D-Flow Hybrid-DRG
D-Flow Hybrid-DRG connects service capture, grouping and billing with payment processing and the handling of responses. German Associations of Statutory Health Insurance Physicians (KVen) and medical practices manage their cases within a shared workflow.
Overview
From registration to payer response
Practices enter cases in the browser. The KV validates the data, manages billing and handles responses from health insurers. Case status, payments and processing steps remain visible together. The solution is in routine use at KVen.
Workflow
How billing works
- Register and approve access: Providers register online. The KV reviews registrations and grants access.
- Enter and validate cases: Practices record services in the browser, supported by plausibility checks during data entry.
- Group cases: The connected grouper determines the DRG and payment amount. Results are returned to the case automatically.
- Submit claims: D-Flow generates EDIFACT messages based on the technical specifications and sends them to health insurers’ data acceptance centres. Dispatch is recorded in the case history.
- Process payments: Departments create and approve payment orders. The connected accounting system handles payouts and returns payment information.
- Resolve rejected claims: Rejected cases are reviewed with their reasons, clarified with the practice and corrected, cancelled or resubmitted as needed.
Daily work
Visibility for KVen and practices
Case processing
KV staff review registered providers and submitted cases, check information and handle queries.
Payment status
Reimbursements from health insurers and payouts to practices can be tracked for each case.
Case history
Data entry, grouping, dispatch and responses are documented along with their processing history.
Reporting
Practices download their own statistics. KVen can generate reports for KBV statistics.
Integration
Connect grouping and accounting
The Gesundheitsforen grouper is connected through a REST interface. Further interfaces link billing to data acceptance centres and the KV’s accounting system. Integrations with different accounting systems are already in use.
Departments maintain validation rules through the D-Flow workflow engine without programming. Permissions distinguish between practices, departments, accounting and administration. We work with you to define the integration into your systems.
Contact
Hybrid-DRG billing with D-Flow
We can demonstrate the workflow and discuss how to connect data entry, billing and payment processing in your KV.