Transcript:
0:01 hi everyone I'm Patrick from North52.
0:03 I'm here today with my colleague Bruce
0:04 to talk about how an r52 can help
0:06 insurance companies with first notice of
0:09 loss and claims processing systems Bruce
0:12 in a previous discussion you showed us
0:14 how North52 and the Microsoft Power
0:15 Platform can be used for streamlining
0:18 and automating the claims to policy
0:19 process
0:20 however now I'd like to take a look at
0:22 making claims using the same system
0:25 what is the main benefit of using a
0:27 business rules engine to automate the
0:29 claims adjudication process
0:30 well really it helps with making that
0:32 process more efficient and and more
0:34 accurate it leads to reduced claim times
0:37 we can also talk about lower costs and
0:40 then ultimately more satisfying
0:42 customers
0:43 can you describe the components involved
0:44 in implementing an automated claims
0:46 process for dental insurance using nor
0:48 52 decision Suite Microsoft dataverse
0:51 and power pages
0:53 sure you know power pages is the web
0:55 platform that enables customers to
0:57 submit that first notice of loss North
0:59 52 Powers the rules
1:01 behind the forms and the decision Logic
1:04 for example when a customer is
1:06 interacting with their form we might be
1:08 showing and hiding or validating the
1:09 information they put on that form
1:11 then Microsoft database provides a
1:14 database behind it that stores all the
1:15 information that we're submitting
1:17 there's some other rules that happen on
1:19 that submission of that data North52
1:21 rules engine Powers those rules as well
1:24 what are some of the coverage and
1:25 restriction records that policies can
1:27 have and how do they affect the
1:29 clearance process
1:30 well we're not really Bound By Any kind
1:32 of restrictions and what we can cover or
1:34 what we can't cover but for the dental
1:36 insurance demo system that we've shown
1:38 the types of restrictions for coverage
1:40 could include things like the term of
1:43 insurance you see how long the policy is
1:45 whether that's a rolling 24-month period
1:48 or a 12-month period the claim limit per
1:51 treatment type so for example you can
1:53 only claim for one tooth a particular
1:56 tooth in a given year
1:59 and you know how much the deductible is
2:01 you know how much are we willing what
2:02 percentage are we willing to pay out for
2:05 that particular treatment type so for
2:07 some treatments it might be 50 for
2:09 example sure
2:10 and then maybe whether there is a
2:12 waiting limit before the coverage starts
2:13 you know some treatments you might say
2:15 well you've got to wait six months
2:16 before the policy will cover those
2:18 so all of these limits of evaluated when
2:21 a claim is processed and the North52
2:23 rules engine determines that using all
2:25 that logic that we put in those rules
2:28 what is the purpose of the decision
2:30 tables and how are they used in the
2:31 claims adjudication process well
2:33 decision tables contain the logic that
2:36 we use to evaluate claims
2:39 and a decision table will be often made
2:42 up of multiple sheets and each sheet has
2:44 some decision logic to process that
2:46 claim validate whether there is that
2:48 coverage is available then maybe another
2:51 sheet will be looking at what is the
2:53 claim limit for that thing and so on and
2:56 then eventually we will get to a point
2:57 where we'll say whether the claim is
2:59 valid or not okay
3:03 can you explain Bruce how the North52
3:05 rules are defined and then used to make
3:08 automated decisions during the claims
3:10 adjudication process
3:11 yeah the rules are defined in the
3:13 decision tables using a variety of the
3:15 500 plus functions that we have
3:17 available within the North52 rules engine
3:20 for example one of the first checks for
3:22 a claim will be to determine whether the
3:25 the treatment type that they're claiming
3:26 for is actually covered sure secondly
3:29 we're going to be looking at whether the
3:31 date of loss is after the coverage start
3:34 date and before the coverage end date
3:37 and then the rule itself will use a
3:39 query function to find all the different
3:41 parameters associated with that
3:43 particular treatment
3:45 and then it checks those values against
3:47 the conditions that are set up in the
3:49 decision table okay if that validates
3:51 then we move on to the next check and so
3:54 on okay
3:56 how do the rules change when a claim
3:58 exceeds a certain threshold and needs to
4:00 be evaluated by a human team for example
4:02 yeah well in our demo scenario it's uh
4:04 the rules are actually quite simple
4:05 we've got years of Customer Loyalty
4:08 we've got a number of previous claims
4:11 and we also take into account the
4:13 automated adjustment amount or the
4:15 amount that we've discounted if that was
4:17 a factor within the um decision-making
4:19 process and if that is less than the
4:22 threshold amount then it will go through
4:25 if not the claim is given a status that
4:28 means a person must follow this up and
4:30 there will be a certain number of tasks
4:31 that they need to do that on a manual
4:32 basis
4:34 how can customers access their policies
4:36 and you know create claims using power
4:39 pages
4:40 yeah so power Pages allows insurers to
4:42 provide a secure access website to their
4:45 customers that could be secured by
4:48 two-factor authentication as well for
4:49 extra security yeah it also allows
4:52 customer data from database to be
4:53 surfaced so their policies previous
4:55 claims history Etc can be shown on that
4:58 website as well
4:59 and what we're using really is the other
5:01 box forms functionality layered with
5:04 North52 rules which allows us to do
5:06 things like field validation showing and
5:09 hiding sections based on certain
5:10 criteria and then obviously once that
5:13 form information is submitted for a
5:15 claim we can go through the claims
5:17 adjudication evaluation process and this
5:19 is all without using any custom code
5:21 whatsoever no JavaScript written no
5:23 c-sharp code it's all being done within
5:25 the North52 rules engine
5:27 are there any limitations or drawbacks
5:29 to using the North52 decision suite for
5:32 claims adjudication if so what are they
5:34 and how would they be addressed yeah
5:37 really the only limitation we face is
5:38 that the insurer will need to be
5:40 committed to using the Power Platform
5:42 but on the other hand that's not really
5:44 a limitation we see that as a massive
5:45 Advantage because you know it allows an
5:48 insurer to develop a system using North52
5:50 in the Power Platform at a much lower
5:52 cost than other competing systems
5:55 how can insurance providers benefit from
5:57 using automated claims processing and
5:59 how can that affect things like customer
6:01 satisfaction
6:03 well automated claims processing helps
6:05 insurance companies streamline their
6:07 operations it will reduce costs it'll
6:10 provide faster and more accurate service
6:12 to their clients
6:15 um and by improving this speed accuracy
6:17 and transparency to their clients it's
6:19 going to have a positive impact on that
6:21 customer satisfaction
6:22 and then obviously that will hopefully
6:24 build stronger relationships with those
6:26 customers who are more likely to return
6:27 and potentially buy more services
6:31 what advice would you give to any
6:32 insurance companies out there that are
6:34 considering using automated clearance
6:37 processing using something like
6:38 Microsoft Power Platform and in our 52's
6:40 decision Suites
6:42 well obviously you know they need to get
6:43 in touch with us either directly or via
6:45 their Power Platform partner there's a
6:48 lot of information on our website at
6:49 north52.com you can email us at sales
6:52 north of gc.com as well and of course
6:54 we'll be very happy to do a demo and if
6:57 we can take some of their requirements
6:58 we can do a proof of concept as well to
7:00 show them how it's going to work
7:05 [Music]
7:10 foreign