Läkemedelsförsäkringen - digitalizing claims handling process
Challenge:
Having a mainly analogue claims handling process, Läkemedelsförsäkringen has decided to move toward a fully digitalized process. This includes claim registration, scanning documentation, appeal handling and archiving closed claims. Aspects such as usability, reliability as well as information security has been evaluated in the process.
Solution
A great change is to replace the physical claim files with digital versions. To manage this, a scanning function is integrated with iFACTS INSMAN. All claim handlers have personal inboxes and access to a structured document handling module, ensuring full traceability and full order in the often-hefty document collection.
Reimbursement calculations can be done in a built-in function.
Appeals can be prepared and sent to the decision board within the system. iFACTS INSMAN’s portal module make it easy to invite external stakeholders to share information in a secure manner.
Benefits
- All data in one system
- Time consuming scanning, when sharing information with external stakeholders is avoided.
- Built-in validation to support the process.
- Scalable solution, online work from alternative locations possible
- Prepared for additional features, such as information sharing with external systems.
Customer
Läkemedelsförsäkringen (The Swedish Pharmaceutical Insurance) covers anyone who is treated with prescribed medication or medication purchased from a legitimate dealer in Sweden and suffer from unforeseen adverse effects of the medication.
The Swedish Pharmaceutical Insurance is financed by the shareholders of LFF Service AB, the Swedish Pharmaceutical Insurance Service, which is comprised of pharmaceutical companies, R&D companies, CROs, KD, Tamro and medical universities.
Background
Läkemedelsförsäkringen has used iFACTS INSMAN as their claims adjustment system since 2007. Their usage covers all aspects of the claim adjustment process, including reserves, payments with built-in validation and file archiving. The long relationship has led to edge functionality such as; nightly updates of information regarding medical products and their owners, an automated cost calculation and payments handling of annuities, tax handling and full integration with the appeal board.
