Health and Human Services

State Government Health and Human Service Departments face changing requirements and regulations, reduced budgets, and increasing numbers of citizens in need of assistance. InRule provides decision management for a variety of applications including eligibility determination, benefits calculation, claims processing, and fraud identification.

Manage changing rules without programmer intervention

InRule enables subject matter experts to manage business rules without programmer intervention, meaning changes can be made to systems more quickly and with greater accuracy. With InRule, rules are managed separately from code so that they are transparent and auditable, ensuring compliance with the CMS Medicaid Information Technology Architecture (MITA) standard. Rule authoring and management can also be tightly integrated with Microsoft Dynamics CRM, making the user experience familiar and easy-to-learn.

InRule helps reduce costs and improve the services you deliver to the public

And InRule has made a real, measureable impact with dozens of public agencies at the national, state and local levels: the Oklahoma Healthcare Authority saved more than $18M while reducing the number of uninsured children from 17% to 6%.

Eligibility

HHS eligibility determination is undeniably complex. Policy to Practice®, InRule’s unique approach to aligning HHS policy with State and Local eligibility systems, improves effectiveness and quality, lowers cost, and mitigates risk. InRule conforms to Centers for Medicare & Medicaid Services (CMS) Enhanced Funding Requirements: Seven Conditions and Standards, ensuring the ability to collaborate across agencies and states.

InRule is the BRMS powering Oklahoma Healthcare Authority’s web-based, fully-automated, real-time eligibility determination system that is available 24 hours a day, seven days a week—the first of its kind. Oklahoma Healthcare Authority.

InRule delivers award-winning results

InRule also powers an Eligibility System for Cancer Care Ontario, a system recognized by Microsoft as one of only two finalists for the Microsoft Web Development Partner of the Year Award 2012. InRule has successfully been deployed in solutions such as Medicaid Management Information Systems (MMIS), Integrated Eligibility, and Chronic Disease and Population Management.

Learn more about InRule and Eligibility Systems

Read the Oklahoma Healthcare Authority case study.

Hear more about Oklahoma’s leading system in the Policy to Practice On Demand webinar.

Download the Policy to Practice white paper.

Medicaid Management Information System (MMIS)

InRule-based solutions have reduced the timeframe for provider reimbursement by 81%. By providing a foundation for the consistent management of reimbursement rules throughout the reimbursement cycle, InRule helps deliver cleaner claims and faster payments. With InRule, providers can reduce the frequency of denials, optimizing reimbursement. And health plans can eliminate the cost of claims rework and streamline eligibility checking and prior authorization.

WIC (Women, Infants, and Children)

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) supports mothers and children across the nation through screening, referrals, nutrition education, breastfeeding support and supplemental foods.

InRule helps state agencies and their partners update their WIC systems to be more configurable, dynamic, and flexible by enabling subject matter experts to manage complex and changing rules outside of code.

Learn more about how InRule delivers configurable and dynamic WIC systems.