SAUDI is a system designed to maintain the “financial health” of Supplementary Health Plan Operators. Our system automates the process of auditing medical service providers' accounts, enabling a clear view for both sides (operators X service providers) and a significant reduction in unnecessary costs.

Acting throughout the entire process, from requesting authorization for medical procedures from the network of providers, to their respective release for payment, SAUDI's objective is for companies in the area to become healthier and achieve better results through a better management of your care costs. The result is surprising in the first 3 months of use.

Below we will present the pain points that SAUDI currently solves for the largest health plan operators throughout Brazil. If you are a medical bill manager or analyst, pay close attention because this could be the ideal solution for you! ; )

 

Requests for Authorization for Hospitalization, Extension, SP/SADT, Exams and Consultations

Medical Area (Medical Audit/Nursing)

PAINS:

– Does your beneficiary need to go to the operator?
– Does your authorizing doctor still use fax/telephone to speak to the requesting doctor?
– Are there customer complaints in the request/authorization processes?
– ANS fines for non-compliance with regulated deadlines?
– What is the level of disallowances applied to authorization requests? Low, Medium, High?

SOLUTION: Authorization Request Module

– Configurable Process Flow, because
– Online interactions with

 

m providers and beneficiaries, via the web
– Electronic document management – GED
– Transaction log
– History of usability of health services
– Automation of Authorization Rules

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– Increases the capacity for technical analysis of requests, through access to support information in real time, optimizing the speed of analysis, registration and processing of authorizations.

– Reduces the risk of improper authorizations, through the possibility of configuring and using automatic audit rules and standardized responses

– Allows continuous improvement of the authorization process, through access to the request and analysis trail;

– Increases the security of decisions, through real-time access to the histories of patients, providers and medical auditors, nurses and analysts.

– Reduces the impact of providers presenting undue or inappropriate charges after improper, unapproved or poorly approved service.

– Reduces the number of accounts glossed in billing

– Contributes to reducing care costs / accident rates

– Contributes to increased results

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– Reduces the risk of delays in responding to requests, avoiding complaints from beneficiaries, through better workflow control, through the possibility of determining a response deadline for granting authorization or denial based on the TISS standard

– Reduces response time to requests, through online digital communication, supported by accurate information supporting real-time decisions

– Reduces operational costs of the Authorization Request process, completely or largely replacing call centers, paper, and emails.

 

OPME QUOTE

Areas: Financial, Medical (Medical Audit / Nursing) and Administrative / Authorization

PAINS:

– Do you currently use any system for analyzing and quoting Opme?

– Do you use fax, telephone, e-mails to contact the referring doctors in case of any queries?

– Do you use fax, telephone, emails to contact suppliers?

– Are you satisfied with the current system?

– Is OPME a concern for the company? Describe.

SOLUTION: OPME and GED module

– Performs OPME quotations with Suppliers, using the WEB as a means of communication between Providers, Operator and Suppliers.

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– Reduces time and standardizes analysis of OPME requests, through correlation of procedures with OPMEs;

– Optimizes prices through correlation of OPMEs and suppliers pre-selected by the operator as alternatives for choosing providers;

– Reduces the risk of requests and authorizations from OPMEs that are inappropriate for the procedure;

– Increases security in purchasing decisions, through complete trail recording of the entire process, including quotes from OPMEs;

– Optimizes OPME prices through previous purchase history with suppliers

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– Reduces operational costs of the OPME request, analysis and purchase processes.

– Establishes digital quote flow, eliminating paper, telephone, emails, faxes, etc.

 

Medical Monitoring of Inpatients / Audit Per Event

Medical Area (Medical Audit/Nursing)

PAINS:

– Do you have inpatient monitoring?

– What are the notes regarding monitoring of hospitalized patients like? How is this information made available during account billing audits?

– How is this information made available for Audit?

SOLUTION: Per Event Module

– Access to diagnostic information during the stay of hospitalized patients.

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– Cost Reduction through on-site recording of inputs and types of accommodation actually used, for subsequent analysis of hospital bills;

– Increases the quality of the on-site audit, through the standardization of digital forms according to pathology

– Better information support for the auditor at the time of the audit

– Ensures the auditor’s schedule and physical presence at the appropriate location

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– Reduces operational costs, allowing management of which patients should be monitored

 

Billing / Gloss Appeal / Concurrent or On-site Audit

Areas: Financial, Assistance Costs / Medical Bills, Medical (Medical Audit / Nursing) and Administrative / Authorization.

PAINS:

– Does every network send electronically?

– When are validations carried out on the electronic files posted across the network (e.g. Password, Beneficiary, etc.) in the xml’s?

– Flexible Process Flow Configuration by (Pathology, Provider, …)

– Audit Trail (Login Record, Date and Time)

– Is your Gloss Resource Manual or Electronic?

– Are they correctly complying with RN 363? The operator has sent the reasons for disallowances and their justifications to ANS

– PEONA level Inflated due to process inefficiency (technical reserve)?

– Recurring disallowance feature that takes a long time to close?

– What is the average total monthly value of Disallowance Resources after the competence closes?

– How much does this value impact your PEONA?

– Undue and unknown charges with the provider network, causing rework with Glossary Resources?

– Are there difficulties in the negotiation flow, or renegotiation of services, prices and agreements with providers?

– Difficulty or lack of transparency of prices/agreements/disallowances with the network of providers?

– Provider network tends to not comply/ Charge according to the contract?

– Considering access to information (Inclusion, Changes and Deletions) is this trail of who did it, date and time and what was done transparent?

SOLUTION: Audit Module

– Automatic verification of values of materials and medicines, item by item, in addition to other procedures and account inputs, avoiding typing errors;

– Online gloss resource;

– Management of tables and Management Reports.

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– Improves technical analysis, allowing doctors and audit technicians to focus more on issues of therapeutic conduct;

– Compliance with RN 363 articles;

– Art. 14. The administrative and technical audit routine must be expressed, including regarding:

– I – hypotheses in which the Provider may incur a disallowance on the billing presented;

– II – deadlines for contesting the disallowance, for the operator’s response and for payment of services in case of revocation of the applied disallowance; It is

– III – compliance with the specific legislation of professional councils regarding the exercise of the auditor function.

Single paragraph. The agreed deadline for contesting the disallowance must be the same as the agreed deadline for the operator's response.

– Reduction in the flow of billing disputes;

– Optimizes electronic auditing of medical bills with the possibility of automated, fast and reliable activities, in accordance with what was contracted – Production Mat;

– Increases reliability of audits carried out, ensuring traceability in all operations carried out in the system, recording “who”, “when” and “what” was modified;

– Improves relationships with the provider network, making the presentation of medical bills transparent and quick;

– Better price negotiation with providers, through better support of historical information on volume of services and prices charged, compared to competitors (Benchmarking) and preparation of service “Packages”.

– Increase and security of results even with business growth;

– Reduction in accident rates, through a marked improvement in claims controls and better contractualization of the provider network.

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– Reduction of rework costs (Post-payment Gloss Resource), through online gloss resource;

– Reduces the operational cost of processing and auditing medical and hospital bills and disallowance resources;

– Reduction of internal work due to external error (The provider is informed so that they can correct their errors)

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– It will enable payment provisioning to service providers with greater accuracy, streamlining and simplifying financial management;

– The reduction in the aging of resources from disallowances subsequent to the closing of the jurisdiction may lead to a reduction in the mandatory value of technical reserves, with a consequent reduction in financial costs.

 

Difficulties with Accessing Documents

Area: Assistance Costs / Medical Bills

PAINS:

– Are there difficulties if the doctor needs access to a document at the time of the internal audit? If so, which ones?

– Are there any losses?

– Storage costs?

SOLUTION: Audit and GED Module

– Online access to information entered by the audit during the beneficiary’s hospitalization.

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– Optimizes the analysis of medical bills, through access to documents attached directly to the bills and available online for consultation;

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– Reduced paper storage costs;

– Greater security considering that the documents are all stored in a database;

 

High cost of call center for customer service and information services for beneficiaries

Areas: Network management and Beneficiary Relationship.

PAINS:

Is there a high cost for a call center to serve the beneficiary?
Responding to information requests:
- Bank slip
– Consultation schedule
– Medical guide

SOLUTION: Beneficiary App

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– Improvement of better price negotiation with the network of providers through increased scale, directing beneficiaries to the network of providers of interest to them.

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– Reduced call center costs

– Greater agility of response for the beneficiary

 

Try SAUDI – the most awarded medical audit system in Brazil

It is not easy to receive this barrage of information and not act to modernize your health plan provider. In this sense, know that you can count on SAUDI, a Medical Audit System tailor-made to put your operator at the forefront of innovation.

With SAUDI it is possible to optimize processes, increase transparency, store, process and organize data according to your interests, make integrations with other management solutions, make your health plan operator comply with a series of legal requirements and even prepare it to really scale. Visit Our site It is schedule a conversation with one of our consultants.