InRule Streamlines Eligibility Determination

Eligibility programs for health and Human Service (HHS) agencies are driven by complex rules that support regulations, policies and calculations. These automated decisions allow HHS agencies to provide customized services that improve outcomes for children and families.

From MMIS, to CCWIS, WIC and other eligibility programs, HHS agencies trust InRule to help them serve their constituents while maintaining compliance with mandates and keeping costs under control.

An InRule-powered eligibility system qualifies applicants, validates their identification and determines eligibility of benefits. This approach can improve efficiency by reducing costs associated with distributing benefits, increasing accuracy, and improving overall quality of service delivered by the administering agency.  Prior authorization, claims processing and adjudication are complex processes, all streamlined by InRule.

In fact, with InRule as the key technology for determining eligibility the Oklahoma Healthcare Authority:

  • Reduced the number of uninsured children by 64%, from 17% to 6%
  • Reduced costs by $18M per year
  • Reduced eligibility wait times for most applicants from 30 days to an immediate response
  • Manages 38,000 applications per month

Read the full Oklahoma Healthcare Authority case study or learn more about the use of InRule in the public sector. Additionally, read about Policy to Practice®, InRule’s unique approach to aligning HHS policy with State and Local eligibility systems that improves effectiveness and quality, lowers cost, and mitigates risk.