AOK SAXONY-ANHALT
SUPPORTING THE CLEARING PROCESS WITH AN SAP INTEGRATED CLEARING APP
GOAL
SAP-integrated clearing-app
SERVICES
development
DURATION
09/2022 – 11/2023
ABOUT THE AOK SAXONY-ANHALT
AOK Saxony-Anhalt, based in Magdeburg, is a statutory health insurance provider from the group of General Local Health Insurance Funds and also serves as a care insurance fund for Saxony-Anhalt. AOK serves around 765,000 insured persons across 44 branch offices.
THE OBJECTIVE
The goal was to develop an application that supports data verification and cleansing within the framework of the GKV-Spitzenverband’s RSA-clearing procedure. This should enable AOK to efficiently and legally identify when insured persons are mistakenly registered with multiple health insurance companies.
THE PROJECT
Primary focus of the project was on the GKV-Spitzenverband’s clearing procedure, which takes place twice a year, determining which individuals are actually registered with which insurance company. The project involved developing a specialized app that allows AOK’s team to process CSV files from other health insurance companies containing potential overlaps in insured persons’ data. This app was designed to help identify, document, and make necessary corrections for these overlaps.
Additionally, the solution needed to ensure seamless integration into AOK’s existing SAP system to provide direct access to digital patient records and other relevant information of the insured.
THE HIGHLIGHTS
One critical aspect of this project was the tight schedule, given that the data reconciliation occurs semi-annually—during both the main and secondary clearing processes. The app needed to be ready on time to handle the time-sensitive steps of the clearing process.
The project was successfully completed under high time pressure, with the app being ready in time for the secondary clearing. This relaxed the process for the manageable number of around 200 cases at this time.
Given its specific functions and added value, this app could potentially serve as a nationwide model for all health insurance funds using SAP systems.
