ROSNO-MS and Asteros automate business processes for medical insurance

February 11, 2010

B.A.C. (part of the Asteros Group) has finished developing an information system for supporting medical insurance services at ROSNO-MS. The IT-system supports the processes responsible for collection and processing of data on compulsory medical insurance policies and on medical services from over 250 medical institutions in Moscow and the surrounding region.

ROSNO-MS specializes in compulsory and voluntary medical insurance. Today, the company provides insurance cover to over 18.5 million people. ROSNO-MS works with more than 2700 medical institutions across Russia and has an extensive network of its own centres which provide insurance policies. The vast quantities of information on insured clients (the insurance agreements concluded with them and the medical services rendered) must all be collected and processed within the company’s information systems. Following processing, the data is consolidated and forwarded to the State Medical Insurance Fund and other relevant authorities.

Before the project started at ROSNO-MS, the business processes connecting the insurance company, medical institutions and government authorities were only partly automated. Downloading and checking of data as well as reporting was carried out in different IT-systems and, in the majority of cases, these operations took place in a semi-automatic mode, which caused errors and workplace inefficiencies. In order to increase the efficiency of work at the insurance company and reduce the financial risks caused by lack of transparency while working with medical institutions, the decision was taken to develop and implement the necessary IT-solutions.

Asteros specialists examined the processes responsible for keeping track of insurance policies and recording medical services rendered at ROSNO-MS. Then the specialists developed an end-to-end IT-solution, which automated the processes responsible for the collection and processing of data and the production of consolidated reports. The system has a modular structure and was deployed on the Microsoft.NET platform.

Today, the IT-solution facilitates interaction between ROSNO-MS and over 250 medical institutions in Moscow and the surrounding region. The information system automatically carries out the following processes:

• keeping a register of insured persons and a record of contracts signed;
• technical checking of incoming data;
• monitoring and assessment of medical services rendered;
• report formation and forwarding to the State Medical Insurance Fund and medical institutions.

“When the system was deployed, our employees received comprehensive access to compulsory medical insurance data. This allowed us to improve and systematize control over the payment of bills from medical institutions; labour expenditure was cut on medico-economic monitoring and assessing the quality of medical services rendered. As a result of the project, we basically received a universal information technology and business platform which allows us to model accounting and data-exchange processes and configure them to fit the specifics of a given region. This brings us closer to achieving our strategic goal of fully unifying and automating the data-exchange process between all of the organizations involved in the medical insurance system.” – Aleksandr Kilyakov, Head of Information Technology, ROSNO-MS.

At the present time, Asteros specialists are providing full technical support and are continuing to develop the solution further. In the future, the system may be replicated and spread to all the regions where ROSNO-MS operates.

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