HCF automates claims processing with ILOG BRMS

Australian Health Fund, HCF, has implemented ILOG Rules for .NET as a component of its automated claims adjudication and payment system.

ILOG Rules for .NET is a part of offerings from ILOG's business rule management system (BRMS) product line, HCF has reduced the time required to evaluate and settle claims by about 30 percent, while automating fraud detection.

HCF is the fourth largest health funds in Australia, offering around 423,000 health memberships covering over 978,000 people and provides around 341,000 policy-holders with HCF life insurance.

The health insurer processes around 27,000 claims to process every day, it needed a robust solution to shorten the time it takes to validate, review and settle claims, while also ensuring consistency.

The new BRMS-based system enables HCF to eliminate redundant data and respond to changes in business and government regulatory requirements. The new system also enables HCF to achieve an automation or pass-through-rate of 80 percent.

Patrick Shearman, chief information officer at HCF Australia said a BRMS was the right strategy and ILOG's solution was the right choice.

“ILOG Rules for .NET fits well into our architecture," he said. "The BRMS also provides flexibility for our future needs and enables IT and business to collaborate to manage business rules."