A Componentized Architecture for Externalized Business Rules

Delta Dental is the leading provider of Dental benefits in the Midwest, serving nearly 5.1 million members. Delta Dental of Michigan uses Business Rules to articulate complex claims adjudication rules, from legacy COBOL programs. These rules are entirely authored, managed, tested and governed by Subject Matter Experts with no programming background. The Business Rules Architecture incorporates a componentized approach to authoring and organizing Business Rules which promotes extensive rule reuse at several levels through layered components. To mitigate complexity, the framework provides features for sandbox testing and regression testing of the rules by the Business Users. It also provides a rich reporting and trace ability back to the Policy charter. As a result of this framework a legacy adjudication COBOL program of 50,000+ lines were reduced to 30+ reusable rules. Nearly 94 % of the claims processed are automatically adjudicated by the rules engine. The purpose of this paper is to describe in detail the insights gained from the architecture and the measurable productivity gains accomplished.