Idea: Linking claims referral cases



Linking claims of a person across different facilities for the same illness episode (referal cases)

openIMIS tracks claims related to an individual using the individual's identifier. In addition to the request to have the system track claims for an individual for an illness episode (OSD - 29), could the system also track referral chains so complete treatment chain can be observed in the dataset. This feature should allow a facility to know easily whether the patient was referred (currently this has to be entered manually -

Other, referral and emergency drop down selected during claim submission) and from where, ideally also see the relevant case history from the referred facility and accordingly apply co-payments etc. according to the agreed business rules. Nepal has a similar need but not clear whether they have been able to automate this or whether they have a work around for this..


Process Group



Linking claim referral cases










Current Relevance


Future Relevance


Global Good


Local Funding




This was the idea mentioned during interviews with various stakeholders in February 2021.


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