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
Nepal - Health Insurance Board
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