FAQ - How does Claims Submission work when a health facility has absolutely no internet?

In scenarios where a health facility does not have any internet, they can continue to use paper claim forms, where they enter all the claims related information. Thereafter based on feasibility a frequency is established in which the forms are physically transferred to a location (example the scheme operators district office) where an authorized user has internet connection and a computer or openIMIS claims mobile app through which they enter the claims in openIMIS.

A second alternative that is used is that the claims app for such a health facility is installed on a phone and its database (drop downs etc.) is updated and configured before hand at a location where there is internet connectivity. Thereafter the health facility claim administrator can use the phone in an offline setting (without internet) to submit claims in the app. Here again then based on feasibility the phone or the folder from the phone with these files can be physically transported to another location and an authorized user can upload these into openIMIS through an upload function. Any subsequent changes in price list or services offered as part of the benefit package need to be reflected in the health facility claims app and hence requires as well close coordination by the scheme operator to ensure database of the claims app at such health facilitieas are update as and when needed.

In either cases a feasible frequency of frequent contact between the scheme operator and the health facility needs to be established because in offline settings there is a need of physical transport of forms or data (in a pen drive or phones memory, etc.). This requires established processes and agreements between all involved actors as this also leads to delays in processing of claims.

 

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