Insurance Eligibility Workflow Engine - A Case Study

HSTC301
ELIGIBILITY RULES
FOR INSURANCE ECOMMERCE PORTAL
www.harbinger-systems.com

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A Harbinger Systems Case Study
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ELIGIBILITY RULES FOR INSURANCE ECOMMERCE PORTAL
Challenge
Eligibility rules needed to be flexible and easily configurable
Rules change frequently with time due to changing policies and regulations
Rules implementation required automation with no programming
Situation
A brick-and-mortar insurance company creating an e-Business app to computerize eligibility workflow
Harbinger Solution
A binary-tree-based eligibility encoding proposed
Intermediate nodes were eligibility questions and terminating node were actions
Oracle RDBMS tables used to encode binary tree structure of eligibility workflow
The largely static eligibility question nodes were encoded as DB stored procedures
COM component developed to run through encoded paths and fire questions to arrive at required action
Technologies & Tools
Oracle RDBMS
Binary tree representation in RDBMS tables
Component Object Model (COM)
Benefits
Company encodes insurance eligibility workflow automation with no-programming
Frequent changes in eligibility can be incorporated within hours instead of days
BOTTOM LINE
Company implemented a complex workflow automation that required no programming and maximum flexibility to match frequent future changes
HSTC301

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Insurance Eligibility Workflow Engine - A Case Study

by Harbinger Systems on Aug 31, 2009

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