Billing and regulation of eHealth providers

We supply health insurance companies with information systems for effective management and financing of health care. The systems we supply are fully automated and fully compliant with Czech legislation.

We deliver a comprehensive and powerful core system that ensures smooth and maximally automated operation of all health insurance agendas and smooth integration of the system. We implement all necessary components of the main information system and superstructure systems including their mutual integration and communication. 

We supply health insurance companies with software for:

• Health care reimbursement,
• collection of insurance premiums,
• registration, integration and communication,
• modelling, analysis and statistics.

The key and most challenging area of the operational system is undoubtedly the expenditure part, which ensures the reimbursement of health care statements in accordance with the reimbursement (and compensation) decree of the Ministry of Health. Healthcare reimbursement involves a number of sub-agendas that need to be carried out during the processing of statements or in subsequent agendas:

• Healthcare reporting, extensive validation checks including very sophisticated processes
• Reviewing doctors' agendas, submitting selected care to reviewing doctors for their required analysis
• Ongoing healthcare billing and generation of billing reports
• Annual billing, so-called regulation and settlement
• Finding patterns of errors and fraudulent behaviour

Our revenue system ensures efficient premium collection. We have built extensive workflows into it that precisely manage, for example, the following agendas:

• Checks on payment discipline,
• The likely amount of the premium,
• Reports of self-employed persons,
• Arbitration committees.

Our system for health insurance companies provides all the records of the subjects.

It uses a very extensive internal and external integration with systems of state institutions such as the Ministry of Health, VZP, SÚKL (State Institute for Drug Control), UZIS (Institute of Health Information and Statistics), ISZR or Insolvency and Commercial Register.

Connection is also possible to the systems of healthcare institutions, insurance payers and also to the ZP Portal.

Internally, the system can be connected to the filing service, accounting system or, for example, to the call centre.

We will link the superstructural portal and mobile solutions to the Internet banking - we will enable payment via the payment gateway, payment button, QR payment, etc.

Authentication will be provided according to the customer's choice by bank identity, citizen's identity or through our own authentication gateway ARICOMA ID.

We provide the health insurance company with an analytics platform for advanced modelling, analysis and visualization, enabling detailed data analysis. This enables health insurance companies to model, monitor and analyse:

• economic indicators,
• status and development of the number and structure of the insured population,
• trends in reported healthcare,
• key economic and healthcare data for management,

The platform also allows you to inspect healthcare facilities or perform in-depth data analysis: 

• Prediction of the exit of insured persons (churn analyses),
• Non-standard phenomena in care reporting (support for fraud detection).

An interesting pilot application in this area (with a possible link to the portal) is the check of insured persons' medication. We can provide information to the insured and their attending physicians about possible contraindications or, on the contrary, incomplete medication in relation to the proposed treatment, identified on the basis of all the data contained in the insured person's file.

Our portal and mobile solution for the insured provides most of the services of a health insurance company without the need to visit the counter in person.

The solution allows the insured persons to:

• Have their current health information at hand at all times, including the care that they have received.
• Share their health information with their doctors.
• Schedule and order health care appointments.
• Find out the availability and navigation to a doctor or pharmacy.
• Communicate with their health insurance company and make necessary payments.