FairPay Solutions Uses InRule® To Streamline Medical Billing Review/Repricing

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"InRule fit our budget, and had the fastest development and deployment for the solution we needed. Some of the other business rule engines required significant ramp up time." Lead Programmer, FairPay Solutions

Since 1999 FairPay Solutions has provided unique software and service solutions for insurance companies and third-party health insurance administrators, including inpatient, outpatient, physician and specialty medical bill review and repricing services.

FairPay Solutions uses rules-based applications to determine which medical bills are candidates for specialty review. The applications use complex criteria, taking into account different lines of insurance, state jurisdiction, industry standards for treatment costs and prevailing laws. The complex criteria are difficult to define using if-then-else constructs, so FairPay uses InRule to implement the logic using rules and decision tables.

FairPay Solutions is the authority on specialty bill review services, providing workers' compensation and auto/liability payers with the first line of defense to identify and dispute inaccurate provider over-billings.  

InRule Streamlines the Authoring of Complex Logic InRule rule applications replace numerous lines of embedded IF/THEN/ELSE and case logic, which was stored and maintained in custom code. FairPay enjoyed a quick transition moving from their previous applications to InRule: they were up and running in less than two weeks.

"InRule lets you get up and running very quickly," says a lead programmer at FairPay Solutions. "It saved my skin!" In addition, FairPay applications must populate a number of XML elements to categorize medical bills, and according the programmer, "XML document manipulation is much easier to accomplish inside an InRule rule application."

Competitive Evaluation Results in Selection of InRule

FairPay evaluated several solutions in their search for a business rules engine. FairPay chose InRule because they found it simple and easy to use, without the overhead and infrastructure imposed by some other solutions. "InRule fit our budget, and had the fastest development and deployment of the solution we needed," said the lead programmer. "Some of the other business rules engines required significant ramp up time." In addition, FairPay found InRule to be the best fit for a .NET environment. "Other rule engines are primarily suited to Java," he says.

FAIRPAY Solutions uses InRule in rules-based applications with complex criteria to determine which medical bills require specialty review and re-pricing.  

FairPay takes advantage of InRule's strengths to get their rule applications up and running quickly. FairPay simplifies rule authoring with InRule's easy to use rule editor and decision tables. Managing FairPay's rule applications is aided by InRule's server-based rule application repository with simple checkin/ check-out functionality and role-based security. FairPay also likes the fact that InRule's engine is accessible by Web Services, Windows Services or local applications, and that testing is easy.

"InRule's test environment is great," says a senior programmer. "Everything is exposed; you know which rules caused which conditions to trigger." In addition, FairPay developers like that InRule is self-documenting and includes several tutorials and samples.

For More Information

Kate McGowan
Director of Marketing
kmcgowan@inrule.com