Press Releases - 15 March 2016

Control health-care sector costs with data analysis software

One reason for rising health care costs is that medical invoices are not properly checked - but modern technology can help.

A further player in the Swiss health-care sector deploys the digital invoice control by Sumex

The Swiss health-care sector costs more every year. One reason for this is the fact that the thousands of medical invoices that are issued every day are not properly checked.* The Sumex suite software solution, programmed by the Swiss IT company ELCA, uses cutting-edge data analysis to identify suspicious invoices. This enables insurers to save millions of Swiss francs each year. Over 40 insurance companies already use Sumex. Cent Systems AG has now been added to this list. The company specialises in processing receipts in the health insurance sector (part of the KPT Group).

Efficient and largely automated processing is crucial when it comes to checking medical invoices. In addition to applying a comprehensive set of rules, the Sumex suite software solution developed by ELCA and Suva analyses data using statistical methods in order to compare invoices and identify potential issues. This ensures that only statements that do not fit established patterns are subjected to a manual check by experts. The great majority of the receipts is processed fully automatically. KPT, one of the biggest health insurers in Switzerland, and its service provider that specialises in invoice processing, Cent Systems AG, are keen to drive internal digitisation forward with the help of Sumex. The comprehensive digitisation and automated invoice checking potential as well as the fast and cost-effective introduction were key reasons for choosing the Sumex solution.

« The relentless rise in costs within the health-care sector make automated electronic processing and checks of invoices essential. With the help of the Sumex suite, we are placing ourselves on a technologically up-to-date and competitive footing. This software enables us to broaden our invoice checks, significantly reducing our operating costs »

Patrik Heierli, Head of IT and a member of the executive board of KPT.

Peter Siegenthaler, Managing Director of Cent Systems AG: “Sumex also enables checks across invoices and covers all statement functionalities pertaining to diagnosis-related groups (DRG).”

Sumex with new front-end based on JavaFX
In January 2016, a new, revised version of Sumex became available – the release 3.0. The key objective was the revision and updating of the user interface (front-end) on the basis of JavaFX technology. ELCA took the strategic decision two years ago to deploy JavaFX technology. “Sumex is a success story in the Swiss software market. The solution is of high technical quality and offers an unparalleled spectrum of functionalities. With this new release, we therefore focused first and foremost on the software user. Thanks to its visually simplified and highly intuitive user interface, the new front-end makes the software even easier and more straightforward to use. The Sumex solution has now reached an advanced stage of development, and we are delighted that Sumex has won over yet another major client”, explains Felix Musterle, Head of Health and Insurance at ELCA in German-speaking Switzerland.

* Source: K-Tipp https://www.ktipp.ch/artikel/d/krankenkassen-das-sind-die-groessten-kostentreiber/ (last accessed on 9 March 2016).

About the Sumex suite

The Sumex suite software solution comprises numerous modules and functionalities that help insurance companies digitise their operations and save substantial costs by automatically processing medical receipts and invoices. On the one hand by boosting efficiency, as the software is faster, cheaper and also more precise than manual invoice checks and can also process larger volumes. On the other hand, the software identifies suspicious and potentially incorrect invoices, enabling insurers to cut their costs.

ELCA originally developed Sumex for the insurance company Suva. Today, further developments of the Sumex core modules as well as their funding are driven by a user group consisting of six member companies. Other insurers use specific Sumex suite modules on a software-as-a-service basis. Each year, Sumex processes over 20 million invoices. 

Additional mobile solutions for insured persons or patients are currently being developed in order to boost digitisation in the Swiss health-care sector, to involve patients even more strongly in the verification process, and to provide them with detailed information about their medical treatment and prescribed medications.

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