NIB
InRule

NIB empowered to make changes to claim rules quickly, increasing productivity & speed to market whilst reducing claim fraud

Challenge

NIB’s claim solution was a combination of COTS, legacy systems (WHICS) and custom configuration
All rules were hard-coded into the solution, creating several problems for NIB:
- Difficulty in changing rules; one change could require engagement with a variety of IT resources; internal, external vendors, and in some cases, a specialist, if the change is needed to interact with legacy software
- Time consuming and costly to make a change
- Unable to justify adding new rules that were “low value” claim items, due to the excessive cost and manual workaround
- No control over the changes; many of the claims required manual review to ensure they were correct
- As the business rules were not centralised and easily managed, customers were able to make incorrect or multiple claims

NIB was looking for a BRE, to replace their existing legacy solution, as most of their rules were hard-coded across multiple systems, making them difficult to modify & implement
InRule was chosen for its flexibility, ease-of-use and scalability
Solentive worked with NIB to create a foundational package of best practice rules, and worked alongside NIB’s IT team to integrate InRule with their existing claim management systems
NIB’s internal IT & BA teams were trained to author the rules alongside Solentive’s InRule consultants, enabling NIB to take ownership of the system
InRule has proven to be a solution to all of NIB’s rules; the transfer of their Hospital and Ancillary Claims component is complete, and we are in the process of transitioning Medical Claims rules
Solentive continues to partner with NIB as part of their contingency plan, and all work is thoroughly documented ensuring corporate memory is not lost

With the implementation of InRule, business teams are no longer reliant on programming to add and update claim rules; with InRule, business analysts can author, test & manage rules
Streamlined delivery processes enables faster implementation of business rules, reducing ongoing IT costs
NIB is no longer reliant on third parties to manage their rules
The ability to write all rules regardless of value, reduces manual workarounds for smaller transaction items across the organisation
Technology is future-proof and can handle a large influx of claims
Manual claim review processes were eliminated, as InRule takes care of this process through automated business logic
Rules are accurately applied across different business units, reducing the likelihood of incorrect or fraudulent claims