Case Study: U.S. Based Healthcare Company accelerates claims management with InRule

U.S. Based Healthcare Company Builds Claims Management Solution With Inrule® and Microsoft Dynamics® CRM

U.S. Based Healthcare Company, a U.S.-based provider of integrated pharmacy benefit management services, relied on a home-grown application integrated with Microsoft Dynamics CRM to manage doctors, drugs, referrals, billing, payments, and pharmacies. As the business grew, its hard-coded, manually maintained business rules became difficult to update, slowing changes to billing and payable processes. The company needed a more flexible way to let business users manage rules and reduce dependence on developers, and turned to InRule for a decision platform.

InRule implemented a low-code decision platform integrated with Microsoft Dynamics CRM to centralize and automate business rules for billing, payables, and claim processing. Using InRule’s irCatalog and decision services, the healthcare company can now manage contract terms and determine provider and patient payments in business language rather than hard-coded tables. The result was significant time and cost savings, faster billing and payable processing, and the ability to handle more claims while freeing IT staff for more strategic work.