Business Rule Configuration

Automate business operations
Enhance accuracy and effectiveness of claims 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 and has 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 the right training and experience to help our customers through the process of developing, testing, and implementing a custom BRC workflow. With this approach you are assured maximum efficiency and accuracy in your claims administration 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 for all your operational processes. We collaborate with you at every step of the way, understanding the finer nuances of your business and 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 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

New challenges emerge for healthcare payers in COVID-19 era

As the world starts to open up gradually, healthcare payers are trying to get a grip on a new set of challenges that have risen due to the pandemic.


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