Smarter Decisions for Claims Compliance and Member Engagement

InRule’s business rule engine (BRE), process automation, and machine learning technologies empower healthcare payers to make faster, more accurate decisions to optimize claims processing, improve compliance, and increase member satisfaction.

Download Datasheet

Contact Us

Elevating Payer Efficiency and Member Satisfaction

Reduce operational costs, enhance accuracy, and deliver faster, more efficient services to improve member satisfaction, reduce fraud, and beat the competition.

Faster Claims Processing

Automate claims adjudication, reduce manual review time, and ensure quicker, more accurate payouts.

Enhanced Fraud Detection

Leverage decision intelligence and machine learning to detect suspicious claims and reduce fraud, waste, and abuse.

Improved Regulatory Compliance

Quickly update decision logic to stay compliant with evolving healthcare regulations, minimizing risks and delays.

Personalized Member Engagement

Automate and personalize member communications to increase engagement, satisfaction, and retention.

“We have set up some pretty complex calculations in InRule, and being able to show the actuarial team what the math really looks like in a simple, straightforward language gives them confidence that the logic we have implemented is correct and aligns with their expectations.”

–Tyler Leinweber, System Analyst, Delta Dental of Wisconsin

%

Faster rating of new plans

%

reduction in rules development time

%

increase in profit gains

Common Use Cases

InRule’s advanced AI decisioning and machine learning empower healthcare payers to enhance every aspect of their operations. Learn more about different areas where InRule can help:

Automate Claims Adjudication

Reduce manual intervention and accelerate claims processing by automating decision-making for claim approvals and denials.

Fraud Detection & Prevention

Leverage machine learning and decisioning to detect and flag suspicious claims, minimizing losses due to fraud and abuse.

Prior Authorization Automation

Speed up prior authorization by automating eligibility checks and decision-making to reduce delays and improve patient access to necessary treatments.

Member Eligibility Verification

Automate member eligibility checks, ensuring accurate coverage verification in real time to streamline claims submissions and reduce delays.

Appeals & Grievance Management

Simplify the appeals process by automating decisions for handling grievances and appeals, helping with compliance and improving member satisfaction.

Pricing Transparency & Plan Management

Provide members and providers with real-time, transparent pricing information and automate updates to health plans, ensuring consistent pricing and reducing discrepancies.

Stay Compliant with Regulatory Changes

Quickly update decision logic to meet evolving healthcare regulations, ensuring compliance without disrupting ongoing operations or delaying claims processing.

Risk Scoring & Predictive Analytics

Utilize machine learning to predict member risk profiles, enabling proactive care management and reducing the likelihood of costly interventions.

Payment Integrity & Reimbursement Validation

Ensure accurate reimbursement by automating the validation of claims against health plan rules and contractual agreements, reducing the need for rework and preventing under- or overpayments.

Delta Dental Modernizes Legacy Quoting Platform with Salesforce® and InRule

For more than 50 years, Delta Dental of Wisconsin has offered benefit services, claims processing, plan administration and services to employers within the state. The organization proudly serves more than 1.8 million subscribers and their family members.

By leveraging Salesforce and InRule, Delta Dental was able to create an online quoting portal that reduced the time it takes to make changes to new rating plans by over 90%.

Read The Case Study