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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, employers/employees, contracts, products, premiumscontributions, providers, claims and accounting in a single platformsoftware. 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.
Business 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 Choice of automated/manual review processes and AI-supported review of selected claims
Processing and payment of claims
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