VSP IMPLEMENTS ILOG RULES SYSTEM TO IMPROVE CLAIMS PROCESS

Seeking to build a high degree of agility into its new claims system, Vision Service Plan (VSP) has implemented Mountain View, CA-based ILOG's BRMS (Business Rules Management System), which will support the carrier's long-term goal of pushing business rules maintenance beyond the exclusive purview of its IT organization.

VSP (Rancho Cordova, CA, $1.8 billion annual in gross revenue), the nation's largest provider of vision care insurance coverage, sought to consolidate its separate medical and eyewear line-of-business claim systems, according to Kyle Kelt, director of information technology. "At the same time we were addressing a new run-time and development architecture based on Java and EJB, and so we decided we needed a rules engine to accompany that architecture, so we could consolidate all of our business rules in a single repository with an easy-to-use interface to update and create those rules," he says.

Moving to a single set of rules improves ease-of-business on the front end -- especially for payors dealing with both lines of business -- and provides a single view of the outcome of claims processing, Kelt adds.

VSP's more than 36 million-member base requires the processing of approximately one million claims per month, primarily over the Internet. "The new architecture is designed to deal with that, and we realized we needed a rules engine as part of it to execute claims-related rules quickly," Kelt says. "We made that requirement with ILOG, as it's probably the smallest part of execution time for running a claims through."

The ILOG portion of the implementation was also one of the less time-consuming aspects of the system consolidation project, which began in late 1999 and now is in the roll-out stage, according to Kelt.

In addition to the immediate benefits of a single centralized set of business rules, the ILOG solution provides the foundation for longer-term benefits. "Extending business rule maintenance out to the business community is one of my key goals," Kelt says. Before reaching that goal, the IT organization needs to segment a portion of rules suitable for business use. "The advantage to us will be speed and flexibility," he explains. "If we can get those rules directly out into the hands of the people who implement them in the business, then they can respond to changing market demands and conditions and support our clients better in that regard."

Given the scale of VSP as a healthcare provider, "we're very happy they're working with us," as leverage to offering services more broadly to the insurance industry, says Maneeza Malik, ILOG's industry marketing director, financial services. "As insurance companies mesh systems together, moving from legacy to open technologies, they need a technology that they can leverage across the board, and that technology is business rules."

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio