The description of the system for a Health insurance implementation can be done in the following way:
1.Overview Provide an overview of the data flow
2.Building a scheme/registers
Points to cover:
- Centralized server where application resides
- Offline application installed on computers - They are not a replacement for the online application but complements it by enabling entry of new enrolments and submission of claims for insurance staff and health facility respectively to ensure activities do not stop due to internet outages.
- Mobile phone application - Used by enrolment agents to undertake enrolments, renewals and feedback collection and by health facility staff to undertake client identification and claims submission.
- Data synchronization - Stored data from the offline application installed on a computer as well from the mobile phone application when used offline, can be extracted, physically transported to a location where internet is available and then uploaded to the online application.
2. Describe how a scheme is constructed (configuration of registers)
Points to cover:
- Creations of Locations - Configured to indicate geographical coverage of the scheme and allocate appropriate access to different users in the system. Currently there can be up to four sub levels defined to indicate geographical boundaries (for eg. Regional -> District -> Municipality -> Village).
- Payers - Configured to indicate a 3rd party payer who would pay the due policy amount on behalf of an insured unit.
- Claims administrator -
- Enrolment Officers
- Users
- Medical Items
- Medical Services
- Price Lists (Medical Service and Medical Items)
- Health Facilities
- Products
3. Describe how operations are handled structured by key processes
3.a. Enrolment Process
- Using web application
- Using mobile application
3.b. Health service utilization
- Using web application
- Using mobile application
3.c. Claims process
Claims Submission
- Using web application
- Using mobile application
Claims Verification
Claims Payment
3.d. Renewal Process
3.e. Reporting
1.Overview of data flow
2.Building a scheme/registers
3.Enrolment process
Enrolment app login:
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