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Modular construction
openIMIS is modular and customisablecustomizable. It offers functionality in beneficiary management (including registration), benefits administration (including payments), and data analysis. Users can pick and choose the modules they wish to use, and can adapt these to their specific needs.
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Modules and functionalities
openIMIS is custom built to manage the high-volume data flows which are required to administer health insurance and social protection schemes. It has been specially designed to manage beneficiaries; benefit packages; providers; claims generation, review and processing; payments; and data analysis.
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Beneficiary management
openIMIS supports the enrolment enrollment of individuals and families, as well as employers and employees, into schemes. Enrolment Enrollment information can be captured directly in openIMIS, or imported into openIMIS from existing beneficiary management systems using shared interoperability standards (i.e. HL7 FHIR).
The software supports the renewal of coverage at designated intervals, the updating of beneficiary records and the issuing of ID cards using QR codes and unique identifiers. Enrolment Enrollment and renewal data, including photos of beneficiaries, can be collected and transmitted using a mobile app.
openIMIS also supports the collection and management of contributions, including issuing payment receipts and tracking whether beneficiary contributions are up to date.
Service delivery
openIMIS supports the verification of scheme membership. When beneficiaries present their ID cards at health facilities, healthcare workers can check their eligibility for services via openIMIS. Beneficiaries are examined and treated, and provided with tests and medicines as needed. The services provided are recorded in openIMIS. Using openIMISthe software, health facilities can generate claims for insurance scheme operators by entering codes for diagnosis and services rendered.
Claims management
openIMIS supports the processing of claims, the generation of payroll (in the case of cash transfer schemes) and the distribution of payments to beneficiaries and healthcare providerssubmission and review of claims. Health facilities which use openIMIS can electronically submit claims to insurance scheme operators for review and reimbursement. openIMIS calculates reimbursements and processes payments to healthcare providers. In the case of cash transfer schemes, the . Claims can be processed either individually or in batches. openIMIS allows for claims which pass automated checks (based on pre-defined criteria) to be selected for medical review. It then calculates reimbursements to healthcare providers for approved claims.
Payments
openIMIS supports the management of payments to service providers and to beneficiaries of cash transfer schemes. The payer or scheme operator can use openIMIS to define the criteria for cash transfers (e.g. inclusion criteria, payment amount, frequency) and to generate a payroll with the amounts to be disbursed to beneficiaries in a given payment cycle. Payment service providers use this list to disburse funds. openIMIS also allows for reconciliation of issued payments against payroll. Unique payment transaction numbers can be generated for each payment, allowing them to be traced to individual households.
Monitoring
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openIMIS allows scheme operators to monitor and analyse the performance of the scheme through the generation of reports and data visualisation, e.g. dashboards.
Standards
openIMIS follows the HL7FHIR R4 standard for information exchange, allowing it to work seamlessly with other systems. This means that it can readily exchange data with everything from widely used data analytics platforms such as DHIS2 to electronic medical record systems like OpenMRS and other existing beneficiary management systems, such as those maintained by social security agencies.
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openIMIS takes care to ensure that the software is free of security-related issues and that all required measures to ensure the safety of data are in place. However, there is an added layer of security that you are responsible for during implementation. As you implement openIMIS, you will need to install and host the software on either a Implementers, however, are responsible for ensuring that the required security measures are in place on the virtual or physical server on which openIMIS is installed and hosted. This server(s) is where your data will be stored. You should ensure that the server you choose to host openIMIS on has the required security measures in place.data from the openIMIS implementation are stored. The openIMIS initiative will never have access to any data from your the implementation of openIMIS.
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