Adjudication Rules Foundation
Simplify Claims Processing with Flexible, Customizable Rules
Description
Introduction:
Manually managing claims adjudication rules is time-consuming and error-prone. Our Adjudication Rules Foundation automates this process, enabling real-time updates and ensuring accurate and efficient decision-making.
Overview:
This Adjudication Rules Foundation empowers business users to configure and manage complex claims adjudication rules like waiting periods, exclusions, and benefit calculations based on ICD and CPT codes. Designed with an intuitive interface and high configurability, this rules foundation allows non technical users to adapt rules to meet evolving regulatory requirements. It enhances flexibility, real-time updates, and scalability for efficient claims processing.
Benefits:
This component streamlines claims adjudication by enabling real-time rule updates and flexible configurations. By automating rule management, it minimizes manual errors and accelerates decision-making, ensuring compliance with policy terms and regulations, leading to improved claims resolution times and operational efficiency.
Features
The Adjudication Rules Foundation enables business users to define and update claims processing rules in real time, ensuring compliance with policy changes and accelerating decision-making processes, reducing claim processing times.
Features and Capabilities
Rule Configurator: Provides a user-friendly interface to manage adjudication rules, such as exclusions and waiting periods.
ICD and CPT-Based Adjudication: Applies rules based on medical codes to ensure accurate and compliant decisions.
Benefit Calculation Module: Calculates payouts based on conditions like waiting periods and benefit limits.
Real-Time Updates: Allows immediate changes to rules, ensuring quick adaptation to policy updates.
Rule Management Flexibility: Empowers non-technical users to configure rules without IT intervention, enhancing agility.
Compliance Assurance: Automatically applies rules to ensure claims are processed in line with policy terms.
Scalable Architecture: Supports expanding rule sets, making it adaptable to evolving business needs.
Resources
Key Information
Platform Modules:
Neutrinos Business Rules Engine: Empower your processes with intelligent, real-time decision automation at scale. Accelerate decision-making and policy enforcement with intuitive rule automation.
Version: 24.07
Neutrinos Microservices and Integration Foundry: Effortlessly connect and scale your services with an integrated microservices and API management and configurator.
Version: 23.11
Neutrinos Dev-Ops and System Management: Gain full visibility into your applications and systems to quickly spot issues, optimize performance, and keep everything running smoothly.
Version: 24.02
Additional References
Badges
Classification
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