Business Rule Configuration (BRC) / Benefits Configuration

Automate business operations by enhancing accuracy and effectiveness of claims and administration processes.

What challenges do you face in your claims operations?

Typically, healthcare payers work in an environment that includes a significantly large number of provider contracts with multiple benefit plans. This can present numerous challenges in running seamless claims operations. Businesses can overcome these issues by setting up a standardized framework and decision paths that can simplify these complexities. The resultant automation of the primary claims adjudication and pricing decisions can help drive greater agility in your organization.

At MDI NetworX, we have put together a dedicated team of analysts that brings years of experience to help our customers through the processes of developing, testing, and implementing a custom healthcare business rule configuration workflow. With this approach, you are assured maximum efficiency and accuracy when administering claims processes.

How We Make It Work

At MDI NetworX, we understand that smooth running operational processes are key to faster claims resolution and better customer experiences. We capitalize on our technological architecture expertise and process discipline to design, develop, and configure business rules software for all your operational processes. We collaborate with you every step of the way, taking time to really understand the finer nuances of your business. Only then do we devise ways to help you perform your business tasks in the most efficient way possible. When you partner with us, you are assured a robust routine and control, as well as consistently standardized delivery for all operational processes.

Standardized healthcare business rules are a function of:
  • Provider Contracts
  • Member Plans
  • Claim Code Edit Policies
  • Allowable Reimbursements
  • Capitation Relationships
  • Pricing

MDI Advantage

Discover New Insights

Take a moment to go through our resource section where our data-driven insights can help improve your operational efficiency.

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