Agilite provides a robust underwriting module that increases processing speed and accuracy of underwriting decisions, while ensuring completeness. Optionally, Agilite includes a sophisticated debit system module and a prescription profiling module to enable the risk evaluation strategy a health plan wants to implement.

Debit Module

Agilite includes an optional debit module that can be configured with the debit manual of the plan’s choice. The debit module integrates seamlessly with the underwriting module to capture debit detail and recommendations at the member level. It also provides a summary of debit conditions, points, and recommendations at a group level for quick review and decision making.

Prescription Profiling

Agilite offers an optional prescription profiling module that interfaces with third-party data services to obtain prescription profiles on prospective applicants and integrates seamlessly with the underwriting module. Profiles include prescription history, likely conditions indicated, and adjusted risk scores for the individual and group.

Pharmacy data is captured at the individual member level and summarized at the group level. This data can be employed in automated, rules-driven processing and manual decision making.

Integrated Rules Engine

Agilite includes a powerful rules engine that can be configured to automate as much of the rating and underwriting process as a health plan wants. The rules engine can be configured to correlate responses to online medical questionnaires, a health plan's debit logic, prescription profiles, and other underwriting rules to automatically propose a rate action or step, such as approve, decline, or pend for further review.