FICO Platform orchestrates the process of getting the right information to the right constituents at the right time to ensure successful enrollment. FICO Platform’s decision management capabilities empower business users to build and maintain applications to enroll members, scrub data, update systems, and communicate with members to minimize administrative burdens and processing across the enrollment lifecycle.

FICO Platform provides a top-rated foundation for automated decisioning in a wide range of industry segments. According to industry research, health care medical and claims processing ranks among the lowest in overall customer satisfaction compared to retail, banking, travel, and other industries. Omnichannel augmented intelligence in FICO Platform delivers 360-degree context and two-way communication to improve patient experience, reduce costs, and improve outcomes.

FICO Platform is the ideal foundation for network and provider management firms for whom outcome equals income, and all parties are striving for cost efficiency. FICO Platform capabilities power contract management using business rules to accurately administer pricing and perform complex contract simulations. Non-technical business users can quickly become proficient in mastering the system, with little to no dependencies on IT. Transparency and compliance are thoroughly and automatically traceable from strategy planning, down to each live transaction.

FICO Platform supports the types of transparent methodologies that can translate best evidence into clinical practice for improved patient outcomes and patient safety. FICO Platform delivers decision modeling capabilities that will empower business users to leverage existing analytic investments, promote collaboration between clinical and data scientist roles, and ensure regulatory compliance with traceable and explainable decisions.

FICO Platform allows medical organizations to easily and accurately manage pharmacy benefits and dispense orders at scale. Top PBMs and retail pharmacies use FICO Platform capabilities to administer rebates, formularies, compliance, interaction libraries, and routing decisions. The system also empowers business and clinical users to respond quickly to changes without depending on IT or vendor support.

FICO Platform allows organizations struggling with legacy custom claims management systems and commercial off-the-shelf software solutions to keep up with the demands of business changes and digital transformation. FICO has batch, real-time, and streaming digital decision capabilities that are rapidly developed with no-code and easily deployed. Update claim edits, routing, and reason codes and incorporate FICO’s juggernaut machine learning capabilities to detect fraud, waste, and abuse in real time.

FICO Platform leverages cloud computing innovations, consumer insights, and advanced analytics to leverage personalized and effective digital intervention strategies. FICO Platform includes award-winning capabilities that have long been a part of leading commercial and insurance care management applications and top health plans’ solutions for segmenting member populations, risk scoring of members, identifying care pathways, generating clinical alerts, and and countless more healthcare claims and automation services.