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.

Other case studies

“Loss prevention is an important part of the insurance process. There is a need to exchange information such as risk grading, technical data and values.”                         Ola Nilsson, Vice president at Essity Risk management

 “Using our own system gives us the power over the information; we can control the data and perform analysis in a better way. We have control over the process and are able to follow the progression of work.

Learn more

“Potential differences in data between systems are caught at an early stage.”

Vattenfall Insurance wants to structure and streamline their workflow between claim management in INSMAN and the accounting in an external system. Routines are reliable and standardized, improved traceability throughout the complete solution is strengthened.

Learn more

”One system supporting all our insurance needs in one complete process”

Since 2010 SKF Reinsurance uses INSMAN to support the entire insurance process, issuing of insurance letters, renewal, invoicing and claims handling. The goal of implementing INSMAN was a complete system for the full process.

Learn more

“Supports the system owners to compile requirements without being IT-specialists.”

“iFACTS method and software is a powerful and flexible tool that matches the city’s model for system inventory, classification, and requirement definition well. It supports us quite simply in creating order and structure in a world, which many perceive as complicated.”

Learn more

“Using our own system gives us the power over the information.”

Essity started using the INSMAN platform for insurance management already in 2007.  They now have control over their insurance needs and can work much more efficiently with the different steps, from renewal to invoicing to handling claims.

Learn more