Insurance blog series: Automated reading of claims documents with IDP – 02 TARMED invoices

As part of claims processing, various claims documents are received by insurance companies. The TARMED invoice, the official tariff structure for ambulatory medical services in Switzerland, is one of these claims documents. Insurance companies have to automatically read out numerous data from TARMED invoices so that end-to-end claims processing is possible.

In this blog series for insurance companies, we will look at different claims documents for which Intelligent Document Processing (IDP) can be used to automatically extract the relevant data for insurance companies.

In part 01 of the ‘Insurance blog series’, we took a closer look at the automated processing of pharmacy receipts.

In part 02 of the ‘Insurance blog series’, we look at the automated processing of TARMED invoices.

IDP brings insurance companies clear advantages – also for TARMED invoices

With millions of TARMED invoices that insurance companies have to process every year, this claim document is anything but a low-volume one.

Even though the particular strengths of Intelligent Document Processing (IDP) lie in the automated processing of unstructured and semi-structured service documents such as pharmacy receipts: IDP can equally handle large-volume and structured claim documents such as TARMED invoices.

In direct comparison to legacy OCR solutions, automation with IDP brings other clear advantages for insurance companies. Among them are the following:

1. With powerful IDP, the entire IT architecture in an insurance company can be reduced2. With powerful IDP, the complexity of business processes in an insurance company can be reduced3. With powerful IDP, general costs can be saved and invested in other areas.

With IDP: Insurance companies read TARMED invoices automatically

As shown in the two sample photos from the platform, leading insurance companies can use IDP to automatically read out all relevant information from TARMED invoices. Among other things, the following typical data is extracted from TARMED invoices and prepared in a structured manner for further processing using business logic.

  • Care provider: Title (e.g. Dr. med.), name of the doctor, address of the doctor’s practice or hospital, billing provider (usually the same as the care provider)
  • Care provider additional information: GLN number (worldwide identification for locations and company addresses), ZSR number (official billing processing directory for medical providers)
  • Patient information: Name, address, billing date and billing number
  • Line items: All line items such as date, tariff and tariff code, description, reference code, quantity, total amount and scaling factor, unit factor and amount (medical and technical)

No-Code App for individual customizations

When there are additional, specific requirements for a claims document, insurers can use the No-Code App to easily make customizations to a document type on their own.

In part 03 of the ‘Insurance blog series’, we will talk about automated processing of fitness invoices with IDP.

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