Agis Automates ‘International Claims Handling’ Within Six Weeks

Agis has a rich history going back to 1827. Although Agis has been around for a while, it is a modern healthcare insurance company, and with 1.2 million customers and 1500 employees, Agis is one of the biggest specialized healthcare insurance companies in the Netherlands. Agis is also the largest healthcare buyer in the Netherlands, spending 6.5 billion euros in 2006 alone. As of 2007 Agis merged with industry-leader Achmea.

Challenge

Since January 2006 the Dutch government passed a new healthcare policy in the Netherlands, requiring healthcare providers and insurance companies to use a new government-regulated system for the pricing of healthcare treatments. As a result, both insurance companies and healthcare providers are forced to adapt their internal processes and systems to be able to comply with a new industry-wide standard for communicating treatment definitions and their corresponding pricing structure. To support this, Agis uses a centralized communication hub (Vecozo) to manage the processing of intra-company claims and declaration requests.

Requested Features

• Enable self-service data entry by country offices and foreign healthcare providers
• Automatically translate foreign claim specifications to the Dutch industry standards ZH-38 and ZH-39
• Provide increased insight and control with respect to the distributed declaration process
• Meet demand for more transparency from Netherlands Authority for the Financial Markets (AFM)
• Pave the way for future international insurance services
• Provide an easily accessible and highly scalable solution to meet fast growing demand
• Provide on-demand management reports

Mendix addresses these challenges by providing a personalized and consistent employee interface that enables data and process harmonization. The Mendix platform empowers employees to interact with back office systems in a managed and secure way. Mendix provides your organization with a consistent and flexible employee gateway that aggregates data and logic from a multitude of back office systems.

Solution

Mendix responded to Agis’s request with a ground-breaking solution. All parties that need to produce declarations now have access to a standardized communication platform, which observes the diagnosis-treatment combination (DBC in Dutch) methodology introduced in the Netherlands in 2005. This new method changed the way healthcare insurance companies pay for the provided healthcare. It combines the whole treatment history based on a code system that incorporates prices and treatment.

On the one hand, this greatly sped up the process by giving Agis’ foreign subsidiaries direct access to the Dutch system. On the other hand, it introduced far-reaching improvements to process insight and the control of all foreign declarations. A pilot was set up together with Vecozo, Agis Netherlands and Agis Turkey. The result was a flexible solution, fully integrated with the existing systems, that worked with the protocols and declaration standards from the Netherlands. Additionally, it connected parties that were previously disconnected. After careful evaluation of the first results of this new pilot process, the green light was given to role out the entire solution.

The business owners of both The Netherlands and Turkey actively participated in the working out of management reports and interfaces, using the final process flow from the Mendix platform. Additional accessibility functions were implemented using Mendix, in order to open up existing foreign systems to the communication platform. This effectively enabled the incorporation of all previously external parties. The platform that was set up was found to be scalable and flexible. The solution provided access through a very user-friendly and well performing web interface. With the help of the Mendix platform, these criteria were met and performance exceeded expectations.

Real-time reporting (Business Activity Monitoring) was also added. This introduced more insight and control into the whole process, making it easier to identify bottlenecks to be fixed in a timely and appropriate manner. Additionally, it increased transparency in terms of the costs and the services provided to customers.

Errors commonly occurred because declaration requests used to be entered by hand without any file safes. The process is now based on data entry, checked through translation tables relating foreign codes to DBCs, and referenced through a rich AJAX interface. The new system has been proven to reduce the error rate dramatically.

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