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Major Process Groups | Business Processes | Proposed module | legacy | Modular | comments |
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Policy | X | Apr 21 | informal sector : enroll Directly insuree (head of familly) and the dependent formal sector: contract per company for every period that include all the company worker | |
Assign beneficiary to a Primary Care Provider (PCP) or primary care unit |
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Insuree | X | Apr 21 | ||
Provider management (Price list) | would be only based on the price list, |
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pre-authorisaiton required to have the eligibility for provider and Beneficiary |
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Policy |
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X |
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Apr 21 | |||||
Accounting | does it include prevaluation ? difficulty: M | ||||
Location and Health Facility (sub level) | X | Apr 20 | |||
Location and Health Facility (price list link) | X | Apr 20 | |||
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Contribution (Policy - contribution) | X | Apr 21 | ||
Claim (hf claim) | X |
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Oct 19 | ||
Claim (claim overview report) | X |
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Oct 19 | ||||
Claim | Restore | difficulty: M if more than just restore | ||
Claim (review) | X |
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Oct 19 | |
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Accounting (batch run) | X | account report available | ||
Payments to beneficiaries (e.g. sickness benefits, funeral benefits) | Accounting | |||
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Accounting | Plan for TZ | |||
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Accounting | Plan for TZ | ||
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Reports / cubes | ~ | Apr 21 (DHIS2) | Report available on service and Item | ||
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...
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Benefit plan (insurance product) | ~ | done via Relative pricing, pricelist and scheme drugs price | |||
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...
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Contribution plan |
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X | Apr 21(FS) |
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Benefit plan ( |
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distribution) | |||
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Reports / cubes | ~ | Apr 21 (DHIS2) | multiple report can be use to compute the MLR | |
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Claims |
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+ AI | ~ | Oct 19 + Apr 21 (AI) | based on product list and eligibility |
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Claims (feedback) | ~ | Oct 19 | Ask feedback from the beneficiary |
Source: Joint Learning Network Report 2012
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Other process groups, not defined in JLN
Major Process Groups | Business Processes | Proposed module | legacy | Modular | comments | |
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Other | Accident management | Accident case management | case auditing | should take over "feedback" D:M | ||
Accident assessment | case auditing | |||||
Payment of one- time cash benefit (e.g funeral benefits) | Cash financing | D:L | ||||
entitlement on recurring cash benefits (e.g. survivor benefits) | rights payment | D:XL | ||||
Social benefit/Family benefit | Retirement management | rights management | D:XL | |||
entitlement for recurring benefit (health insurance) | rights payment | D:XL | ||||
entitlement of one-time event based support | Cash financing | D:L | ||||
children financial support | rights management | D:XL |
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possible module structure as reporting table based on module wiki pages
Process Group | openIMIS Module | FE repo | FE Version | BE repo | BE Version | Doc |
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Beneficiary Management | Policy | |||||
Insuree | ||||||
Provider Management | ||||||
possible property table in a module page
Module Name | |
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FE repo | |
BE repo | |
Dependencies |
|