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https://openimis.atlassian.net/wiki/spaces/OP/pages/2679799817/Use+cases+served+by+openIMIS+-+overview#Health-insurance Rework intro paragraph:

Paper-based systems make the exchange of data between patients, health service providers and scheme operators slow, inefficient, and susceptible to errors and fraud. Ultimately, this can lead to health insurance schemes becoming financially unviable. Digitalisation results in more efficient data management, helps to streamline business processes and provides the information needed to monitor a scheme’s performance.

https://openimis.atlassian.net/wiki/spaces/OP/pages/2679799817/Use+cases+served+by+openIMIS+-+overview#openIMIS-supports-the-following-business-processes-for-health-insurance

openIMIS supports the following business processes for health insurance

  • Beneficiary Managementmanagement

  • 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