MEDIFACT
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MEDIFACT is the central, data-driven intelligence of the Single Health Insurance Fund. “All-knowing” would be an exaggeration – but MEDIFACT is intended to become more precise exactly where bureaucracy, media discontinuities, and error-prone processes currently make the system expensive.
As a powerful mainframe computer operating on a secure public infrastructure, MEDIFACT becomes the true workhorse of the Single Health Insurance Fund: it processes tens of thousands of cases simultaneously and in real time – accurately, transparently, and without fatigue.1005x 1005-01x
MEDIFACT works with medically relevant information: patient data, images, reports, and consultation transcripts – wherever legally permitted and wherever it truly matters for treatment, quality, and reimbursement.
Systems such as ‹ChatGPT› can handle published knowledge very well (and have been of great help here), but they do not have access to individual patient records. MEDIFACT, by contrast, is based on structured and verifiable data from everyday medical practice – and can derive the decisions required in the healthcare system from this data.
Speaking of digitalization: I view the further development surrounding the Electronic Patient Dossier (EPD) critically. In my opinion, there is a risk that some objectives may once again fail in practical implementation – similar to earlier approaches related to the legislation on electronic patient records.
MEDIFACT is continuously supplied with relevant data, images, and consultation transcripts from new personal trackers. The information comes from direct exchanges with service providers, medical professionals, and entries in the patient record. On this basis, MEDIFACT can make precise and reliable decisions.
MEDIFACT largely relieves service providers of time-consuming documentation work, thereby creating valuable capacity. This time can be invested in direct patient care and in training. As a result, medical and nursing services expand many times over without increasing staff numbers.
The consumer program «Kassensturz» demonstrated impressively on 16 September 2025 the consequences of excessive documentation requirements: enormous volumes of writing – and at the same time alarming deficits in training.
The Main Tasks of MEDIFACT
- Allocation of case numbers (proper assignment of all processes).
- Transcription and evaluation of reimbursement requests: Service providers no longer send invoices, but tracker data, audio recordings, images, and medication consumption data. MEDIFACT calculates the services and initiates the reimbursement.
- Patient information: Reports from service providers are translated into easily understandable language. Confidential content that is not relevant for handling is removed. Patients receive an SMS or email asking them to review and confirm their request or to comment on it.
- Documentation: Creation of the correct entries for the patient record.
- Staff evaluation: Recording qualifications and professional experience, as well as determining the remuneration paid by the Single Health Insurance Fund to service providers.
- Flat-rate payments: Use of hospital beds, operating theatres, intensive care beds, recovery rooms, expensive equipment, etc. MEDIFACT calculates reimbursements individually, fairly, and transparently.
MEDIFACT can do much more – click here.
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