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NIB is empowered to make changes to claim rules quickly, increasing productivity and speed to market with InRule, whilst reducing claim fraud

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Business Challenge

  • NIB‘s claim solution was a combination of COTS, legacy systems (WHICS) and custom configuration

  • All rules were hard coded into the solution, creating several problems for NIB:

  • Difficulty in changing rules; one change could require engagement with a variety of IT resources; internal, external vendors, and in some cases a specialist if the change is needed to interact with the legacy software
  • Time consuming and costly to make a change
  • Unable to justify adding new rules that were ‘low value’ claim items, due to the excessive cost and manual workarounds
  • No control over the changes; many of the claims required manual review to ensure they were correct
  • As the business rules were not centralised and easily managed, customers were able to make incorrect or multiple claims

Results

  • With the implementation of InRule, business teams are no longer reliant on programming to add and update claim rules; with InRule, business analysts can author, test & manage rules

  • Streamlined delivery processes enables faster implementation of business rules, reducing ongoing IT costs

  • NIB is no longer reliant on third parties to manage their rules

  • The ability to write all rules regardless of value, reduces manual workarounds for smaller transaction items across the organisation

  • Technology is future-proof and can handle a large influx of claims

  • Manual claim review processes were eliminated, as InRule takes care of this process through automated business logic

  • Rules are accurately applied across different business units, reducing the likelihood of incorrect or fraudulent claims

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Solution & Approach

  • NIB was looking for a BRE to replace their existing legacy solution, as most of their rules were hard coded across multiple systems, making them difficult to modify & implement

  • InRule was chosen for its flexibility, ease-of-use and scalability

  • Solentive worked with NIB to create a foundational package of best practice rules, and worked alongside NIB’s IT team to integrate InRule with their existing claim management systems

  • NIB’s internal IT and BA teams were trained to author the rules alongside Solentive’s InRule Consultants, enabling NIB to take ownership of the system

  • InRule has proven to be a solution to all of NIB’s rules; the transfer of their Hospital and Ancillary Claims component is complete and we are in the process of transitioning Medical Claims rules

  • Solentive continues to partner with NIB as part of their contingency plan, and all work is thoroughly documented ensuring corporate memory is not lost

Solution & Approach

  • NIB was looking for a BRE to replace their existing legacy solution, as most of their rules were hard coded across multiple systems, making them difficult to modify & implement

  • InRule was chosen for its flexibility, ease-of-use and scalability

  • Solentive worked with NIB to create a foundational package of best practice rules, and worked alongside NIB’s IT team to integrate InRule with their existing claim management systems

  • NIB’s internal IT and BA teams were trained to author the rules alongside Solentive’s InRule Consultants, enabling NIB to take ownership of the system

  • InRule has proven to be a solution to all of NIB’s rules; the transfer of their Hospital and Ancillary Claims component is complete and we are in the process of transitioning Medical Claims rules

  • Solentive continues to partner with NIB as part of their contingency plan, and all work is thoroughly documented ensuring corporate memory is not lost

Let’s start a project together

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