| Hospitals Contribution Fund |
|
| Industry: |
Healthcare |
| Solution: |
Straight through processing program |
| Products: |
ILOG Rules for .NET |
|
- Improves straight through processing (STP)
- Reduces claims handling and settlement costs
- Reduces time to market for policies
- Increases processing time
|
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| "ILOG BRMS was the right strategy. Not only have we realized our vision of STP, ILOG Rules for
.NET has assisted HCF to become a leader in the field of claims automation." |
Patrick Shearman
Chief Information Officer
Hospitals Contribution Fund
|
Business
Hospitals Contribution Fund (HCF) is the fourth largest health fund in Australia. A not-forprofit
organization, HCF covers nearly 1.5 million people with health and life insurance.
Goal
The fund belongs to a market that is constantly changing. More than 48 percent of the
people in Australia are covered by private health insurance, and the country’s insurers
frequently offer new products and services to remain competitive. The market is also
closely monitored by the government, which often introduces new regulations. HCF used
to rely on a custom-built C++ rule engine to automate decision making in its claims
processing applications, but the engine’s rules were hard-coded and took at least a
month to update. HCF needed a new claims assessment module designed to process
more than 10,000 claims per day and support new offers, regulations and business demands.
Application
HCF found the answer in ILOG Rules for .NET, ILOG’s business rule management system
(BRMS) for the Microsoft .NET platform. Business users can directly access the rules and
implement policy changes in less than a day through a custom Web-based editor or
Microsoft Office applications. ILOG Rules for .NET also allows HCF’s IT personnel to take
full advantage of their preferred .NET development system and gives them a fast, highly
scalable rule engine capable of real-time performance. With far better regulatory
compliance and automated end-to-end processing that includes fraud detection, the new
system has helped HCF’s straight through processing (STP) program by improving its
automated pass-through rate by 80 percent.
Results
ILOG Rules for .NET has enabled HCF to automate its claims processing completely, furthering an initiative to standardize on STP. The new claims assessment module allows frequent changes for regulations and a quick response to new business requirements, and makes rules visible, or "transparent," to business users for a faster turnaround in updating the system.
Technical
ILOG Rules for .NET provides the ability to accelerate changes in an application to better support business needs and requirements.
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