Administering claims accurately in an environment with a large number of provider contracts and multiple benefit plans is not easy. Business rules help manage this complexity with the help of standardized framework and decisions paths and help automate the primary claims adjudication and pricing decisions.

Our team of analysts have the required training and experience to help guide your organization through the process of developing, testing, and implementing a custom BRC workflow. Our approach maximizes both the efficiency and accuracy of your claims administration processes.

MDI Advantage

Optimize Claims Workflow

Increase Auto-Adjudication

Improve Processing Accuracy

Reduce Operational Uncertainty

Enhance Service Levels


MDI NetworX has the technological architecture and process discipline to design, develop and configure business rules for all operational processes. We work collaboratively with our clients and implement their way of doing business in the most efficient way possible. Our technology-enabled approach ensures a robust routine and control and consistent standardized delivery for all operational processes.

Business rules are a function of

  • Provider Contracts
  • Member Plans
  • Pricing
  • Allowable Reimbursements
  • Capitation Relationships
  • Claim Code Edit Policies

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