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.

Our business rule configuration ensures timely and accurate benefits and plan setup aligned with the Schedule of Benefits, enhancing auto-adjudication rates and increasing claims processing efficiency.

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
Our healthcare business rule configuration includes thorough testing and validation to ensure the accuracy and reliability of benefit configuration changes, minimizing errors and ensuring seamless operations.
We enable a faster time-to-market for new products and benefit configurations, allowing you to capitalize on market opportunities promptly.
Our solutions ensure that your benefits configuration meets regulatory requirements, reducing the risk of penalties and ensuring compliance with industry standards.
As part of a structured business administration process, our configurations drive clarity, consistency, and governance across all operational workflows.

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

MDI Advantage

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Optimize Claims Workflow

By infusing technology into operations and incorporating standardization of processes, healthcare payers will notice significant ease and optimization in managing claims workflows and administering claims processes.
Our Business Rule Management System leverages automation capabilities to streamline the benefits of configuration processes, reducing manual work effort and maximizing system efficiency.
We enable scalable and precise Business Rule Configuration in payers, helping health plans implement decision frameworks that reflect contractual and regulatory requirements.

Icon of person speeding up time to represent the increase of claims auto-adjudication using business rule configuration.

Increase Auto-Adjudication

Our expertise in configuring benefits helps formulate the efficient algorithms to increase auto adjudication rate by a significant margin.

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Improve Processing Accuracy

With most processes automated, you are assured higher levels of accuracy in your claims operations. The result is greater process efficiencies in your organization.
By reducing errors, enhancing auto-adjudication rates, and streamlining claims processing, our solutions help you achieve better operational outcomes.

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Reduce Operational Uncertainty

We are committed to ensuring you greater operational efficiencies and accuracy through our business rules solutions. The simplified framework defines clear actions, thus reducing, if not eliminating, ambiguity in your claims operations.
Our efficient benefits configuration processes minimize administrative costs through global delivery, optimizing resource utilization and resulting in cost savings for your health plan.
Claim-level validation ensures proper provider reimbursement and member liability, thereby enhancing the integrity of the claims administration process.

Contract icon representing the relationship between business rule configuration and enhanced service levels guarantees.

Enhance Service Levels

Streamlined processes enhance operational efficiencies and lead to faster claims resolution and administrative processes. The simplified framework ensures greater customer satisfaction.

Discover New Insights

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

Reducing Escalations in 10-Day Appointments with InsightPro’s Real-Time Workflow Controls

Streamlining Enrollment Intake for a Regional Medicare Advantage Plan

Driving Accuracy and Confidence in Claims Adjudication at Scale

NPS Survey 2023

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