(Intro paragraph)openIMIS is a versatile open source software which supports the administration of various schemes related to health financing and social protection. Designed in accordance with industry standards for interoperability, openIMIS offers a standardised but adaptable way to manage information flows related to various forms of health insurance, employment injury insurance as well as other social protection schemes by bringing together beneficiary, service provider and scheme operator data into a single platform. Some key use cases of openIMIS are highlighted below.
Use cases in health financing
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openIMIS supports the following business processes for health insurance
Beneficiary Management
Collecting and managing contributions
Issuing membership ID cards to beneficiaries
Verifying scheme membership
Health service claims generation and submission
Medical review of selected claims
Processing and payment of claims
Current implementations
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Voucher schemes
Challenge:
Business processes covered:
Current implementations: Tanzania Mainland
Use cases in social protection
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Enrolment
Accident reporting
Health service utilization
Health service claims generation and submission
Claims review process
Processing and payment of claims
Current implementations
Employment Injury Insurance - Social Security Fund Nepal
Cash transfer
Challenge:
Business processes covered:
Current implementations: