Authors:

Miriam Schulze, CEO of BAYOOMED

Alexandra Heuel, Project Manager at BAYOOMED

Julia Schliesch, Marketing Generalist at BAYOOMED

Since the introduction of Sections 33a and 134 of SGB V, the prescription and billing of digital health applications (DiGA) have been firmly established within the statutory health insurance system. The legal framework requires providers not only to integrate their systems technically into the healthcare system but also to comply with complex processes when billing health insurance companies.

These requirements present DiGA manufacturers with the following challenges, among others:

• High technical complexity: The processes involved in billing are technically demanding, particularly when it comes to integrating with health insurance providers’ IT systems and complying with mandated standards.
• A Fragmented Health Insurance Landscape: Health insurance providers have different requirements and procedures, which makes the DiGA billing process confusing and complex.
• Technical and billing-related processes: Many DiGA manufacturers do not have an established network or the necessary resources to quickly and efficiently resolve technical and billing-related issues concerning DiGA billing.
• Maximizing Liquidity Potential: Many DiGA manufacturers do not fully utilize their liquidity potential when billing for DiGA, which can lead to financial bottlenecks.
• Financial Controlling: Working with health insurance companies often results in high DSO (Days Sales Outstanding), ADD (Average Days Delinquent), and ART (Accounts Receivable Turnover), which can have a negative impact on financial performance in the context of DiGA billing.
• Complex Payments: The large number of transactions and a lack of traceability make it difficult to maintain smooth accounting procedures when processing DiGA reimbursements.

The VeriDiGA API

To address these billing challenges, CONVEMA handles prescription code verification and the billing of digital health services to health insurance providers.

With the VeriDiGA API, CONVEMA ensures code validation and compliant billing of DiGA services with currently 93 health insurance providers.

VeriDiGA offers various features specifically tailored to the needs of DiGA manufacturers and to ensure efficient billing of DiGA:

• Dashboards: An intuitive and clear overview of all relevant billing data. The dashboards enable DiGA manufacturers to monitor their DiGA billing in real time, identify bottlenecks and sales trends early on, and make informed business decisions using predictive models.
• Payment Overview: A clear and organized presentation of all incoming payments supports efficient bookkeeping and improves transparency in DiGA billing.
• Invoice Resolution: CONVEMA handles the resolution of outstanding invoices for DiGA manufacturers as part of the billing process. Thanks to personal contacts with representatives at health insurance companies, CONVEMA achieves quick and transparent solutions to billing-related issues.
• Customer Support Portal: A central portal provides support teams with direct access to verify activation codes and assist insured individuals in activating DiGA applications.

In addition to the features of the VeriDiGA portal, CONVEMA offers personalized consulting on market access opportunities, current developments in the healthcare sector, and solutions to specific billing-related questions through regular dialogue with industry experts.

The VeriDiGA solution simplifies and optimizes the entire prescription code verification and DiGA billing process for manufacturers, allowing them to focus more on their core business.

Billing statutory health insurance providers presents many DiGA manufacturers with technical and organizational challenges. With BAYOOMED’s DiGA Services—including invoicing and code validation services—these processes can be managed efficiently and transparently. Our service handles key aspects of invoice processing and ensures that billing data is submitted reliably, payments are processed in a traceable manner, and revenue is realized more quickly.

If you’d like to learn more about our invoicing service or other DiGA services, please feel free to contact us. We’ll be happy to provide you with a no-obligation consultation on the right solutions for your project.

You can find more information here.