•    A solution for facilitating data exchanges and reimbursements between healthcare professionals, insurance companies, mutuals and beneficiaries

•    More than 10,000 bills for healthcare products and treatments are processed every day by Almerys, the 1st multidisciplinary network of registered healthcare professionals (pharmacists, opticians, dentists, medical labs, radiologists…)  

•    An opportunity to develop new products and services for health insurance firms, mutuals and healthcare professionals


■ Orange, via Almerys, the leader in direct payments to healthcare providers in France, is developing its third generation third party payments system and has already observed positive results: strong support from French pharmacists with nearly 94% citing spontaneous adoption and 100% of French regions currently involved
Deployment of the TP 3G system is continuing at a rapid pace with more than 6,000 pharmacies equipped to date. Moreover, 1,200 medical laboratories and 1,000 radiologists will be equipped by January 2010. To achieve this, the main publishers of software for healthcare professionals are already on board.
The TP 3G system was created working closely with representatives in the healthcare field, particularly national pharmacist’s unions (the Union des Syndicats de Pharmaciens d’Officine and the Union Nationale des Pharmaciens de France).
50,000 healthcare professionals will be concerned by this new service by the end of the year 2010.

■ The TP 3G system is based on an infrastructure of real-time data exchanges secured and hosted by Orange Business Services. It allows healthcare providers (doctors, pharmacists, medical laboratories, radiologists…), after authentication, to consult the patient’s healthcare coverage with him in real time.


■ The service also allows insurers and mutuals to provide policyholders with a secure smart card (Cleyris™) that is compatible with national health service card readers, thus replacing paper cards. This smart card provides access to key data concerning beneficiaries (coverage, benefits…). This data is constantly updated in “real time” and hosted on the Almerys applicative platform. With the patient’s permission, the healthcare provider can read his card, log on to the applicative platform and calculate his insurance coverage in real time.
The Cleyris™ card also enables transmission, once again with the patient’s permission, of detailed data concerning treatments to the insurance company.
In the context of this system, which involves exchanges of personal and confidential data, Almerys is a trusted third party and a member of the national federation of TTP (Fédération Nationale des Tiers de Confiance).

■ Around the Cleyris™ system, Almerys has developed many different services such as electronic preventive healthcare records, reinforced by an authentication module and electronic signature.

■ A solution that benefits all players in the healthcare sector
Dematerialisation of flows and real time data management simplify third party insurance payments by enabling:

health insurers and mutuals to optimise management of policyholder benefits and offer new forms of complementary coverage, particularly costs that are not reimbursed under the mandatory national healthcare scheme. This represents nearly € 2 billion. These reimbursements concern the family benefits basket, vaccinations, preventive acts and certain key products for physical rehabilitation, etc.

guaranteed payments to healthcare professionals while avoiding overpayments. Verification of the policyholder’s identity also enables professionals to check his status (cancellation, suspension of guarantee…) and obtain information on the coverage he is entitled to on that day.  Initial analyses show a reduction in overpayments of up to 2% of the total cost of services thanks to immediate verification of benefits and coverage. Moreover, this service is free for healthcare professionals, allowing them to significantly reduce the cost of managing direct insurance payments as well as overpayments.
    
policyholders to avoid paying in advance. They are reimbursed more quickly, benefit from new services accessible on line (reimbursement records) and sign for all contractual medical acts.