Enterprise Rules Adjudication Engine

Engine capabilities

• Real-time decision engine

  Designed for synchronous evaluation so a decision can return inside the dispensing workflow, subject to measured deployment performance.

• No-code rule configuration

  Designed so policy teams can build and edit rules through a configuration interface, subject to the contracted deployment scope.

• AI-assisted rule creation

  Designed to let teams draft a rule in plain language and review proposed structured logic before approval.

• Clinical protocols

  Designed to encode clinical protocols — including step therapy, chronic disease pathways and dose optimisation — for consistent application.

• Benefit rules

  Supports configuration targets for eligibility, coverage tiers, co-payments, quantity limits and authorisation pathways by payer and plan.

• National formulary rules

  Designed to support centrally maintained national formulary rules across participating pharmacies.

• ICD-10 integration

  Integration-ready for ICD-10 validation workflows where diagnosis context is available.

• CPT integration

  Integration-ready for CPT procedure context in benefit and clinical decision workflows.

• Drug database integration

  Designed to integrate licensed drug databases for interactions, classes, strengths and equivalents.

• Audit trail

  Target audit capability retains inputs, triggered rules and outcomes for reproducibility.

• Version control

  Target version-control capability maintains rule-set history, including changes and responsible users.