© 2014 Fair Isaac Corporation. Confidential. 1 Blaze Advisor Business Rules Management System (BRMS)

2 © 2014 Fair Isaac Corporation. Confidential. Blaze Advisor Integration with IFM ► Blaze Advisor BRMS provides the capability for non-technical resources to configure and deploy: ► Fraud, Waste and Abuse rules on data elements included in the data feeds to/from Insurance Fraud Manager (Professional, Facility) ► Capability to implement blues card rules prior to payment ► Workflow management rules to more effectively manage the review of individual claims within Insurance Fraud Manager ► Rules which manage systemic issues identified by IFM or other means ► Blaze is preconfigured to accept your data ► Blaze uses existing IFM feeds. No new data feeds required from IT. ► Blaze can be expanded to accept ANY data source ► Clients can choose to integrate any data source to make a claim payment decision

3 © 2014 Fair Isaac Corporation. Confidential. Current State Implementation IFM Data Feeds Client Claim System Decision (Pend, Deny, Pay) Blaze Advisor Integration with IFM IFM User Interface IFM Scoring Engine    Dynamic Profile Providers Members Claims Dental Pharmacy Ratio of X-rays to exams $ billed vs. peers Procedure mix vs. peers Max single-day activity Profile Variable N Derive Powerful Variables Scores and Reasons Predictive Models

4 © 2014 Fair Isaac Corporation. Confidential. IFM Data Feeds Client Claim System Decision (Pend, Deny, etc) Blaze Advisor Integration with IFM IFM User Interface IFM Scoring Engine    Dynamic Profile Providers Members Claims Dental Pharmacy Ratio of X-rays to exams $ billed vs. peers Procedure mix vs. peers Max single-day activity Profile Variable N Derive Powerful Variables Scores and Reasons Predictive Models Blaze is pre-configured to ‘plug and play’ with IFM, using IFM data feeds and advice files Rules, Strategies, Models The addition of Blaze Advisor provides a platform to close FW&A gaps through business rules

5 © 2014 Fair Isaac Corporation. Confidential. IFM Data Feeds Client Claim System Advice File (Pend, Deny, Pay) Blaze Advisor Integration with IFM IFM User Interface IFM Scoring Engine    Dynamic Profile Providers Members Claims Dental Pharmacy Ratio of X-rays to exams $ billed vs. peers Procedure mix vs. peers Max single-day activity Profile Variable N Derive Powerful Variables Scores and Reasons Predictive Models Blaze Advisor’s Rule Management interface allows non-technical users to deploy rules Rules, Strategies, Models Fraud Rules Waste Rules Abuse Rules Policy Gap Rules Analyst Rule Control Define Decision (Pend, Deny, etc)

6 © 2014 Fair Isaac Corporation. Confidential. IFM Data Feeds Client Claim System Advice File (Pend, Deny, Pay) Blaze Advisor Integration with IFM IFM User Interface IFM Scoring Engine    Dynamic Profile Providers Members Claims Dental Pharmacy Ratio of X-rays to exams $ billed vs. peers Procedure mix vs. peers Max single-day activity Profile Variable N Derive Powerful Variables Scores and Reasons Predictive Models Additional data sources can be leveraged to analyze and decision claims Rules, Strategies, Models Fraud Rules Waste Rules Abuse Rules Policy Gap Rules Analyst Rule Control Define Other Data Sources Decision (Pend, Deny, etc)

7 © 2014 Fair Isaac Corporation. Confidential. Learnings from both IFM and Non-IFM findings can be deployed via Blaze IFM Data Feeds Client Claim System Rules, Strategies, Models IFM User Interface Fraud Rules Waste Rules Abuse Rules Policy Gap Rules Analyst Rule Control Define IFM Scoring Engine    Dynamic Profile Providers Members Claims Dental Pharmacy Ratio of X-rays to exams $ billed vs. peers Procedure mix vs. peers Max single-day activity Profile Variable N Derive Powerful Variables Scores and Reasons Predictive Models Advice File (Pend, Deny, Pay) Deploy Adaptive Loop Non- IFM findings IFM findings Blaze Advisor Integration with IFM Other Data Sources Decision (Pend, Deny, etc)

8 © 2014 Fair Isaac Corporation. Confidential. Rule Examples: ► Blues Card Edits ► High Unit Rules ► Social Security Death Master ► Provider Black Lists ► Always Approve ► Always Deny ► Derived data based on complex calculations/formulas. Blaze Advisor Integration with IFM