American Community Mutual Insurance Company (ACMIC) Selects Corticon

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ACMIC reduces costs and improves service by automating claims processing with Corticon Business Rules Platform

We observed first hand the business benefits of the Corticon BRMS in an implementation at a subsidiary

Corticon Technologies , the leading provider of Business Rules Management Systems (BRMS) announces another successful customer project: American Community Mutual Insurance Company® (ACMIC) has gone live with an upgraded claims processing system built on Corticon BRMS.

For over 70 years, ACMIC has provided protection for healthcare expenses, offering a broad range of affordable traditional, HSA and other consumer-directed health insurance products for groups, individuals and families. ACMIC continually looks for ways to reduce the cost of health insurance without sacrificing service quality. One of the best ways is to automate claims processing, an expensive and time consuming process. By automating the claims process, insurance companies can accelerate claims payout, which improves customer satisfaction. At the same time, automation reduces costs by substantially reducing the amount of manual labor involved in claims review.

For over 20 years, ACMIC has been using the same mainframe-based claims system. One downside to this implementation is that there are many manual tasks still required outside the system, including adjudication, re-pricing, and exception handling. Furthermore, it is costly and time consuming to change the legacy system. ACMIC realized that a business rules engine could be used to automate the types of decision-making tasks inherent in claims processing. Thus, they evaluated the market to find the best possible solution.

ACMIC needed a rules engine that was easy to use, and could integrate with both their legacy environment and modern .NET systems. They needed a rules engine that was scalable and provided enterprise strength. After an extensive evaluation process, ACMIC chose Corticon's BRMS. According to ACMIC, Corticon is an easy-to-use, flexible product.

"We observed first hand the business benefits of the Corticon BRMS in an implementation at a subsidiary", stated Tim Waskiewicz, Enterprise Architect Manager at ACMIC. "The Corticon Business Rules Modeling Studio made the capture and editing of business rules a breeze, and facilitated the sharing of business rules among stakeholders because the logic was completely transparent. In addition, deployment of rules within our Service Oriented Architecture (SOA) was streamlined and simple."

The Corticon solution excelled in addressing ACMIC's most critical requirements, specifically

  •      Ease of Use: With the Corticon BRMS and its business-friendly, spreadsheet-like authoring environment, new users quickly became productive.
  •      Empower Business: ACMIC's goal is to empower subject matter experts to directly manage the business rules. One hundred percent of the business rules can be managed in Corticon's model-driven rule authoring environment. By contrast, other rules engines required complex rules to be managed by skilled programmers.
  •      Business agility: The ease of use and business empowerment of the Corticon solution yield accelerated application development. Changing business rules is now an exercise that can be measured in hours as opposed to weeks or months.

  •      Enterprise Strength: ACMIC needed a rules engine that could be used both for the current project, as well as for future projects. The product needed to scale across the enterprise, supporting multiple users and applications, while ensuring secure and controlled access to rule change. And, it needed to scale to support millions of transactions per day.

As a first project, ACMIC focused on claims routing, a part of the claims process that involves reviewing submitted claims against healthcare network contracts to ensure the appropriate re-pricing amounts. ACMIC found that Corticon could easily handle this problem and automate this part of the process.

After the initial success with the claims routing project, ACMIC has started to extend Corticon into other business domains. They are currently working to automate the claims adjudication and re-pricing process. In addition, they are looking at using Corticon in other areas of the business including contract administration, underwriting and self-service web portals.

"Corticon is pleased to help ACMIC transform their claims servicing process", said Dr. Mark Allen, CEO of Corticon Technologies, Inc. "We look forward to helping them extend this success to other areas of the business."

About Corticon Technologies
Corticon Technologies, Inc. delivers software solutions that unleash "The Power of DecisionsTM", helping organizations achieve unprecedented automation, agility and control of operational decision-making tasks. Many of the world's most successful organizations rely on Corticon's Business Rules Management System (BRMS) to discover, model, execute and improve their operational decisions in areas such as claims adjudication, underwriting, order processing, diagnostics, compliance and audit.

Corticon is a privately held company headquartered in Redwood City, California, with European headquarters in the Netherlands, worldwide distribution via regional offices and an extensive partner network. Recognized as a leading BRMS vendor by industry analysts and thought leaders, Corticon's products are in use today at many of the world's largest banks, insurance companies, media companies, telecommunication providers and government organizations, collectively automating millions of decisions per day.

About American Community
With beginnings dating back to 1938, American Community Mutual Insurance Company is one of the oldest health insurance companies in the nation. Based in Livonia, Michigan, American Community is currently licensed in 41 states. The company markets individual and group health insurance products in 14 states through an agency force of 14,000. For more information, visit http://www.american-community.com.

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Samira Abrari
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