Case Studies

Automating Healthcare e-Invoicing: From Digital Signature to Automated Delivery with full Compliance

11 May 2025 No comments yet

Organization

A regional healthcare procurement and administrative authority overseeing the digital modernization of the financial and accounting systems of public health entities. The organization manages mission-critical IT infrastructure for ERP, e-invoicing, and accounting across dozens of hospitals and health units.

The initiative focused on streamlining the active invoicing process to the national SDI system, ensuring full legal compliance with e-invoicing obligations for public and private healthcare entities.

The Challenge

With the progressive enforcement of e-invoicing regulations across public and private sectors (mandatory since 2014 and 2019, respectively), the regional healthcare system faced increasing demands to:

  1. Digitally generate and sign XML- compliant e-invoice documents
  2. Ensure reliable transmission to SDI (National Public e-invoicing system)
  3. Handle growing document volumes and response flows from SDI, such as delivery receipts, rejections, and status updates
  4. Maintain integration with SAP-based ERP systems while improving usability and performance
  5. Guarantee legal compliance with eIDAS, the Italian Digital Administration Code (CAD), and national procurement and archiving standards
  6. Support asynchronous message exchange and high availability under peak operational loads

The system had to function across a complex ecosystem, involving certified email channels, HSM-based digital signature, legal archiving, ERP systems, and SDI interoperability protocols.

The Solution

The authority adopted the Coopera platform to develop and deploy a robust, modular, and asynchronous middleware (Billing) for e-invoicing orchestration, fully integrated with SIAC and SDI.

Key features of the solution included:

  1. A dedicated Billing middleware that orchestrates the complete active invoicing lifecycle
  2. Seamless integration with SAP (SIAC) for invoice data acquisition and status propagation
  3. Automatic digital signature (CADES) via HSM with full certificate validation
  4. Multi-entity configuration for healthcare providers, including customized PEC channels, authorized signers, and security credentials
  5. Full support for batch transmission, retry logic, and asynchronous SDI response management (RC, SE, ER, DT, etc.)
  6. Web service interoperability for invoice submission and status updates, enabling real-time synchronization
  7. A high-performance, event-driven microservices architecture based on ESB, enabling parallel processing and live failover
  8. Compliance with eIDAS, SDI 1.7 specifications, and GDPR-level traceability (audit logs, session tokens, secure channels)

Coopera Modules Involved

Coopera’s middleware Billing solution enabled healthcare entities to digitally generate, sign, and transmit XML invoices to the SDI (Sistema di Interscambio) with full compliance, high availability, and seamless ERP integration.

  • Document Management

    Archival and classification of outgoing XML invoices, signed copies, transmission receipts, and SDI responses (RC, DT, SE, ER…).

  • Email Management

    Asynchronous handling of PEC messages, fallback flows, and delivery reports as part of the SDI multi-channel strategy (PEC, WS, FTP).

  • Case Management

    Aggregation of invoice documents, transmission logs, and response flows into structured cases per entity, provider, or payment cycle.

  • Process Automation

    Coordination of invoice lifecycle: generation, digital signing, multi-channel delivery, response handling, and error retries.

  • Content Lifecycle Automation

    Management of states (generated, signed, sent, acknowledged), retention policies, and legal document tagging.

  • Digital Signature

    Automated HSM-based CAdES signing of XML invoices prior to SDI transmission, with legal time-stamping and certificate validation.

  • Coopera Integration HUB

    Bi-directional integration with SAP (SIAC), SDI (web service, FTP, PEC), and Central Bank where needed for financial execution.

  • Content Analytics

    Real-time visibility of transmission status, pending responses, rejected invoices, and flow KPIs by entity and channel.

Benefits & Results

The Billing platform allowed multiple healthcare entities to automate all e-invoicing flows with legal and operational guarantees. Coopera ensured real-time transmission, centralized observability, secure signing, and SDI compliance—contributing to significant error reduction and full fiscal integration at regional scale.

Results achieved:

  1. Successful end-to-end automation of electronic invoice transmission to SDI across all healthcare entities
  2. Processing of thousands of invoices per day with real-time feedback and traceability
  3. Elimination of manual tracking and reduced error rates in transmission and signature validation
  4. Seamless interoperability with PEC, ERP (SAP/SIAC), HSM signing systems, and SDI
  5. Increased resilience and system availability thanks to hot-swappable microservice architecture
  6. Improved SLA management, auditing, and visibility for compliance and reporting
  7. Modular architecture ready to scale with growing volumes and regulatory requirements

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