Medscheme has created a platform for its medical aid administration business, which reviews around 400 000 claim lines a day. The solution, powered by FICO® Blaze Advisor™ decision rules management system, has reduced claim interventions by 15% in a six-month period and has dramatically reduced the time needed to change business rules and strategies.
For its achievements, Medscheme won a 2018 FICO® Decisions Award for Decision Management Innovation.
“Our vision is to create a world with sustainable healthcare, and at the heart of our business is processing medical claims of members and healthcare providers,” said Denise Sleem, general manager and project lead at Medscheme. “By modernising our claims management capabilities, we have become more agile, more efficient and more effective, which means members and healthcare providers get faster answers on claims.”
Medscheme created a framework using cloud-native technologies including Kubernetes, Docker and Spring Boot, within which the FICO Blaze Advisor decision rules system runs. “This environment is extremely scalable, and can be used either on-premise or with any of the big three cloud provider spaces, and can be run in a hybrid model as well,” said Drikus Britz, lead solutions architect at Medscheme. “The solution allows for zero downtime deployments within a day should the need arise. We are running in an active-active mode across multiple data centers, allowing for almost zero downtime during disaster recovery situations for real-time claims.”