Navigation Links
Swiss Medical Group Selects ILog JRules to Streamline Claims Processing
Date:9/30/2008

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 centrally maintaining and managing the business rules with the utmost of transparency have made a significant impact on improving efficiency. With the previous system, conspiracy to defraud between medical students, practitioners, patients and internal personnel was problematic and difficult to control. Today, deception is avoided by electronically processing claims using ILOG JRules and avoiding long-standing contracts between the claims processor and the practitioner.

Prior to automating the system, fraudulent claims were not easily identified; this resulted in payment for procedures not covered under the government's healthcare plan. Today, false claims are detected with ILOG JRules and are efficiently processed by determining what percentage of each procedure is covered by the government and which portion can be paid for by the Swiss Medical Group plan.

ILOG has consistently built on its history of product innovation to make it one of the industry's leading providers of business rule management systems (BRMS). Forrester Research has recognized ILOG as a resounding leader in Business rules platforms, including the sole leader in rules platforms for .NET, a leader in business rule platforms for Java, for business analysts and for overall feature sets. Customers of ILOG's award-winning BRMS products include eBay, Equifax, Grupo Santander, Travelocity, Visa and many other leading Global 2000 companies and governments worldwide. ILOG's BRMS product line includes ILOG JRules(R), ILOG Rules for .NET(R) and ILOG Rules for Cobol(R) To learn more about ILOG's BRMS products, please visit http://www.ilog.com/products/businessrules.

About ILOG

ILOG delivers software and services that empower customers to make better decisions faster and manage change and complexity. Over 3,000 corporations and more than 465 leading software vendors rely on ILOG's market-leading business rule management system (BRMS), supply chain planning and scheduling applications, as well as its optimization and visualization software components, to achieve dramatic returns on investment, create market-defining products and services, and sharpen their competitive edge. ILOG was founded in 1987 and employs more than 850 people worldwide. For more information, please visit http://www.ilog.com.

ILOG, ILOG JRules and ILOG Rules for .NET are registered trademarks of ILOG S.A. and ILOG, Inc. All other company and product names are trademarks of their respective owners.


'/>"/>
SOURCE ILOG
Copyright©2008 PR Newswire.
All rights reserved

Related medicine news :

1. Swiss study suggests surgery may offer best chance of long-term prostate cancer survival
2. First Pharmaceutical Company Comes to Hoboken, NJ: Swiss-Based Octapharma to Move U.S. Headquarters to SJP Properties Waterfront Corporate Center II
3. Swiss Systems Biology Initiative announces Flagship Projects
4. Swiss Institute of Bioinformatics announces major breakthrough
5. MSU engineering team designs innovative medical device
6. ATS Medical to Present at the 2007 Thomas Weisel Partners Healthcare Conference
7. Providence St. Joseph Medical Center, Caregivers Reach Agreement on a Union Contract
8. Owner and Operator of Florida Durable Medical Equipment Company Convicted of Medicare Fraud
9. Father and Daughter From Tanzania Receive Their First Medical Examination in Newport Beach
10. Doctors and medical ethicist discuss whether doctors should participate in capital punishment
11. Preparation for Natural Disasters Critical for People With Diabetes, Chronic Medical Conditions
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/26/2016)... , ... June 26, 2016 , ... Brent Kasmer, a legally blind and certified personal ... personalized through a fitness app. The fitness app plans to fix the two major problems ... offer a one size fits all type program , They don’t eliminate all ...
(Date:6/25/2016)... Austin, TX (PRWEB) , ... June 25, 2016 , ... ... Fellow of the American College of Mohs Surgery and to Dr. Russell Peckham for ... popular and highly effective treatment for skin cancer. The selective fellowship in Mohs Micrographic ...
(Date:6/25/2016)... ... June 25, 2016 , ... First Choice Emergency Room ... Dr. Sesan Ogunleye, as the Medical Director of its new Mesquite-Samuell Farm facility. ... of our new Mesquite location,” said Dr. James M. Muzzarelli, Executive Medical Director of ...
(Date:6/25/2016)... (PRWEB) , ... June 25, 2016 , ... On Friday, ... presented a Bronze Wellness at Work award to iHire in recognition of their exemplary ... part of the 7th annual Maryland Workplace Health & Wellness Symposium at the BWI ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... Those who ... with these feelings, many turn to unhealthy avenues, such as drug or alcohol abuse, ... Marne, Michigan, has released tools for healthy coping following a traumatic event. , Trauma ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... Research and Markets has announced the addition of the ... report to their offering. ... failure, it replaces the function of kidneys by removing the ... the treatment helps to keep the patient body,s electrolytes such ... Increasing number of ESRD patients & substantial healthcare expenditure on ...
(Date:6/23/2016)... DUBLIN , June 23, 2016 ... the "Pharmaceutical Excipients Market by Type (Organic Chemical ... Preservative), Formulation (Oral, Topical, Coating, Parenteral) - Global Forecast ... The global pharmaceutical excipients ... 2021 at a CAGR of 6.1% in the forecast ...
(Date:6/23/2016)... 23, 2016 Roche (SIX: RO, ROG; OTCQX: ... its Elecsys BRAHMS PCT (procalcitonin) assay as a dedicated ... shock. With this clearance, Roche is the first IVD ... solution for sepsis risk assessment and management. ... and PCT levels in blood can aid clinicians in ...
Breaking Medicine Technology: