Automation potential in invoice processing

The digitization of TARMED invoices and the system-supported reading of detailed benefit items is now common practice among health insurers. The approach of checking, processing and billing these invoices specifically and automatically using electronic rules and regulations has also been implemented by the majority of major companies in the industry.

SWICA has already been one step ahead in this context for some time: all "non-TARMED" invoices are digitised and the majority are processed automatically.

The most important at a glance

  • The digitization of medical cost calculations leads to an increase in the degree of automation as well as to an increase in the efficiency of processing.
  • The number of documents to be processed manually/checked by clerks decreases overall.
  • Incorrectly billed services are automatically recognized during the inspection by rules and regulations - on the basis of the detailed positions provided in electronic form by the scan service provider.
  • Detailed information read from the invoice allows further, more in-depth evaluations even after initial processing ("data mining"). 
  • The deflection rate of documents for detailed checking by clerks can - as a further advantage of electronic processing - be controlled by SWICA itself via the flexible set of rules.
  • Last but not least: Questions from customers about invoices can be answered directly on the basis of the digitized original invoice, regardless of location.

Challenges in the project

There are many challenges in a project to optimize the automation of invoice processing - some of them are listed here:

  • Sourcing & Logistics: At what time or in which step of the (previous) postal delivery will the digitization be carried out?
  • Tariff system: How can the manual inspection effort be reduced in compliance with the law and the AVB?
  • Regulations: How can service costs to be paid out be reduced?
  • Management of the parties involved: How can it be ensured that all parties work together efficiently and that potential pitfalls are identified at an early stage?
  • Knowledge of the system landscapes: Which dependencies between the components and the sub-processes have to be considered?
     

« We are glad that we had Inacta on board. This enabled us to elegantly avoid some of the pifalls that we would have seen too late. Despite the complexity and the many parties involved, we were able to realize all the potential benefits quantified by Inacta.»

Marcel Wild, Head of Services, SWICA

Sourcing & Logistik

Whether an internal or an external sourcing is to be aimed at depends strongly on the strategic orientation. At SWICA, the existing external sourcing was continued, whereby a concept specifically tailored to SWICA was developed and implemented for the logistics part.

Tariff system & set of rules

When introducing digitized processing of non-TARMED receipts, one of the goals is always to reduce the service costs to be paid out. In order to achieve this goal, the information from the non-standardized document types must be recorded in a structured manner. Furthermore, rules must be defined in order to be able to invoice the receipts as automatically as possible on the basis of the transmitted information. However, these two parts are highly dependent on each other - so it is essential to find creative, yet well thought-out solutions here.

Management of the parties

A digitisation project, like most projects, has several parties involved. Here, too, everyone has a slightly different background: Logistics, scanning, core system, workflow, archive, data center operation. The best approach is therefore,

  • to convey a common target image to the project employees
  • to motivate the project staff to contribute their share to the success of the project.

Knowledge of the system landscape

A further guarantee of success is the knowledge of the sub-processes, components and their dependencies. This includes

  • Preparation (inbox, AVOR)
  • scanning, recognition and validation
  • Invoice verification (general and customer-specific rules and regulations).
     

«Based on its experience, Inacta was able to advise us on questions of logistics and target processes as well as on the strategy with regard to collective bargaining - the corresponding concepts are still used today.»

Markus Wälti, Specialist Processes & Projects, SWICAA

SWICA - because health is everything.

With around 1.3 million insured persons, SWICA is one of the largest health and accident insurers in Switzerland. It offers compulsory basic insurance (OKP) under the Health Insurance Act (KVG), supplementary insurance and property insurance under the Insurance Contract Act (VVG) and accident insurance under the Accident Insurance Act (UVG).

«This project once again demonstrated what is possible on the basis of orchestrated cooperation between all the specialists involved. Not only the initially planned part (Non-TARMED receipts) was implemented, but also two sales processes (applications, mutations) - all based on the jointly-agreed key data.»

Jürg Porro, Associate Partner, Inacta

 

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