Sumex AG was founded in 2019 and emerged from the long-standing collaboration between ELCA Informatik AG and Suva. Sumex AG is a leading technology provider that aims to make an important contribution to the automation and cost stabilisation of the Swiss healthcare system – a goal that Suva is also pursuing in its current medical cost management programme.
The original press release from Suva can be found here: Medical costs under control: Suva saves CHF 105 million. Sumex is proud to work together with Suva on continuous cost optimisation in the insurance sector.
Medical costs under control: Suva saves 105 million francs
Last year, Suva checked 2.5 million medical and hospital invoices. A good 70 per cent of the invoices were processed automatically. 268,000 invoices contained errors or inaccuracies and were rejected. This saved CHF 105 million in medical costs. This amount benefits Suva policyholders in the form of lower premiums.
Healthcare costs are rising steadily due to the rapid development of medicine and longer life expectancy. This also applies to medical costs, i.e. the costs of medical and therapeutic services in favour of accident victims. Last year, Suva paid CHF 1.27 billion for medical costs.
With its medical cost management, Suva makes an important contribution to preventing unjustified cost increases without restricting the quality of benefits. This applies to medical care as well as therapy and rehabilitation following an accident. In this way, Suva protects its insured persons from unjustifiably high medical or hospital costs.
Cost savings lead to lower premiums
In 2023, Suva checked a total of 2.5 million doctor and hospital invoices. Of these, 70 per cent were processed automatically. 268,000 invoices (10.7 per cent) contained errors or inaccuracies and were returned to the billers for correction. Consistent invoice checking saved CHF 105 million in medical costs (2022: CHF 96 million, + 10 %). This cost saving benefits Suva policyholders in the form of lower premiums.
"Suva's aim is to provide the best possible care for its insured persons, and at the same time the insured persons want the lowest possible premium," says Michael Widmer, Team Leader Medical Costs at Suva. "That's why we check every invoice very carefully to see whether the costs charged actually correspond to the services provided. Because today's cost control is tomorrow's premium".
How invoice verification works
During invoice verification, the system automatically checks the medical expense invoices that arrive at Suva. If everything is in order, the invoice is authorised for payment. If the system detects errors or inaccuracies, the invoice is forwarded to Suva's medical cost specialists. They check whether the tariff provisions have been complied with and whether the treatment is related to the accident at all. If an irregularity cannot be justified, the invoice is sent back to the biller for correction. Most rejections involve duplicate invoices and incorrectly billed or uninsured benefits.
Further measures to curb the rise in costs
Other measures taken by Suva to curb the rise in costs include tools for the electronic exchange of data and information with service providers, tariff agreements with doctors, hospitals and therapists, advice on the application of tariffs and the checking of applications for cost approval and cost estimates.
Awareness-raising campaign "Costs under control"
With its current "Costs under control" campaign, Suva aims to raise awareness of accident costs among employers and employees and sensitise medical service providers to the measures needed to curb the rise in costs. The campaign will run until 20 October 2024 on suva.ch and Suva's online channels: suva.ch/heilkosten.
About Sumex
The company offers open platforms for insurance companies with a focus on process automation, cost reduction and innovative solutions. In 2022, Sumex AG will merge with Secon AG to form a leading provider of ERP and claims management software for the Swiss healthcare sector. The aim is to reduce complexity, ensure compliance and increase efficiency by automating standard insurance processes.
With the Sumex Suite, Sumex AG offers a flexible workflow solution for the automated processing of claims documents in the Swiss healthcare sector. Sumex AG also offers other services, such as the preparation and provision of up-to-date tariff and reference data or a service for digitising scanned medical invoices.