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Medscheme Transforms Claims Management Efficiency using FICO Decision Technology

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  • Medscheme has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day, based on FICO® Blaze Advisor™ decision rules management system
  • Medscheme won the 2018 FICO® Decisions Award for Decision Management Innovation
  • Medscheme is one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector

Medscheme, one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector, has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day. The innovative solution, powered by FICO® Blaze Advisor™ decision rules management system, reduced claim interventions by 15 percent 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.

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“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 modernizing 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.”

“Our focus is on efficient and effective administration services that are optimized and responsive to varying medical scheme needs at any given time,” said Andrew Wright, executive manager for Shared and Support Services at Medscheme. “We thus need to constantly challenge the way we work and where we wish to invest in enhancing our broader healthcare administration capabilities that will ensure they are relevant into the future.

“Furthermore, Medscheme requires flexibility in its claims capability, which is especially important today as we bring on board new clients with thousands of members with their own set of rules. Our claims engine needs to easily accommodate the variety of client scheme needs and integrate seamlessly with our core administration system, with very little room for errors or delays.”

Transforming a Legacy System
In rebuilding their claims management system, Medscheme had clear requirements. They needed modern, scalable technology that could support their needs into the future, integrate well with the rest of their IT infrastructure, and meet stringent SLAs for claim review times. The new system had to make rules and policies visible, be accessible to business and technical teams, and be much easier and quicker to change.

“The business rules that informed our decisions in our claims processing were mostly locked up in code, data and people’s minds,” explained Sleem. “We had to discover them, document them and move them swiftly into the new system. FICO has been a terrific partner for us in this effort.”

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.”

Due to the high volume and complex rules associated with medical claims, Medscheme needed to think carefully about performance. “We use Hazelcast to cache information related to our clinical data that does not have a high frequency of change,” Britz said. “This allowed for the decision engine itself to remain stateless, while having frequently used information a lot ‘closer’ to the engines, which drastically improved speed. To further improve performance, we enhanced the components that serialize and de-serialize the incoming and outgoing requests to and from Blaze Advisor. We also have moved to a semi de-normalized object model inside Blaze Advisor, which gives us the most efficient way of rule writing and execution at runtime.”

Clear Benefits to Modernization
Medscheme has recorded a number of benefits of their new system:

  • Fast processing of an average of 400,000 claim lines per day
  • Easy to respond to a query about a decision, due to fully documented business rules
  • Claim interventions reduced by 15 percent over a six-month period
  • 99.9% uptime — a stable product on a stable platform with the ability to do online deployments
  • Ability to respond quickly to market changes and varied client requirements
  • Multiple resources able to work on multiple changes to the decision services code at a time
  • A consolidated rules management repository enables flexibility and traceability of decisions
  • More agile rule capabilities for changing benefit designs, allowing for increased volume and complexity

“We are impressed by the technical ingenuity of the Medscheme team,” said Nikhil Behl, vice president of marketing at FICO. “This is a fantastic solution to a common problem — modernizing a legacy system to improve efficiency and customer satisfaction.”

FICO® Blaze Advisor™ decision rules management system gives businesses maximum control over high-volume operational decisions. Blaze Advisor provides companies with a scalable solution that delivers unprecedented agility and actionability for smarter business decisions. FICO Blaze Advisor is part of the groundbreaking FICO® Decision Management Suite for building and deploying decision management applications.

 

Photo source: SOURCE FICO

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VersaPay Announces Dream Office REIT as Newest CRE Client

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VersaPay Corporation (TSXV: VPY) (“VersaPay”), a leading provider of cloud-based invoice-to-cash solutions including electronic invoice presentment and payment, automated accounts receivable, cash application and collections management, is pleased to announce that it has added Dream Office REIT (“Dream Office”) as its newest commercial real estate client.

“With our real estate portfolio expanding in Canada and the US, our objective is to enhance our tenants’ experience and provide them with a convenient web-based and mobile portal where they can access their account, retrieve invoices, communicate and make secure electronic payments,” stated Joanne Leitch, Vice President, Property and Operations Accounting at Dream Office. “We want to create efficiencies by eliminating manual processes, minimize errors and reduce the need for tenant account reconciliations. VersaPay offered the platform to make all of this possible.”

“Through our vendor selection process we searched for a company who could provide a platform with extensive functionality with whom we could partner to provide our tenants an improved experience. VersaPay provided what we were looking for in addition to a robust integration with our JD Edwards ERP to provide real-time AR and cash review,” stated Travis Vokey, Vice President and Head of Technology for Dream Office.

“We are so pleased to be working with Dream Office, a forward-thinking Commercial Real Estate company located right here in Toronto,” said Craig O’Neill, CEO of VersaPay. “Dream is a leader in its industry, offering high-quality central business district office properties to an impressive list of tenants. One of the keys to its success has been providing tenants with a market leading experience in all facets of the business, and we’re delighted to extend this to their tenants’ experience in billing and payments.”

 

SOURCE VersaPay Corporation

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Xoom Rolls Out Domestic Money Transfer Services in the U.S.

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Xoom, PayPal’s international money transfer service, today rolled out the ability for customers to send money to recipients in the U.S. for the first time. Through strategic alliances with Walmart and Ria, Americans can now use Xoom to send money fast for cash pick-up typically in minutes at nearly 5,000 locations across the country*.

Xoom’s services potentially benefit more than 44 million foreign-born people in the U.S.1 who send remittances to family and friends in their home countries. With the introduction of domestic money transfer services, Xoom will now serve even more customers, including more than half of Americans who make domestic person-to-person (P2P) payments2. Using Xoom’s mobile app or website, consumers will have the ability to send money quickly and securely for cash pick-up at any Walmart or Ria-owned store in the U.S.

“Many of our customers in the U.S. already send money to loved ones in the country, and they usually prefer that the money is available right away,” shared Julian King, Xoom’s Vice President and General Manager. “This rollout reinforces our commitment to make money transfers fast, easy and affordable for everyone, whether they are at home or on-the-go.”

“At Ria, we are delighted to further consolidate our relationship with Xoom and Walmart,” said Juan Bianchi, CEO of Euronet’s Money Transfer Segment. “Our continued partnership is a fine example of how Ria’s technology can serve as an enabler between platforms, offering consumers and partners an added layer of security and compliance screening, in turn facilitating value creation within the Fintech ecosystem.”

Many consumers in the U.S. face personal, institutional and policy-related barriers to access the financial system. These underbanked consumers rely heavily on fringe financial service providers to conduct routine financial transactions and pay high fees in the process. With Xoom’s introduction of domestic transfers, Americans can send money at affordable rates for cash pick-up quickly at 4,684 Walmart stores and 175 Ria locations across the United States. For more information on store locations and eligible banks, visit xoom.com.

A pioneer in digital remittances, Xoom is a fast way to securely send money, pay bills and reload phones for loved ones in over 160 countries globally. These remittances serve as a lifeline for many people around the world and are used to pay for every day needs like utility bills, healthcare, and education costs, as well as emergencies. The largely cash-based system of sending money across borders is full of paperwork, high fees, standing in line and an ever-present uncertainty of when, and if, the money will arrive when it’s needed. By providing fast and more secure payment options for customers to seamlessly and securely send money across borders by going online or using a mobile device, PayPal and Xoom are helping to expand and improve the financial health of millions of people worldwide.

*Fees and Limitations apply

 

SOURCE PayPal, Inc.

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SpeakEasy Awarded Cultivation, Processing and Cannabis Sales Licence by Health Canada

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SpeakEasy Cannabis Club Ltd. (CSE: EASY) (Frankfurt: 39H) (“SpeakEasy” or the “Company“) is pleased to announce that it has received Health Canada’s coveted licence for cultivation, processing and medical sales. The Company, situated on 290 acres of fertile land in the Okanagan’s renowned Golden Mile, has demonstrated adherence to the industry’s rigorous compliance standards, and can now grow and provide its high quality, small-batch cannabis to the burgeoning recreational and medical markets.

With the receipt of the licences, the Company has immediately begun cultivation of cannabis in its 10,000-square-foot, purpose-built, state of the art facility. The Company has aquired an extensive library of unique genetics that will be used as starting material for the cultivation of cannabis at the facility.

SpeakEasy’s outdoor cultivation site has also been completed and stands ready to receive these genetics for the 2020 growing season. SpeakEasy plans to submit its evidence package for the outdoor field and amend its licence to allow outdoor cultivation on its 60 acre field. “Receiving our licence at long last, is a dream come true for all of us in the SpeakEasy family. The support we have received from shareholders, employees, family and friends has been overwhelming and I appreciate you all more than I can say,” says Marc Geen, founder of SpeakEasy. “When it comes to producing phenomenal craft cannabis, farms will always be superior to factories and culture will always speak louder than corporations. Real people recognize authenticity and SpeakEasy intends to lead by example, sharing the story of our people through the excellence of our product.” With the anticipation of receiving its outdoor licence, SpeakEasy is positioned to become one of the largest cannabis producers in Canada with extremely low cost per gram outdoor grown flower and extremely high quality small batch indoor flower.

SpeakEasy recently completed the transformation of a 60 acre orchard into a custom built outdoor cannabis cultivation environment. The fertile agricultural land is expected to enable the farm to produce up to approximately 70,000kg of cannabis flower and the Company plans to double the output to up to approximately 150,000kg, pending approval of its outdoor cultivation licence.

Construction commenced in the fall of 2017 on the 80,000-square-foot SpeakEasy campus in anticipation of demand for SpeakEasy’s craft cannabis flower and value added products. Buildings two and three were completed to lock-up in the second quarter of 2019 and building four, another 26,600-square-foot facility commenced in the spring of 2019 and is also at the lock-up stage of its development. The anticipated use of building four is the processing of sun grown outdoor flower and biomass for extraction. SpeakEasy has accumulated an impressive library of unique genetics from sources outside existing licence holders, empowering the Company to develop new strains, unique to SpeakEasy, for both indoor and outdoor cultivation.

SpeakEasy founders and team members are long standing advocates for the value of community and harnessing the power of combined expertise through successful farming cooperatives. SpeakEasy now plans to apply the same values for cannabis farming. SpeakEasy’s innovative business model is designed to support industry-leading talent through shared knowledge, resources and passion, with a commitment to maintaining exceptional quality standards and developing unique cannabis strains. The Company empowers experienced growers and geneticists to operate independently with the freedom to develop each cultivar to perfection.

 

SOURCE Speakeasy Cannabis Club Ltd.

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