State Government Health and Human Service Departments face changing requirements and regulations, reduced budgets, and increasing numbers of citizens in need. InRule provides enterprise decision management for a variety of applications including, eligibility determination, claims processing, and fraud identification.
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 is the BRMS powering Oklahoma’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. 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. I nRule has successfully been deployed in solutions such as Medicaid Management Information Systems (MMIS), Integrated Eligibility, and Chronic Disease and Population Management.
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-based solutions have reduced the timeframe for provider reimbursement by 81%. InRule provides a foundation for the consistent management of reimbursement rules throughout the reimbursement cycle, delivering cleaner claims and faster payments for Providers and Payers. With InRule, providers can reduce the frequency of denials, optimizing reimbursement. Health Plans can eliminate the cost of claims rework and streamline eligibility checking and prior authorization.
InRule provides the ability for Health Insurance Exchanges to improve eligibility and pricing functionality by enabling geographic- and time-specific rules; managing complex calculations, and allowing subject matter experts to update rules as policies, programs, plans, providers and requirements change.