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- Creations of Locations - Configured to indicate geographical coverage of the scheme and allocate appropriate access to different users in the system. Currently there can be up to four sub levels defined to indicate geographical boundaries (for eg. Regional -> District -> Municipality -> Village).
- Payers - Configured to indicate a 3rd party payer who would pay the due policy amount on behalf of an insured unit.
- Claims administrator - The personnel responsible at a health facility who is authorized to submit claims on behalf of the health facility.
- Enrolment Officers - The personnel (enrolment officer/agent) responsible for enroling and renewing families/enrolled units.
- Users - Different actors involved in processing data of the insurance scheme are configured here. All users created are given a location and a role according to the function they need to perform in the system.
- Medical Items - A universal list of all possible medical items covered by the scheme are configured. These form the basis of establishing facility specific price lists.
- Medical Services - A universal list of all possible service packages covered by the scheme are configured. These form the basis of establishing a facility specific or facility type/group specific price lists.
- Price Lists (Medical Service and Medical Items) - A facility specific list of medical services and items are configured. These could be a price list offered by one facility or a type of facilities (eg. all dispensaries) or a groups of facilities (eg. all government facilities). These are based on the price lists negotiated by the insurance scheme.
- Health Facilities - A list of contracted health facilities can be configured. These include all different levels of facilities (primary, secondary or tertiary levels) as well the link to respective price lists agreed with the insurance scheme.
- Products - A list of all insurance products on offer by the health insurer can be configured. The product includes the conditions it applies to the customer as well as to the health facility. These include different provider payment mechanisms (eg. capitation with adjusters, fee for service, service packages, etc.) and limits like ceilings per event, per individual or per family as well co payments etc. A health insurer can have one or multiple products and can offer it either in all locations or restrict them by location.
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