Case Study: Swiss health insurer Sanitas achieves seamless rule‑engine migration and streamlined accounts‑payable auditing with ACTICO Rules

Swiss Health Insurance Company Sanitas Automates Account Auditing and Payments with ACTICO Rules

Sanitas, a leading Swiss health insurer, relied on its custom accounts-auditing application Heureka to process millions of accounts payable each year. Faced with the need to replace an aging rule engine, simplify a complex rule landscape and convert RETE and flow rules without interrupting operations, Sanitas selected ACTICO and its product ACTICO Rules to take over rule management for Heureka.

ACTICO implemented ACTICO Rules to migrate and centralize roughly 150 rule packages, integrate TARMED and Sanitas-specific checks, and feed enriched XML results into the Syrius payment system. The cutover was completed in record time with no disruption to users; audits now automatically approve about 50% of invoices, statistics and error types are produced for management and processing, and the Heureka architecture and rule maintenance have become significantly simpler and faster to change — supporting a platform that has processed >21 million invoices (>111 million audit items) since 1995.

Sanitas

Urs Knecht

Director of Software Development