Hospitals Contribution Fund Australia
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"ILOG BRMS was the right strategy. Not only have we realized our vision of STP, ILOG Rules for .NET has assisted HCF to become a leader in the field of claims automation."

Patrick Shearman Chief Information Officer Hospitals Contribution Fund

Business
Hospitals Contribution Fund (HCF) is the fourth largest health fund in Australia. A not-forprofit organization, HCF covers nearly 1.5 million people with health and life insurance.

Goal
The fund belongs to a market that is constantly changing. More than 48 percent of the people in Australia are covered by private health insurance, and the country’s insurers frequently offer new products and services to remain competitive. The market is also closely monitored by the government, which often introduces new regulations. HCF used to rely on a custom-built C++ rule engine to automate decision making in its claims processing applications, but the engine’s rules were hard-coded and took at least a month to update. HCF needed a new claims assessment module designed to process more than 10,000 claims per day and support new offers, regulations and business demands.

Application
HCF found the answer in ILOG Rules for .NET, ILOG’s business rule management system (BRMS) for the Microsoft .NET platform. Business users can directly access the rules and implement policy changes in less than a day through a custom Web-based editor or Microsoft Office applications. ILOG Rules for .NET also allows HCF’s IT personnel to take full advantage of their preferred .NET development system and gives them a fast, highly scalable rule engine capable of real-time performance. With far better regulatory compliance and automated end-to-end processing that includes fraud detection, the new system has helped HCF’s straight through processing (STP) program by improving its automated pass-through rate by 80 percent.

Results
ILOG Rules for .NET has enabled HCF to automate its claims processing completely, furthering an initiative to standardize on STP. The new claims assessment module allows frequent changes for regulations and a quick response to new business requirements, and makes rules visible, or "transparent," to business users for a faster turnaround in updating the system.

Technical
ILOG Rules for .NET provides the ability to accelerate changes in an application to better support business needs and requirements.