Swiss Medical Group Selects ILOG JRules to Streamline Claims Processing

Logistics Insight Asia - New Products, 13/10/2008

ILOG has announced that Swiss Medical Group, a leading medical services provider in Argentina, is using ILOG JRules to automate its medical claims processing. With the new Claims Excellence Application, 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.

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.

ILOG, www.ilog.com.