openIMIS is a versatile open source software which supports the administration of various schemes related to health financing and social protection. Designed in accordance with industry standards for interoperability, openIMIS offers a standardised but adaptable way to manage information flows related to various forms of health insurance, employment injury insurance as well as other social protection schemes by bringing together beneficiary, service provider and scheme operator data into a single platform. Some key use cases of openIMIS are highlighted below.
Use cases in health financing
Health insurance
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.
openIMIS supports the following business processes for health insurance
Beneficiary Management
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
Current implementations
Use cases in social protection
Employment injury insurance (EII)
As contributory social insurance schemes for employment injury gain in favour, there is a growing need for digital solutions which can help to manage the complex information flows involved. An effective accident reporting system and simple, efficient claims procedures are needed to ensure that workers or their survivors receive benefits promptly. Paper-based systems make the exchange of data between employees, employers, healthcare providers, and insurance scheme operators slow, cumbersome and susceptible to errors and fraud. Digitalisation allows for more efficient data management, helps to streamline business processes, and provides the information needed to monitor a scheme’s performance.
openIMIS supports the following business processes for EII
Enrolment
Accident reporting
Health service utilization
Health service claims generation and submission
Claims review process
Processing and payment of claims