The scope of services provided by a health insurance fund is defined in collective and selective contracts. Collective contracts define the legally determined services, while selective contracts define services that go beyond this. In terms of contract management processes, selective contracts differ from “ordinary” contracts. Each individual contract can contain thousands of different contract participants, as a health insurance fund concludes selective contracts directly with the local service providers. Due to changes on the part of the contract partners (e.g. specialists, hospitals, medical care centres) or due to the expansion and adaptation of services, contract management must permanently maintain selective contracts. otris contract simplifies this process through automation and connection to external databases.
Public register for transparency
The newly established contract transparency office of the Federal Social Security Office has the function of a publicly accessible register. Insured persons, supervisory authorities and Land authorities are given a transparent overview of the total stock of all selective contracts concluded by health insurance funds with service providers. The Federal Social Security Office can additionally check the correct billing of services through statistical evaluation of the data.
Connection to otris contract
Health insurance funds are obliged to report all selective contracts to the contract transparency office. The data must be up-to-date and transmitted in a prescribed format. With otris contract, health insurance companies minimise the bureaucratic effort involved in data selection and provision. The system exports the required data from otris contract, converts it into the prescribed format and transmits it to the transparency office.
otris consulting is very familiar with the topic of selective contracts and knows the necessary processes and technical requirements. The system adaptations for health insurance companies already using otris contract can be implemented with manageable effort.
Our consultants will be happy to answer your questions on the connection of the contract management software to the transparency office and present the system to you in a webcast.