Automated Reimbursement Calculations – Neutra

Challenge

Nature of collaboration

Following a multi-phase initiative to digitize contract, reimbursement, and document workflows, we worked alongside Squareflow to deliver coordinated systems tailored to Neutra’s operations. Squareflow was in charge of integrating and customizing Odoo as Neutra’s new ERP, covering contract management, document intake, and workflow orchestration. Our role focused on implementing Skwiz, Sagacify’s solution for intelligent document processing, and building the reimbursement engine. Collaboration included aligning system responsibilities and interfaces: Odoo handled document routing and business logic, Skwiz extracted structured data from incoming files, and the reimbursement engine applied client-specific rules to compute refund proposals, which were then validated and finalized within Odoo. Throughout the process, Neutra’s teams remained involved at each stage for manual review and validation.

What we built

The reimbursement engine was delivered as a dedicated web-based platform, integrated into a multi-system architecture involving Odoo and Skwiz. Documents first enter the system via Odoo, which handles intake and initial routing. They are then transferred to Skwiz, where classification and data extraction are performed. Once validated, structured data returns to Odoo, which determines if the claim should proceed for reimbursement calculation.

When eligible, claims are forwarded to the engine, which first reconstructs the invoice structure line by line based on the extracted data, then applies client-specific rules to compute reimbursement amounts for each individual line. These rules incorporate:

• INAMI codes and APB drug data
• Contract conditions such as ceilings, deductibles, and exclusions
• Product-specific logic tied to guarantees or plan types
• Date-sensitive rule sets, stored as distinct configurations and applied based on the date of service

Each rule change is scoped to its validity period, ensuring updates do not alter previously processed claims.

The engine returns a reimbursement proposal to Odoo, where a designated collaborator reviews the result. If the proposal is accurate, Odoo generates the corresponding payment statement. If not, the collaborator can either apply manual corrections or return the case to the engine for recalculation. Manual oversight is also present at earlier stages, including during data extraction and claim preparation, ensuring control throughout the full reimbursement chain. Each transaction is logged to maintain traceability from initial intake to final payment.

Conceptual View of Sagacify’s
Reimbursements Calculation Engine