Sumex

Electronic checking of medical care invoices

Sumex II, which stands for “Suva Medical Expert System II”, was developed by ELCA Informatik AG on behalf of Suva and is now employed by a user group consisting of seven other companies from the accident and health insurance sector. The standard solution replaces the manual checking of paper invoices with automated electronic processes. The system brings flexibility to the electronic checking process and enables millions of francs to be saved every year, thereby reducing healthcare costs in Switzerland.

Sumex II has been an established name in the electronic checking of medical expenses for many years now, which is reflected in its current Swiss market coverage of over 50%. All conventional medical care costs in Switzerland are supported by Sumex II, both for inpatient and outpatient care. This includes the new SwissDRG Tariff (Diagnosis Related Groups) invoicing system. Read more about the DRG Expert module in our flyer (available in German).

The Sumex II product suite consists of a number of modules which each deliver functionality to the relevant area of the electronic invoice checking process and which can be tailored to the individual requirements of each health insurance company:

• Sumex II and Sumex II Hospital – Invoice workflow and checking
Sumex II takes care of all document processing  (invoices, cost approvals and MCD), from import and checking to forwarding to third-party systems.
 
• Sumex II TMS – Tariff data and information 
Sumex II TMS carries out a quality check on the tariff data provided, supplements the data with custom rules and supplies the data to Sumex II to ensure efficient invoice checking.

• Sumex II TMS plus – Reference data and Webclient
In addition to tariff data, Sumex II TMS plus also provides additional reference data. Individual contracts with specific service providers can also be managed and Webclient provides an overview of all data entered in Sumex II TMS.

• Sumex II IRP – Business rules and dynamic deviations
Sumex II IRP allows dynamic  “business rules” for  Sumex II to be defined for each sector. This enables the relevant specialists to react more quickly to changes in the market or legal situation and to define ad-hoc checks without IT support.

• Sumex II OCR – Automated entry of paper invoices
Sumex II OCR carries out the automated entry (scanning and identification) of paper invoices using state-of-the-art OCR technologies in preparation for downstream processing in Sumex II. This means it is also possible to check paper invoices using Sumex II.

• Sumex II OLE – Optimised activity recording
Sumex II OLE enables service providers to efficiently record services to be billed including an upstream invoice check.