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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.

Learn more about the health insurance use case at: openIMIS for Health Insurance

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

Tanzania Mainland

Cameroon - BEPHA

Nepal - Health Insurance Board

Zanzibar

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.

Learn more about the employment injury insurance use case at: openIMIS for Employment Injury Insurance

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

Current implementations

Employment Injury Insurance - Social Security Fund Nepal

Unconditional Cash Transfer

As the use of cash transfers becomes more widespread, there is a need for simple, flexible digital solutions which can streamline the administration of such schemes. Beneficiaries require money quickly, without having to navigate complicated administrative procedures. Payment service providers and payers/scheme operators need to be able to distribute funds efficiently to the right people and to use data to adjust the operations of the scheme, for example by adjusting inclusion criteria to reach more beneficiaries. Paper-based systems are too slow and cumbersome to manage the complex flows of information required to determine beneficiaries’ eligibility, enroll them in the scheme, calculate payments and manage the scheme’s operations. Digitalisation can help to streamline these and other processes.

Learn more about the employment injury insurance use case at: openIMIS for Unconditional Cash Transfers

openIMIS supports the following business processes for unconditional cash transfers

  • Registration of beneficiary households

  • Registration of payment service providers

  • Definition of payment criteria and generation of payroll

  • Disbursements of payments to beneficiaries

  • Data analysis

Current implementations

The Gambia

Scheme workflows and openIMIS adaptation

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