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smart PKV

Smart PKV is our standard product for the automated processing of medical service documents in private health insurances. Extracting and processing of all relevant data with rules and regulations specifically defined for private health insurance companies.
smart PKV allows relaibly reading the person treated and the practitioner involved. By using specific information extraction mechanisms (TopDown search), information that is not included in the document, e.g. the insurance number of the person treated, can also be integrated into the processing operation.
Processing medical diagnoses is based on the standard international system for classifying illnesses, known as ICD-10.
The individual medical services items are extracted using GOÄ tables.
Smart PKV classifies the medical services mail documents into more than 65 field-tested classes and then extracts all relevant information.

With smart PKV, 75,000,000,000 medical service documents are processed each year.

Your Advantages using smart PKV

  • Processing of the entire, non-structured medical services mail
  • Automatic classification and extraction
  • Classification into more than 65 field-tested classes
  • Automatic process and document formation including consistency check
  • Automatic extraction of all relevant data (incl. position table)
  • Extensive German private health insurance business logic
  • Comprehensive checks of content with matching data (GOÄ, GOZ, ICD10 etc.) and identification of erroneous invoices
  • Open interfaces for other external checks (XML)
  • Enhanced checking options to uncover fraud
  • Automatic ICD10 encryption
  • Standard connections to central data pools for processing barcode data

Our User Forum for Invoice Processing

Invoice processing in the age of digital change - We make you ready for the future!

The INVOICE user forum offers our customers a platform for a comprehensive exchange of information and experience. The focus is on current topics and future trends in invoice processing as well as specific application scenarios and project experiences for industries and companies.

Any questions left?

Question

Which information from the medical services mail does your product already read in the standard version?

Answer

In the standard version, smart PKV already extracts all the data relevant for medical service settlement, such as person treated, practitioner, invoice date, treatment, purchase or prescription date, invoice amount including reduction, currency, GOÄ/GOZ (doctors' and dental fee schedule) tables, drugs (incl. drug code) and diagnosis.

Question

Do you provide a connection to the IBM Insurance Service Hub (ISH)?

Answer

Yes, the product Datenpool Connector enables the assignment of defined content in medical service invoices from IBM ISH. In order to do this, data pool barcodes printed on medical service documents are read and the related invoice information is queried online from the ISH. The provided information is available as quality-assured invoice information and is used by smart PKV as the basis for automatic features that process the information further.

Question

For us, it is particularly important to monitor and control the processes in the medical service invoicing. How can you support us here?

Answer

Our standard product Reporter Pro ensures process optimization while the system is running. The product enables you to perform comprehensive controlling in terms of document volume or document entry performance and thus the ROI of document processing. All information is presented in clear, intuitive, graphical reports.

Contact Insiders Technologies

Insiders Technologies GmbH

Brüsseler Straße 1
67657 Kaiserslautern
Fax: +49 (0) 631 92081 1711

Your contact for product information

Dr. Katrin Stöbener
Customer Support
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