Wisconsin brings automation to Health Insurance Exchange

Corticon automatic rules engine will streamline eligibility process

Wisconsin officials hope to make it easier for people using the state’s health insurance exchange system to move as efficiently as possible through the eligibility process with minimal interaction from case workers.

The state is using Corticon’s automatic business rules engine with its HIX system to streamline the eligibility process. Many systems collect information and then determine a person’s eligibility later. However, Wisconsin’s system will determine eligibility upfront and then intelligently guide the information selection process, with little or no interaction with case workers, Corticon officials said.

The Patient Protection and Affordable Care Act (PPACA) created a new competitive private health insurance market – through State-run Health Insurance Exchanges – that will give individuals and small businesses access to affordable coverage. Through the marketplace potential buyers of health insurance can meet sellers and be guided through the eligibility process.

The Health and Human Services Department has $49 million in grants to help 48 states and the District of Columbia plan for and establish these health insurance exchanges. The Affordable Care Act recommends business rules engines as a key component of HIX systems, according to Corticon officials.

Wisconsin received an early innovator grant as part of health care reform and, as one of the seven early adopters of HIX, chose Corticon. Corticon’s Business Rules Management System employs a model-driven approach that lets business analysts and policy makers model and deploy business rules without the need for traditional programming.

About the Author

Rutrell Yasin is is a freelance technology writer for GCN.

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