Customers
Coverage across Australia
Insurer fast-tracks claims
Straight-through processing (STP) health insurance claims with a .NET solution is definitely doable, as Hospitals Contribution Fund (HCF: www.hcf.com.au) can attest.
Australia’s fourth largest health fund, HCF has more than 423,000 health insurance memberships covering over 978,000 people, and provides more than 341,000 policyholders with life insurance. On average, HCF processes 27,000 claims per day. This requires a software solution that consistently and fairly validates, reviews and settles claims.
HCF’s solution is an underwriting system based on ILOG Rules for .NET, ILOG’s business rule management system (BRMS) for the Microsoft .NET platform. As a key component in an automated claims adjudication and payment system, ILOG Rules for .NET greatly reduces the costs associated with processing claims.
Automated response
The BRMS-based system lets HCF eliminate redundant data and quickly respond to changes in business and government regulations. Policies are captured in business rules and stored in a central repository that ILOG Rules for .NET makes accessible to business users. Rule changes are made in days, instead of weeks, and only three people are needed to manage the system.
HCF has reduced the time required to evaluate and settle claims by about 30 percent, and has achieved an automation rate of 80 percent. The system also makes fraud detection an integral part of the claims process so that HCF can spot suspicious claims early.
“A BRMS was the right strategy, and ILOG’s solution was the right choice,” says Patrick Shearman, chief information officer at HCF and chairman of ILOG’s BRMS user group in Australia. “ILOG Rules for .NET fits well into our architecture. The BRMS also provides flexibility for our future needs and enables IT and business to collaborate to manage business rules. Not only have we realized the vision of STP, ILOG’s BRMS has assisted HCF to become a leader in the field of claims automation by being the first health insurance entity in Australia to implement it.”
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Bringing more to those who need help
Support for the dependent
When Spain passed a law promoting care and autonomy for its dependent people, including the elderly and disabled, the country’s 17 autonomous regions were given the job of implementing it. In the Castilla y León region (www.jcyl.es), the Social Services agency responded by reengineering its IT systems to accommodate the law’s precise eligibility criteria, which could best be addressed with automated decision making.
As part of the project, called Social Services Unified Access System (SAUSS), the agency placed all of its programs under a central process management system to automate much of the work and shorten the time for delivering services. The agency selected an IBM FileNet BPM system to process requests, and Microstrategy to calculate statistics and perform scorecard balancing.
To facilitate the development, deployment and maintenance of the business rules governing the complex decisions applied by the system, the agency chose ILOG JRules, the market-leading ILOG business rule management system (BRMS). ILOG JRules provided a complete life-cycle rule management environment that supported both business and IT users.
Rapid service
The new system has greatly improved the productivity of approximately 600 of the agency’s personnel by helping them handle the greater workload resulting from the new law. The system does most of the paperwork, allowing agency staff to focus on exceptional cases.
On average, requests for social services are processed faster, and benefits delivered more quickly. The system has also enabled the agency to implement a clear process that requires less interaction between applicants and agency administrators. It allows the agency to provide transparent and fair decisions through consistent scoring and application of eligibility criteria across all the agency’s centers.
“We identified the business rule management system as a key component for improving the agility of our IT architecture in order to cope with regulatory and internal policy changes,” explains José Maria Molina, IT project director at Social Services. “We chose ILOG JRules because of the depth of its functionality, robustness, and ease of use and integration.”
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Better service for policyholders
Quotes delivered in five seconds
Triple-digit growth is desirable in any market, but with it comes intense pressure to perform. Anbang Property and Casualty Insurance (www.ab-insurance.com) has been in this enviable position for three years, and adopted ILOG JRules, the market-leading ILOG business rule management system (BRMS), to further improve operations.
Anbang is one of China’s leading insurance companies. With 37 branches and 300 subbranches, it operates in all the provinces and major cities in China, and it lists Fortune 500 companies Sinopec and SAIC as major shareholders. As a result of its triple-digit growth, Anbang must process more than 10,000 policies per day. Manually handling so many requests can create bottlenecks that stifle efficiency and growth.
Over 10,000 policies per day
With ILOG JRules, Anbang has automated its entire underwriting process, enabling the company to process over 10,000 policies per day while ensuring consistent adherence to underwriting guidelines. The BRMS automates such functions as eligibility checking, risk assessment, scoring, rating and quote generation.
The new system has greatly reduced the time needed to implement rule changes – from weeks to just days – and enables Anbang to deliver quotes within five seconds. Policy requests move through faster, and Anbang’s pass-through rate has increased to over 70 percent.
“We chose ILOG JRules because it addressed our requirements on all fronts,” says Hailan Yu, vice general manager, IT, Anbang. “With JRules, we were able to extend rule management capabilities to our business users, and have a technology in place that provides us with the flexibility we need to support our rapidly changing IT and business environment.”
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KineMatik interface enhanced with ILOG JViews Gantt
Coordinating life science projects
Advances in the life sciences come from intensive R&D projects spanning teams, departments and even different organizations. Project management software has become essential for keeping research programs on track by coordinating activities and providing a central resource for planning and scheduling work, sharing files and viewing status information.
KineMatik (www.kinematik.com) specializes in collaborative enterprise solutions for the life sciences. The company’s flagship product, eNovator, enables organizations to capture, manage and reuse data and other information through a suite of specialized modules: Electronic Lab Notebook, Learning Management Systems, Quality Management System, Navigation Module, and Project & Portfolio Management (PPM).
Dynamic interface
The PPM module serves as a central resource for coordinating activities. To enhance and streamline the module’s interface, KineMatik selected ILOG JViews Gantt. For more than a decade, ILOG Gantt charts have been used to accurately and intuitively visualize interactive schedules. They can display information in real time and let users test changes or implement actions through onscreen editing.
KineMatik tested other visualization systems before deciding that ILOG JViews Gantt was the best one for improving the PPM interface. With help from an ILOG presales team, KineMatik determined that the best approach to the problem was to use a Java applet solution. KineMatik integrated ILOG JViews Gantt into the latest version of PPM in just three man-months, an achievement credited to the quality and easy customization of the ILOG product.
“Happier end users are the biggest business benefit we have seen so far,” says Fergal Cott, senior software engineer at KineMatik. “Our latest product release incorporating ILOG JViews Gantt has been very well received by our customers. From a technical standpoint, our logic has been greatly simplified and future features will be easily met by our solution.”
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Storage yards at Singapore port
Optimized container transshipment
The turnaround time for a container ship in port depends greatly upon the efficiency of the port’s cargo-handling facilities. Every activity, including storage, ground transportation and loading, must be optimally planned to achieve the fastest and safest turnaround.
As the largest container transshipment hub, PSA Singapore Terminals (www.singaporepsa.com) operates some of the most modern and efficient facilities in the shipping industry. The company handles one-fifth of the world’s container transshipment throughput, and serves 200 shipping lines with connections to 600 ports in 123 countries.
Fast, accurate yard and vessel planning are essential to the company’s operations. When a ship comes in, its containers must be offloaded and temporarily stored until they can be loaded onto other vessels. For this pivotal operation, PSA Singapore Terminals uses an intelligent yard planning solution based on ILOG Constraint Programming (CP).
ILOG CP quickly finds feasible solutions to difficult constraint satisfaction problems. In this application, it has to meet a stringent set of safety and operational conditions in assigning temporary yard locations to containers waiting for connecting vessels.
ILOG CP also serves in an intelligent ship planning module that determines the order in which containers are moved from the storage yard and loaded onto a vessel. A good loading plan can take several hours to do manually, but with ILOG CP, the ship planning module can produce a plan in less than 30 minutes.
PSA Singapore Terminals is widely recognized as an industry benchmark for port efficiency, reliability and professionalism. ILOG optimization helps the company balance customer service goals and improve staff productivity, while taking into account the port’s resources and capabilities.
“ILOG optimization technology has allowed us to improve operational efficiency for yard and vessel planning,” says Chua Kee Thiam, head of Information Technology, PSA Singapore Terminals, “while taking into account available resources and operating constraints.”
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Robot at Carnegie Mellon University
Directing search and rescue robots
Rescue workers risk their lives daily to help those struck by disaster. To save more lives, remotely controlled robots are increasingly being used to search for survivors. Planning is crucial to their operation, as a robot must systematically cover an area and perform certain tasks under specific conditions to improve its chances of success.
A leading authority in its field, the Robotics Institute of Carnegie Mellon University (www.ri.cmu.edu) has focused much of its research on optimizing the search activities of rescue robots. The institute has created the Constraint Optimization Coordination Architecture (COCoA), a solution that uses goals and site-specific information to create task schedules that can be performed by robots. To be effective, COCoA must render solutions in real time. It does this by using anytime algorithms, which are designed to produce a solution whenever they are interrupted, with domain-specific heuristics and ILOG CPLEX, the market-leading mathematical optimizer. Unlike other solvers tested for this program, ILOG CPLEX consistently delivers workable solutions in seconds, giving COCoA the responsiveness needed for real rescue operations.
“ILOG CPLEX is recognized as the best software in the world for solving MILPs [mixed integer linear programs],” says Mary Koes, COCoA project developer at CMU. “We didn’t have to reinvent the wheel and write our own libraries, which allowed us to focus on the problem modeling and anytime algorithms.”
COCoA covers an entire problem, including goals, time limits and a map of the rescue site, and produces search schedules that list even small tasks such as “shut off circuit breakers before completing other goals.” Its possibilities may go beyond search and rescue to areas that include remote exploration for natural resources.