Products > innovas expert systems
 

The product

The automation and acceleration of medical auditing is one of the key topics in the accident and health insurance market. Large parts of the formal and contextual auditing routines can now be mapped by means of automatic processing. Human specialists and experts are not replaced during this process; the modern software simply acts as an aid in making decisions of constant high quality and substance in an increasingly complex settlement landscape. The innovas service range adapted to Global Side thus offers this market environment one of the most comprehensive, technological and, above all, developed and seasoned solutions available.

The auditing components at a glance

Auditing components

With ZABAS and KOLUMBUS, we have brought the successful auditing product families from innovas and Global Side under one technological umbrella. The invoicing components as per DRG, BPflV (Federal Ordinance on Hospital Rates), GOÄ (medical fee schedule), GOZ (dental fee schedule), GebüH (Non-Medical Practitioner Fee Ordinance) and PZN cover the entire medical auditing spectrum. And KOLUMBUS connect is a product already successful on the market that is used to exchange data electronically between cost bearers and providers.

Background

The cooperation agreement signed in 2007 between innovas and Global Side allowed the partners to make a far-reaching decision in terms of focussing on medical auditing. This technological cooperation involves the merger of KOLUMBUS and ZABAS, both successful on the market, into a joint product portfolio. This means that our customers benefit from a new range of products and a further step towards technological refinement.

Technology

The component-based design of the innovas expert systems means that the products can be used in various integration scenarios and models. From a historical point of view, the systems have emerged from various claims settlement types. The partners are currently working on further technological collaborations.

Market

The innovas auditing service offering is aimed at both the private and statutory health insurance market. innovas and Global Side have developed different components to meet the various needs.

KOLUMBUS/ZABAS as a stand-alone system

Integration scenario 1

If introduced as a stand-alone system, COLUMBUS/ZABAS is integrated into the existing system environment with individual modules, or all of the modules, in order to create an end-to-end solution. This then links the auditing core and regulatory dialogue with the health insurance claims system. The receipt data pool is also part of the end-to-end solution. The system communicates exclusively with the life insurance claims system.
KOLUMBUS/ZABAS as sub-components

Integration scenario 2

If KOLUMBUS/ZABAS are introduced as sub-components, the auditing core and expert dialogue are added to the existing system environment as a module. Communication takes place with the health insurance claims system and the health insurance claims regulatory dialogue. KOLUMBUS/ZABAS as an end-to-end system