […]