Insurance Eligibility Workflow Engine - A Case Study

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An e-Business application that computerizes eligibility workflow through a flexible, rule-based engine requiring no programming, this application enables quick authoring and implementation in the face of changing eligibility policies and regulations.

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Insurance Eligibility Workflow Engine - A Case Study

  1. 1. HSTC301<br />ELIGIBILITY RULES <br />FOR INSURANCE ECOMMERCE PORTAL<br />www.harbinger-systems.com<br />
  2. 2. HARBINGER SYSTEMS<br />Overview<br />Harbinger Systems is a leading provider of software engineering services to some of the world's best product companies. Our services span solution consulting, software design, development, testing and test automation.<br />By leveraging cutting-edge technologies, Harbinger Systems works with its customers as a partner in technology innovation.<br />Services<br /><ul><li>Software Product Development
  3. 3. Web 2.0
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  8. 8. Digital Marketing</li></ul>A Harbinger Systems Case Study<br />www.harbinger-systems.com<br />Follow Us<br /><ul><li>blog.harbinger-systems.com
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  12. 12. www.linkedin.com/companies/382306</li></ul>Also Read Our White Papers…<br />Interactive User Experience (IUX): Going Beyond Interfaces<br />Comparing Adobe Flex & JavaScript<br />The Enterprise Software Makeover Guide<br />Five Javascript Frameworks: A Point-by-point Comparison<br />www.harbinger-systems.com<br />
  13. 13. ELIGIBILITY RULES FOR INSURANCE ECOMMERCE PORTAL<br />Challenge<br />Eligibility rules needed to be flexible and easily configurable<br />Rules change frequently with time due to changing policies and regulations<br />Rules implementation required automation with no programming<br />Situation<br />A brick-and-mortar insurance company creating an e-Business app to computerize eligibility workflow<br />Harbinger Solution<br />A binary-tree-based eligibility encoding proposed<br />Intermediate nodes were eligibility questions and terminating node were actions<br />Oracle RDBMS tables used to encode binary tree structure of eligibility workflow<br />The largely static eligibility question nodes were encoded as DB stored procedures<br />COM component developed to run through encoded paths and fire questions to arrive at required action<br />Technologies & Tools<br />Oracle RDBMS<br />Binary tree representation in RDBMS tables<br />Component Object Model (COM)<br />Benefits<br />Company encodes insurance eligibility workflow automation with no-programming<br />Frequent changes in eligibility can be incorporated within hours instead of days<br />BOTTOM LINE<br />Company implemented a complex workflow automation that required no programming and maximum flexibility to match frequent future changes<br />www.harbinger-systems.com<br />HSTC301<br />

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