smart PKV
smart PKV is our standard product for automated processing of medical service documents.
smart PKV extracts all the data relevant for medical service settlement from incoming documents, such as person treated, practitioner, invoice, treatment, purchase or prescription date as well as invoice amount including reduction, currency, GOÄ/GOZ (doctors' and dental fee schedule) tables, pharmaceuticals (incl. pharmaceutical code) and diagnosis. smart PKV contains all the requirements and specialist logics for processing incoming mail specific to German private health insurance. The integration of external rules and regulations for unrestricted checking of the available data has been provided for. However, the standard version of the product provides the most important checking methods commonly used in the private health insurance area, including those for cross-process checks.
The product complies with the legal requirement that, when prescriptions are processed, pharmaceutical discounts can now only be claimed from the responsible "Central Office for Settlement of Pharmaceutical Rebates" (ZESAR). In accordance with the Act on the Reform of the Market for Medicinal Products (AMNOG), all exported prescription data for settlement is to be sent to this central office electronically.
The advantages of smart PKV
- Processing all of unsorted incoming mail with medical services documents
- Automatic classification of medical services mail into more than 65 field-tested classes
- Automatic process formation including consistency checking
- Automatic document formation including consistency checking
- Automatic extraction of all relevant data (incl. position table)
- Extensive German private health insurance business logic (subclassification of doctor's invoice as out-patient, in-patient or attended patient)
- Open interfaces for additional external checks (XML)
- Comprehensive checks of content and logic with matching data (GOÄ, GOZ, ICD10 etc.) and identification of erroneous invoices
- Highly-ergonomic and efficient verification of classification and extraction results
- Enhanced checking options for detection fraud
- Automatic ICD10 encryption
- AMNOG-compliant prescription processing via ZESAR for pharmacentical discounts
- Customer-specific dynamic configuration
Supplementary products to smart PKV
Datapool Connector
Datapool Connector
The Datapool Connector product facilitates the assignment of specified content of medical service invoices from the IBM Insurance Service Hub (ISH). In order to do this, data pool barcodes printed on medical service documents are extracted and the related invoice information is queried online from the ISH. The information provided by the ISH is available as quality-assured invoice information and is used by smart PKV as the basis for automatic features that process the information further (such as determining reductions and ICD10 encryption).
Reporter Pro
Reporter Pro
Reporter Pro is our standard product for process optimization for running systems. Reporter Pro facilitates comprehensive controlling with respect to document volumes, the document capture performance and therefore the ROI of the incoming document processing system. The information is displayed in the form of easy-to-understand and intuitive reports containing graphics.
