– Benner Conecta Platform integrates the database of beneficiaries and providers, enabling greater security in the process of requesting authorization and sending invoices, in addition to having facial biometrics
– The Mobile application, on the other hand, prevents refund fraud by having free choice and refund requests functionality, with the check-in function
– In addition to these two solutions, Benner also offers Data Analytics, responsible for carrying out an analysis of the beneficiary's portfolio consumption behavior and mapping suspicious behavior
With the aim of contributing to reducing the number of cheats In the healthcare sector, the Benner Group, a Brazilian supplier of software solutions and services that transforms company processes into results, has been investing in solutions that support this mitigation.
According to unprecedented research by the Institute of Complementary Health Studies of the consultancy firm PwC Brasil (IESS), annual spending on fraud in the private healthcare sector is estimated at 20 billion. Among the main factors that contribute to this high value are ideological fraud and reimbursement requests, which occur on the part of the beneficiary, and sales simulations, through the provider.
According to the Benner Group's Head of Health Product and Market, Rodrigo Garcia, the losses resulting from these frauds go beyond the financial scope. “There are additional consequences beyond the economic aspect. This situation substantially compromises the operator's ability to provide adequate assistance, resulting in direct damage to the quality of health services and, consequently, preventing the provision of adequate care to the patient, affecting the system as a whole”, he explains.
Therefore, to increase security in the sector and reduce the volume of fraud, Benner has two outstanding solutions. The first of them is the Benner Connect, a cloud connectivity platform, which integrates the database of beneficiaries and providers, enabling greater security in the process of requesting authorization and sending invoices.
The security offered by Benner Conecta is also reinforced by facial biometrics in the eligibility process and by the agility and flexibility in the parameterization of rules. Still on facial biometrics, it presents itself as an ally in the fight against fraud as it is also linked to health procedures, ensuring that a provider only covers procedures actually carried out. Furthermore, Conecta, as it is a microservices solution, can be integrated into any system on the market, which contributes to the high volume of use, serving more than 100 thousand service providers in Supplementary Health.
Garcia explains that the solution is capable of identifying multiple test requests, which prevents false production. “If a hospital requests a specific test and, subsequently, another hospital makes the same request within a short period of time, the system can generate an alert in response”, he reports.
In addition to Benner Conecta, the Group has the “Mobile Application”, a complete service and relationship platform specialized in health, which helps bring operators closer to their beneficiaries. The Mobile has more than 25 native functionalities, including free choice and refund requests, with check-in functionality, to prevent fraud at the time of the request. In addition, it offers the generation of a virtual card for the beneficiary, which avoids printed cards and supports the digitization of the entire process.
According to Garcia, the functionality makes part of the fraud impossible by ensuring the presence of the beneficiary at the clinic, office or hospital. “The Mobile application prevents refund fraud as it requires an in-person check-in process. You need to be physically at the location and, on the same day, register the refund in advance. In other words, when arriving at the office for a consultation, it is necessary to insert the locator into the application, which will allow this information to be sent instantly to the application, serving as proof of presence”, he comments.
In addition to these two solutions, Benner also offers Data Analytics, responsible for carrying out an analysis of the beneficiary's portfolio consumption behavior and mapping suspicious behavior. Among the data analyzed by the tool is the comparison of user and provider location, users with the highest reimbursement volume, networks with the highest incidence, users with the highest fraud rate, in addition to crossing the CID between Network and Reimbursement.
Garcia comments that technology has great potential to contribute to reducing fraud in the healthcare system. “The key to reducing the volume of fraud and maximizing results in the healthcare sector lies in technology. With appropriate solutions, it is possible to avoid waste, reduce costs and guarantee efficient and quality patient care”, he concludes.
