openIMIS is a web-based software that allows for seamless exchange of information between beneficiaries, providers and payers of health financing and social protection schemes.
Versatility through modular design
openIMIS is modular and customizable. It offers functionality in beneficiary management (including registration), benefits administration (including payments), and data analysis. Users can pick and choose the modules they wish to use, and can adapt these to their specific needs.
Modules and functionalities
openIMIS is custom built to manage the high-volume data flows which are required to administer health insurance and social protection schemes. It has been specially designed to manage beneficiaries; benefit packages; providers; claims generation, review and processing; payments; and data analysis.
Beneficiary management
openIMIS supports the enrollment of individuals and families, as well as employers and employees, into schemes. Enrollment information can be captured directly in openIMIS, or imported into openIMIS from existing beneficiary management systems using shared interoperability standards (i.e. HL7 FHIR).
The software supports the renewal of coverage at designated intervals, the updating of beneficiary records and the issuing of ID cards using QR codes and unique identifiers. Enrollment and renewal data, including photos of beneficiaries, can be collected and transmitted using a mobile app.
openIMIS also supports the collection and management of contributions, including issuing payment receipts and tracking whether beneficiary contributions are up to date.
Service delivery
openIMIS supports the verification of scheme membership. When beneficiaries present their ID cards at health facilities, healthcare workers can check their eligibility for services via openIMIS. Beneficiaries are examined and treated, and provided with tests and medicines as needed. The services provided are recorded in openIMIS. Using the software, health facilities can generate claims for insurance scheme operators by entering codes for diagnosis and services rendered.
Claims management
openIMIS supports the submission and review of claims. Health facilities which use openIMIS can electronically submit claims to insurance scheme operators for review. Claims can be processed either individually or in batches. openIMIS allows for claims which pass automated checks (based on pre-defined criteria) to be selected for medical review. It then calculates reimbursements to healthcare providers for approved claims.
Payments
openIMIS supports the management of payments to service providers and to beneficiaries of cash transfer schemes. The payer or scheme operator can use openIMIS to define the criteria for cash transfers (e.g. inclusion criteria, payment amount, frequency) and to generate a payroll with the amounts to be disbursed to beneficiaries in a given payment cycle. Payment service providers use this list to disburse funds. openIMIS also allows for reconciliation of issued payments against payroll. Unique payment transaction numbers can be generated for each payment, allowing them to be traced to individual households.
Monitoring
openIMIS allows scheme operators to monitor and analyse the performance of the scheme through the generation of reports and data visualisation, e.g. dashboards.
Standards and interoperability
The openIMIS Initiative actively contributes to standardization initiatives such as OpenHIE, GovStack andDCI to ensure interoperability in a larger system context. As a result, openIMIS follows e.g. the international FHIR standard for information exchange, allowing it to work seamlessly with other systems. This means that it can readily exchange data with everything from widely used data analytics platforms such as DHIS2 to electronic medical record systems like OpenMRS and other existing beneficiary management systems, such as those maintained by social security agencies.
To learn more about the mapping, visit this Wiki page
Data security and privacy
openIMIS takes care to ensure that the software is free of security-related issues and that all required measures to ensure the safety of data are in place. System owners (eg. scheme operators), however, are responsible for ensuring that the required security measures are in place on the virtual or physical server on which openIMIS is installed and hosted. This is where data from the openIMIS implementation are stored. The openIMIS initiative will never have access to any data from any implementation of openIMIS.