The Solution
TEKNOVARE, working as a subcontractor, managed and delivered the business rules and rules engine for eligibility and claims processing system for this national healthcare provider.
During this engagement TEKNOVARE:
- Worked with the provider’s Policy and Compliance group to define the business rules for determining qualifying event dates for two specific healthcare programs.
- Implemented the qualifying event date rules using ILOG's JRules business rules management system.
- Integrated the qualifying event date rules engine to the provider's existing Cache eligibility system.
- Worked with the provider’s QA testing team to perform acceptance testing on the eligibility date calculation rule sets.
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