About Sanitas

With around 820,000 customers, Sanitas is one of the largest health insurers in Switzerland. The company offers a broad range of insurance solutions for private individuals or corporate customers. As of 2017, premiums earned were CHF 2.8 billion.

Auditing millions of accounts payable annually

Rules Technology is a Perfect Fit to Manage Tariffs

Sanitas Group is a leading health insurance provider in Switzerland. In order to manage the complex and voluminous task of auditing several million accounts payable annually, Sanitas uses a custom-developed application they call „Heureka”. Since 2009, all rules are managed by the business rules management system, ACTICO Rules.

Conversion to ACTICO Rules succeeded in establishing a clear structure for the business logic and greatly simplifies the architecture of the Heureka system.

Challenge

Simple Modification of Tariffs

A rules engine was considered to be the best solution for integrating the TARMED tariff into the auditing process. Acquiring such a tool would allow the implementation of future rate changes to made with ease and independent from the specific application.

Objectives

  • Replace the existing rules engines
  • Conversion in record time while operations continue
  • Clearly structured rules and simplified system architecture
Solution

Migrating Rules Independently from IT

Sanitas replaced its existing system with ACTICO Rules. The developers at Sanitas were in charge of the rules migration and managed to put the rules in production without any user disruption. Key characteristics of the solutions:

  • Tests and replacement in very short time
  • Clear structure of rules and simplified system architecture
  • ACTICO Rules is a powerful and intuitive system
IMPACT

Account Auditing and Payment Generation with ACTICO Rules

The system is responsible for reviewing the accounts payable and generating payments for services through the central IT system, where all clients, policies, products, etc. are administered and accounts payable are booked. ACTICO Rules reads the master data, rates and movement data required for the audits from various databases, thus making the overall process seamless and efficient.

ACTICO Rules – the central rules engine

Automated account auditing and payment generation at health insurance companies.

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