Case
Overview
We implemented 32 interconnected systems at EOPYY, Greece’s national health insurer, covering everything from claims and payments to citizens’ own health insurance records. As a result, clearance times have fallen sharply from an average of around 40 days, and the new systems are built to move toward real time.
We implemented 32 interconnected systems at EOPYY, Greece’s national health insurer, covering everything from claims and payments to citizens’ own health insurance records. As a result, clearance times have fallen sharply from an average of around 40 days, and the new systems are built to move toward real time.
The challenge
EOPYY, Greece’s National Organisation for Healthcare Services Provision, pays for the care of more than 10 million people – about 98% of the population. Its 23,400 contracted providers send it claims, and every claim has to be checked before it is paid.
Most claims already arrived electronically, but the checks relied on manual work and paper supporting documents. The information needed sat in separate systems with limited integration. On average, getting a claim from submission to payment took around 40 days.
For the doctors, pharmacists and hospitals waiting on those payments, 40 days is a long time to carry the cost of care already delivered. For EOPYY, it meant spending could only be monitored by sampling, after the fact.
The solution
Building on EOPYY’s existing systems, we implemented 32 systems, subsystems and applications that exchange data securely with each other. They cover claims and settlements, financial management, medical supplies, provider and contract registries, and the Health Insurance Record, which gives citizens access to their own diagnoses, hospital stays, visits and medication online and through a mobile app.
Connecting these systems made automation possible. A claim can now be checked against provider, contract, and product data the moment it arrives, with quality-of-service criteria applied by rule. Most supporting documentation is now digital. Claims move from submission to settlement with much less manual work, and staff still review cases where needed.
The same connected setup supports EOPYY’s wider services, giving citizens and providers easier access to information.
The results
Clearance times have been cut significantly from the previous average of around 40 days, and the work continues toward real time.
EOPYY can now monitor transactions as they happen rather than sampling them afterwards. That gives it accurate, current financial data for audit, expense monitoring and budgeting. Administrative and management costs have also been cut.
For EOPYY’s 10 million insured citizens, the change is closer to home: their diagnoses, hospital stays, visits and medication are now in one place, on the web and on their phone.
The challenge
EOPYY, Greece’s National Organisation for Healthcare Services Provision, pays for the care of more than 10 million people – about 98% of the population. Its 23,400 contracted providers send it claims, and every claim has to be checked before it is paid.
Most claims already arrived electronically, but the checks relied on manual work and paper supporting documents. The information needed sat in separate systems with limited integration. On average, getting a claim from submission to payment took around 40 days.
For the doctors, pharmacists and hospitals waiting on those payments, 40 days is a long time to carry the cost of care already delivered. For EOPYY, it meant spending could only be monitored by sampling, after the fact.
The solution
Building on EOPYY’s existing systems, we implemented 32 systems, subsystems and applications that exchange data securely with each other. They cover claims and settlements, financial management, medical supplies, provider and contract registries, and the Health Insurance Record, which gives citizens access to their own diagnoses, hospital stays, visits and medication online and through a mobile app.
Connecting these systems made automation possible. A claim can now be checked against provider, contract, and product data the moment it arrives, with quality-of-service criteria applied by rule. Most supporting documentation is now digital. Claims move from submission to settlement with much less manual work, and staff still review cases where needed.
The same connected setup supports EOPYY’s wider services, giving citizens and providers easier access to information.
The results
Clearance times have been cut significantly from the previous average of around 40 days, and the work continues toward real time.
EOPYY can now monitor transactions as they happen rather than sampling them afterwards. That gives it accurate, current financial data for audit, expense monitoring and budgeting. Administrative and management costs have also been cut.
For EOPYY’s 10 million insured citizens, the change is closer to home: their diagnoses, hospital stays, visits and medication are now in one place, on the web and on their phone.
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