When Financial Responsibility Determination Goes Wrong, Margin Disappears Fast.
Determining who pays what across contracts, entities, and exceptions is one of the most complex and error-prone parts of healthcare administration. DOFR DICE makes it systematic, traceable, and accurate so decisions don’t turn into disputes, rework, and lost revenue.
Financial Responsibility Is High-Stakes. Yet Still Largely Manual.
Every claim requires a decision on who pays what across contracts, entities, and exceptions.
In most organizations, that logic isn’t system-driven. It lives in spreadsheets, manual processes, and institutional knowledge spread across teams.
When it breaks, revenue is misallocated. When contracts change, rules fall behind. When auditors ask questions, answers aren’t traceable.
$20–$40Bn Estimated annual opportunity across the U.S. market from automating financial responsibility determination.
Claims/min processed
DOFR factors evaluated
Weeks to go-live
Years healthcare administration expertise
Built for the Complexity Core Systems Can’t Handle.
Core platforms typically cover standard claims scenarios. They offer little support when financial responsibility becomes multi-party, dynamic, and contract-driven.
DOFR DICE is built for bringing structure, accuracy, and control to the most complex layers of financial responsibility.
The DICE Framework
Four stages. One deterministic DOFR operation.
Define
Service definitions and components established across 50+ factors for professional and hospital claims. Every variable mapped and agreed before configuration begins. Nothing assumed. Nothing left to interpretation.
Integrate
Connects to your existing claims environment through file upload, direct database connection, or API. Automated data synchronization across systems. Pre-built integration toolkit for widely used core systems eliminates custom development entirely.
Configure
Financial responsibility rules, denial logic, and routing workflows configured for every contract in your portfolio. Shared risk, dual risk, global risk, and Knox-Keene structures handled within one system. Every configuration tested against real claims scenarios before deployment.
Evaluate
Proprietary claims evaluation API determines financial responsibility in real time. Every determination rule-driven, consistent, and traceable back to the contract term that governed it.
A System for Controlling Financial Responsibility at Scale.
Each capability addresses a specific breakdown in how financial responsibility is defined, applied, and maintained across your operations.
Centralized Contract Configuration
All DOFR contracts managed in one system. When a contract changes, the update is made once and applied consistently across every affected determination. No more version mismatches across spreadsheets or siloed teams.
Proprietary Rules Engine
Financial responsibility determined across 50+ factors at line and claim level. Covers shared risk, dual risk, global risk, tri-partite, and four-party Restricted Knox-Keene structures. Every rule documented, testable, and auditable.
Real-Time Claims Evaluation API
5,000 claims per minute. Rule-driven results at the speed adjudication requires. Manual queues exist only for genuine exceptions. Not for claims the system simply couldn't classify.
Version Control and Change Management
Every rule change tracked, timestamped, and documented. When an auditor asks why a claim was determined a specific way on a specific date, the answer is in the system. Not in someone's inbox or memory.
Definition Management
Service and component definitions maintained centrally with auto-update capability. Definition ambiguity, a primary source of adjudication disputes, is eliminated by design. One definition. Applied everywhere. Updated once.
Denial Logic and Routing Workflows
Denial rules and routing logic configured within the same system to identify all denial reasons, not just the one determined first. Claims outside standard parameters are routed with full context and not dropped into a manual queue without explanation.
Intuitive DOFR Analytics and Performance Dashboards
Contract-by-contract and service-by-service performance reporting. Revenue projections, leakage identification, and what-if commercial simulation built in. Statutory reporting available without additional configuration.
Drill-Down Claim Traceability
Every determination is traceable from outcome back to the rule, contract term, and service definition that governed it. Dispute and audit support built into the system and not reconstructed manually after the fact.
100% Test Coverage Pre-Deployment
Every configuration tested against defined claims scenarios before go-live. No rule set reaches production without a complete test cycle.
Automated DOFR Status Reporting
Scheduled reports covering resolution rates, dispute activity, and contract compliance generated and delivered automatically. Leadership has visibility into DOFR performance without requiring manual compilation or analyst time.
Connects Without Disrupting What You Already Have.
DOFR DICE integrates with the claims systems and data infrastructure already in your environment. Your core platform continues to operate as it does today.
Core Systems
Pre-built integration toolkit with dedicated adaptor, pre-configured data transformation, and schema mapping built for widely used core systems like EZ CAP, Quick Cap etc.
File-Based Integration
DOFR contracts and rules data accepted via structured file upload. Excel-based contract templates supported for initial data ingestion.
Database Connection
Connects directly to your claims database with automated data synchronization. No manual data transfer required.
API Integration
Real-time DOFR determination within any claims processing workflow. Built for high-throughput environments.
Built for Teams Owning DOFR Risk.
Designed for the Teams Who Own the Consequences of DOFR Complexity
Claims Operations
Automated determination at adjudication. Full traceability. 100% test coverage before go-live. Manual queues only for genuine exceptions.
DOFR & Contract Ops
Centralized contract management. Controlled configuration and amendment process. Faster client onboarding. No custom script maintenance.
Finance & Revenue
Contract and service-level performance reporting. Leakage identification. Commercial simulation for evaluating new contract structures before signing.
Compliance & Audit
Every determination traceable to its governing rule and contract term. Statutory reporting built into the analytics layer. Audit support without manual reconstruction.
Customer Service
Full claims decision visibility for faster dispute resolution. Investigation support without escalation to the claims or DOFR team.
Executive Leadership
Revenue leakage identified and arrested at the operational level. Month-to-month licensing means the decision to continue is based on demonstrated results, not contractual obligation.
Hear What Our Customers
Say About Us
I have worked with Key Software, Inc. since 2018 and value their deep understanding of our business needs. Their support is excellent, responsiveness unmatched, and results consistently delivered on time."
Key Software, Inc. has enhanced our claims and utilization platform efficiency by understanding our workflows and business needs. Their team, led by Karthik, is innovative and solution-focused, working seamlessly with both technical and business teams.
I have worked with Key Software since 2018 and value their deep understanding of our business needs. Responsiveness unmatched, results consistently delivered on time
Key Software's DOFR solution gave us visibility into our contract performance that we simply did not have before. What used to take weeks of manual effort now runs automatically.
Frequently Asked
Questions.
Everything you need to know before evaluating DOFR DICE for your organization.
Does DOFR DICE replace our existing claims platform?
No. DOFR DICE layers onto your existing environment without requiring changes to your core platform. Your current system continues to operate as it does today.
How long does implementation take?
16 to 24 weeks depending on portfolio complexity. Client involvement is 4 to 6 hours per week. Key Software manages configuration, testing, and deployment throughout.
What is the commercial commitment required?
Month-to-month licensing. No upfront capital expenditure. No multi-year contract required to begin.
Our platform already has a DOFR module. Do we still need this?
Core platform DOFR modules handle standard arrangements. If your operation still carries Excel files, custom scripts, or manual processors alongside that module, DOFR DICE handles what the module does not.
Can we see it work with our own data before committing?
Yes. A proof of concept using your own contract data can be made available. One to two contracts and up to five services per contract is sufficient to demonstrate performance against real operational conditions.
We already have an automation driven DOFR module. Do we still need this?
Automation driven DOFR modules involve running hundreds of scripts individually on top of legacy systems. These are usually brittle and break in complex scenarios. DOFR DICE ensures those scenarios are seamlessly handled by operating at the database layer.