Industry challenges
File volume
Thousands of claims and reimbursement requests to process daily.
Prescription consistency
Do the dispensed medications match the GP's prescription?
Medical card coverage
Verify patient entitlements under GMS, DPS, or Long Term Illness schemes before each procedure.
Document fraud
Detection of falsified prescriptions and billing inconsistencies.
Documents processed
- —Medical prescriptions
- —HSE claims forms
- —Medical cards and GP visit cards
- —Hospital invoices
- —Pre-authorisations
- —Medical reports
- —Admission forms
- —Treatment Benefit Scheme documents
Automatic validations
- ✓Dispensed medications = prescribed medications
- ✓Prescribing doctor registered with the Medical Council of Ireland
- ✓Patient entitlements verified at date of care (GMS, DPS, LTI)
- ✓Billed amount compliant with HSE agreed rates
- ✓Date consistency between prescription and care
- ✓Patient identity verified across all documents (PPS number)
Measured results
85%
time saved
+25%
fraud detected
-45%
reimbursement delay