BRMS-based System To Reduce Claim Fraud and Costs by 30 Percent
SUNNYVALE, Calif., Oct. 1 /PRNewswire-FirstCall/ -- ILOG(R) (Nasdaq: ILOG, Euronext: ILO, ISIN: FR0004042364) today announced that Swiss Medical Group, a leading medical services provider in Argentina, is using ILOG JRules(R) to automate its medical claims processing. With the new Claims Excellence Application(R), Swiss Medical has been able to reduce unnecessary medical treatments, provide faster payments to practitioners, and lower incidents of fraud and abuse. With ILOG JRules as a key part of its new, more efficient system, Swiss Medical is able to automate rules across multiple clinics while reducing costs.
Swiss Medical has grown to over 60,000 practitioners and 730,000 patients in the past 18 years by providing extra services using a personalized plan. With over 2 million claims per month, a laborious and vulnerable paper-based system for claims processing became inefficient. ILOG JRules was incorporated into Swiss Medical's automated system to unify business rules throughout Swiss Medical's entities and to streamline its claims processing. With ILOG JRules, Swiss Medical is automating such functions as fraud detection, claim assignment and adjudication, and payment and settlement.
"ILOG has been instrumental in helping us implement our Claims Excellence Management project," said Luciano Graffi, database administrator, application architecture and operations management, Swiss Medical Group. "This project focused on achieving short- and medium-term monetary gains by incorporating a wide set of rules that span across the claims process. Using ILOG JRules to standardize our claims process, we have reached our goals of becoming paperless, eliminating process silos, and reducing fraud and abuse. In addition, the new system has enabled us to reduce claim costs and fraud by an estimated 30 percent, resulting in significant savings."
Automating the claims process and
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