JUBULA is a system supporting the review activities of DRG (Diagnostic Related Groups) in Slovakia, which is intended for review physicians at health insurance companies. It shows review physicians hospitalization cases with the results of the checks as coded by the healthcare provider, as well as alternative coding options (variants) and inclusion in other DRG groups. It focuses on the review of hospitalization cases before healthcare providers are paid for them. It has a fraud prevention mechanism so that the health insurance company does not have to recover already recognized and paid healthcare for DRG cases that have been incorrectly reported and identified only in the post-review process.
Key Functionality
Automatic processing and evaluation of data received from the insurance information system
Storage of processing results for medical examiners for further use
Clear display of hospitalization cases for the review physician with extensive filtering options and specially designed screens for their review
Revision of hospitalization cases at the level of the actual case itself or from the perspective of the insured
DRG coding compliance checks (more than 2,000 checks implemented)
Proposals to correct the reported case
Key Benefits
Improving the quality of post-review activities over DRG
Automatic assessment of the correctness of coding of hospitalization cases
Identification of alternative classification of hospitalization cases into DRG groups
Fraud Detection System
Identification of extreme values (operations, diagnoses, treatment times)
