Automated Triggers with 72 hour delay:
Should this claim be referred?
To make this decision we will need some rules.
Here are some of the sample rules provided by
We will walk through the entire process of modeling these rules, including the discovery of errors, ambiguities and incompleteness using Corticon Studio.
We’ll find that even these two apparently simple rules contain problems which Corticon will help us discover and resolve
By referring to the rule statements we can deduce the existence of objects such as these:
Case – the entity that is being considered for referral
This will be modeled in the Corticon vocabulary:
Figure 1 Client Business Object
This helps to make sure the data model makes sense
This can be done in the Corticon Testing tool which is built into Corticon.
We can also set up some expected results to verify that our rules are producing the answers we expect.
We’ll see during the demo how Corticon will automatically compare the actual and expected results and flag any variations once the rules have filled in the output column
Figure 2 Sample Test Data
There are no hard and fast rules about how to divide up the rules into groups, but a good way to start is to group the rules according to the main attribute that they are determining.
The book “The Decision Model” has some good guidelines on how to organize rules.
Here are some of the components in this problem
These are the rule statements that would be on the rule sheet. The rule statements are always the starting point for rule modeling.
Figure 3 Rule Statements
Now we are ready to model the rules.
Within this phase of rule modeling there are a number of steps
Here’s what the rules might look like
Figure 4 Rules Modeled As Specified
Note that it’s also possible to toggle this view to a natural language view:
Figure 5 Natural Language
We already have some test data and expected results so we can run our rules:
This is what we will get:
Figure 6 A Test Case
Figure 7 Repetitive Motion
Figure 8 Back Injuries
Note that the various codes are assigned BEFORE the conditions are evaluated. These codes could also be looked up from a database
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