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openIMIS has been instrumental in helping Nepal implement social health insurance. Complicated processes, particularly around enrolment and claims processing, have been made easier. The availability of Android-based apps for enrolment has meant that enrolment assistants can go door to door to bring households into the scheme. A web-based claims entry and adjudication module significantly diminishes paper-based transactions and reduces paperwork for health facilities. This has enabled the Health Insurance Board to achieve a rapid rate of expansion.
The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) and the Swiss Tropical and Public Health Institute provide technical assistance to the Health Insurance Board for the customisation and implementation of openIMIS.
Interoperability
The primary focus of interoperability with openIMIS in Nepal has been around the electronic submission of claims via Electronic Medical Record Systems. There are a few service providers that use EMRs in their hospitals and work is currently underway to design standard approaches to allow them to submit claims electronically. An integration of openIMIS and Bahmni (used in 4 health facilities in Nepal) has been implemented, and is used by Bayalpata Hospital to submit their claims automatically to openIMIS. Other hospitals and EMR systems are also adapting their APIs to FHIR R4 to enable digital claiming to openIMIS.
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