A versatile open source solution for health insurance schemes
Many countries are working to extend social health protection as part of the drive to achieve Universal Health Coverage. openIMIS offers insurance scheme operators an efficient way to manage beneficiary, provider and payer data so that health insurance schemes can work at scale.
openIMIS was originally developed to facilitate the administration of social health insurance schemes for people in the informal sector in low and lower-middle income countries. It has subsequently been modified for use in administering health insurance schemes focused on the formal sector as well.
...
| Insert excerpt | ||||||||
|---|---|---|---|---|---|---|---|---|
|
openIMIS offers a range of functional modules which can be combined into tailored solutions for the delivery of specific social protection schemes. The health insurance solution powered by openIMISallows scheme operators to manage beneficiaries, contracts, products, contributions, providers, claims and accounting in a single software. A key strength of openIMIS is its capacity to support the digital creation, submission and review of claims, including AI-supported review. It also connects seamlessly with other open source products, such as DHIS2 and openMRS, using FHIR standards.
Supported processes
openIMIS supports the following business processes for health insurance:
Beneficiary Employer/employee management
Collecting and managing contributions
Benefit package design/configuration
Issuing membership ID cards to beneficiaries
Verifying scheme membership
Health service claims generation and submission
Medical review of selected claimsClaims review and management
Processing and payment of claims
Benefits
For beneficiaries, openIMIS simplifies enrolment procedures, reduces the number of ‘touch points’ (therefore saving both time and money), and makes it easy to verify one’s coverage status at point of care. For health facilities, it streamlines the processes associated with a health financing scheme and makes it easy for them to receive reimbursements. For scheme operators it reduces operational costs and allows for better monitoring and analysis of the scheme’s overall performance. For decision makers, data from openIMIS can enhance policy making and planning related to health service delivery
Example workflow
...
Current implementations
Further information
Visit the wiki page or download the factsheet for this openIMIS use casesolution:
| View file | ||
|---|---|---|
|
...