ACS PROCESSES 
GAINS 
BASIC SYSTEM FUNCTIONS 
COOPERATIVE WEBSITE Centralized view
Bring together forms, invoices, receipts and production.
Direction product
ACS
Automation of Medical Cooperative Processes
Objetivo
ACS aims to safely streamline a cooperative's operational process. Its main objective is to centralize information on health plan forms, invoices, payments and denials in a safe and effective way. The system works as an interface between doctors and health plans.
The general process involving a cooperative takes place in the following phases:
The doctor receives the guides (consultation, examination, hospitalization, etc.) of the agreements. - The guides are filled out in patient care.
- The guides are sent to the cooperative
- The cooperative enters the forms into the ACS system. The Office Automation system is under development and interfaces with ACS, allowing form data to be imported automatically.
- The cooperative generates invoices in ACS, which are then sent to the health plans.
- The agreements analyze the invoices received and pay or disallow them to the cooperative.
- After the cooperative has been paid by the health plans, it records the invoices as received in ACS.
- Denied forms are reviewed by the cooperative, with appeals managed through ACS.
- The cooperative closes the doctors' production report in ACS, with all tax calculations performed automatically by the system.
- After closing the sheet, the cooperative makes the payment to the cooperating doctors and makes the extract available on the internet.
Registration of medical records and guides informed by doctors - Invoice generation or cancellation
- Sending reports on invoices to agreements
- Receiving or canceling invoices
- Closing or reopening of doctors' production sheet
- Issuance of management and statistical reports, such as: Payment Statement, Production Sheet, Summary of Payment Events, Percentage of Assistance per Member, Percentage of Assistance per Agreement, Evolution of Billing per Member, Evolution of Billing per Agreement, etc.
- Make Payroll available on the Web Site
- Making Open Chips Available on the Web Site
- The system provides the Cooperative with a general control of the information of doctors and health insurance, providing the physician with all the administrative and bureaucratic part of payments and disallowance of guides
- There is a gain of 70% in relation to the cooperative's operational flow:
The time spent performing the calculation of services manually is much longer than the time spent typing them into the system The margin of error for the information of the services' values becomes minimal when calculated by the system - Invoices in the system are generated by grouping the forms (guides). Consequently, the cooperative will receive these forms in the system providing the number of the generated invoice, that is, it is not necessary to receive and check the form per form.
- Data integrity and consistency
- The system provides the cooperative with reports of income reports (Cédula C) and monthly arrears (apportionment of the cooperative's expenses)
- When closing the production sheet, all the automatic calculation of taxes to be deducted from medical services is done
- When the file is included, the value of the service is automatically calculated on the screen, avoiding typos in the value of the services.
- Frequently performed functions: Inclusion of Guides informed by doctors; Generation of invoices; Generation of file for agreements in the TISS XML standard Glosa Resource Inclusion of pending events on the payroll (inclusion of any benefit or discount for a certain doctor, is widely used for on-call duty) Closing of the cooperative physician's production sheet
- Registration of basic system tables: Covenants Doctors Physicians' Workplaces Income Tax and Social Security Banks Table TUSS System events Procedures Sub-Specialties Procedural proceeds and discounts ICD (International Disease Code) Reasons for disallowance
- Management information viewed in the system: Covenants
- Management and statistical reports generated by the system Bank deposit Overdue charge Yield reports Percentage of assistance per member Percentage of assistance per agreement Evolution of billing per member Evolution of billing per agreement Covenants in delay Medical Services Statement
The objective is to make the main services of the Cooperative available on the Web, seeking to offer members more flexibility and convenience in accessing information.
- The cooperative's website aims to make the information available on two levels. Public access, where information about the Cooperative, Agreements, Specialties, and the address of the offices of its Members is made available Access to the Cooperative, where it is possible to issue a Payroll statement, Income Statement (financial statement) and Proof of Income Paid and Income Tax withholding. It is also possible to access all the information of interest to the member in the Wall section.
Integrated cooperative workflows
Centralize forms, invoices, payments and denials
ACS connects cooperatives, physicians and health plans.
Operational workflow
Track steps through member payment.
Denial support
Organize analysis and appeals.
Automated calculations
Support production closing and related calculations.
Where ACS creates value
For health cooperative administrative workflows.
Form intake
Centralize documents sent by physicians.
Health plan billing
Generate and track invoices.
Member production
Close production and provide statements.
ACS FAQ
Who is ACS designed for?
Health cooperatives managing relationships between physicians and health plans.
Which steps does it centralize?
Forms, billing, receipts, denials, production closing and payments.
Does ACS support denial handling?
Yes. It supports analysis and appeal workflows.
Can members receive information online?
Yes. Statements can be provided online after closing.
Want to integrate your cooperative operation?
Talk to Direction about your workflows and requirements.