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:1/17/2017)... ... January 17, 2017 , ... Achieve TMS West, ... opening a new office in San Clemente, California this month. Achieve TMS West ... California, successfully treating individuals struggling with major depression. Depression impacts over 15 million ...
(Date:1/17/2017)... ... January 17, 2017 , ... Peoples Health is ... Health network on Dec. 1, 2016. Peoples Health, a Metairie-based Medicare Advantage company, ... an exciting addition to our provider network, and the addition will benefit our ...
(Date:1/17/2017)... ... January 17, 2017 , ... SensorInsight ®, ... Sigfox in the U.S.A. to offer Internet of Things (IoT) solutions based ... large-scale environmental sensor deployments such as monitoring solutions used to detect potentially hazardous ...
(Date:1/17/2017)... ... January 17, 2017 , ... SC&H Group, a leading audit, tax, ... in its IT Advisory Services practice . Rossi is the third technology consulting ... for strategic IT guidance grows, and the practice continues to expand.     , Bringing more ...
(Date:1/17/2017)... ... 17, 2017 , ... Physicians Education Review®, LCC (PER®) announces ... for the 34th Annual Miami Breast Cancer Conference®, on March 9-12, 2017 at ... Talamo, said, “We are delighted to have Sandra Lee join us as our ...
Breaking Medicine News(10 mins):
(Date:1/17/2017)... YORK , Jan. 17, 2017 The ... 8.02 billion by 2021 from USD 6.35 billion in ... factors driving the growth of this market are rising ... demand for minimally invasive surgeries. The global ... procedure, application, and region. On the basis of type, ...
(Date:1/17/2017)... -- Jazz Pharmaceuticals plc (Nasdaq: JAZZ ) today announced ... Phase 3 clinical trial comparing the efficacy and safety ... prevention of hepatic veno-occlusive disease (VOD) in adult and ... are at high risk or at very high risk ... conducted across approximately 100 medical centers in ...
(Date:1/17/2017)... -- Market Research Future published a Half Cooked Research Report on Endoscopy ... USD 33.6 million during the period 2016 to 2022 from USD ... ... been examined as a swiftly growing market and expected to grow ... device in various regions.  The increasing growth in endoscopy procedures is ...
Breaking Medicine Technology: