Accessing the demo server

A demo of the latest release of openIMIS is hosted at demo.openimis.org

Mobile application for the demo server to manage beneficiaries enrolment and renewal can be downloaded from the Google Play.

Mobile application for the demo server to enquire insuree status and submission of claims can be downloaded from here (file with extension “.apk”).

Credentials

The demo instance of openIMIS can be accessed with the following credentials:

Test scenarios

You are free to test the system and add new or modify existing dataset in the system as the dataset will be restored to its original state by the end of each week. If possible please do not modify the specific cases mentioned below and otherwise the below mentioned cases will not match with the data you find on the demo server until they are restored back at the end of the respective week. Description of all user fields is provided in the user manual that is provided here or after login go to the top right of the screen and click on the ‘?’ symbol to access the manual.

If you would like to look at existing examples in the dataset for understanding key processes then you can look at the following:

Enrolment

• You can view the enrolment of the Macintyre family (search under Insurees and Policies - Families/Groups with Insurance Number/Household ID: 070707070) of 5 who enrolled on the 20^th of last month. Clicking on the insurance number underneath the headline saying "1 Families/Groups Found" will lead you to the details page of the Macintyre family. They paid 10000 units in cash (see under Contributions) on the 20^th to be covered under the product code BCUL0001 that offers coverage for up to 6 members at a cost of 10000 units. To view what is offered in the covered product search for product code BCUL0001 (under Administration -> Products). The family was enrolled by Enrolment Officer (sri sid) and can (see under Policies) avail services at all health facilities covered by the insurer for a period of one year starting from the 20^th.

• Alternatively, you can practice and enrol a family yourself by following the next steps (refer to the user manual on docs.openimis.org for detailed functionalities):

  • Create a family: Insurees and Policies → Add a Family/group → enter all the required information and save

  • Add family members: Insurees and Policies → Families/Groups → search the family where to add members and click on it → on the next screen click on the green "+" sign in the insuree section → enter the insuree-related information and save.

  • Add an insurance policy: Insurees and Policies → Families/Groups → search the family where to add members and click on it → on the next screen click on the green "+" sign in the policy section → enter the policy related-information and save.

  • Add a contribution: Insurees and Policies → Families/Groups → search the family where to add members and click on it → on the next screen click on the green "+" sign in the contribution section → enter the contribution-related information and save.

Renewal

In order to look at a renewal scenario you can view a number of examples:

• The Jorrison family (search under Families/Groups with Household ID: 172000001) which had a policy that expired on the 5^th of last month. You can renew their policy by selecting (under Policies) the expired policy (by clicking the line and thereby making the line blue). Thereafter just click on the R symbol above it to renew the product by entering the date from which this was renewed and by which Enrolment Officer. Once the policy is renewed you can make the family Active under the renewed policy (indicated under Policy Status) by adding a payment (under Contribution) against this policy.

• The Nathan family (search under Families/Groups with Household ID: 173000001) which has a policy expiring on the 15^th of this month. You can renew their policy by selecting (under Policies) the expired policy (by clicking the line and thereby making the line blue). Thereafter just click on the R symbol above it to renew the product by entering the date from which this was renewed and by which Enrolment Officer. Once the policy is renewed you can make the family Active under the renewed policy (indicated under Policy Status) by adding a payment (under Contribution) against this policy.

• The Duby family (search under Families/Groups with Household ID: 174000001) which has a policy expiring on the 25^th of this month. You can renew their policy by selecting (under Policies) the expired policy (by clicking the line and thereby making the line blue). Thereafter just click on the R symbol above it to renew the product by entering the date from which this was renewed and by which Enrolment Officer. Once the policy is renewed you can make the family Active under the renewed policy (indicated under Policy Status) by adding a payment (under Contribution) against this policy.

Claims Management

Claims has a number stages in IMIS and to view the different stages you can look the following examples in respective stages. You are also free to take these cases forward through the remaining stages or build you own claims cases and enter them for existing users or users that you have created.

Claims submission

A claim can be entered in the system by going to the page under Claims called Health Facility Claims. To view an existing claim that was entered by a designated Claims Administrator for his/her respective Health Facility you can view the example of Claim No. CIG00001 by searching for this number under Claims No. field. Claims Status field should be set to Entered as the claim is in this status. Once the search yields the claim you can select the claim by clicking on the Claim No. CIG00001 to view the details of the entered claim. At this point changes can be made to the claim before it is submitted for automatic checking by the system of the claim against the product definition in the system.

Claims verification

System check: In order to view a claim in the system which has gone through the automatic checking process of the claim you can do so in Review page under Claims. Set the Claim Status field to Rejected to view a claim that was automatically rejected by the system after it was submitted for system check. Search for Claim No. RAD00001. To view this claim select the claim and click on Review. You will find that the facility had entered this claim and it was rejected in the automatic checking by the system due to the limitations that were defined in the configuration of the Product. The reason for rejection are indicated as 3 (service was not covered by the policy) and 10 (service had a restriction and was to be covered only in out-patient setting while this was an inpatient case).

Reviewer check: In order to view a claim in the system which has gone through a manual check by a (medical reviewer) reviewer you can do so in Review page under Claims. Set the Claim Status field to Checked and search for Claim No. UPDH0009. You will find here that based on selection criteria available in the system a claim reviewer had selected this claim for review but not for feedback. If you open this claim by selecting it and clicking on Review you will find details of the claim where it is indicated that the reviewer found that even though the system approved (Status set to Passed) the service M14, the diagnosis did not match with the service that was provided and hence the reviewer decided to reject this claim by indicating 0 in the App. Qty (Applied Quantity) field. The Approved amount is hence 10 instead of the claimed 21010 units. The claim is currently saved allowing the opportunity for the reviewer to get further clarification to reconsider his/her decision before processing this claim.

Claims payment

The last step in the claims processing is the claims payment stage which you can do so in Review page under Claims. Set the Claim Status field to Valuated and search for Claim No. JADH0001. You can select this claim and click on Review to view final details of what payment will be made against this claim submitted by the health facility. This is a claims which has gone through all stages of checking and is now ready for payment. Payments for claims to health facilities are generally done in batches (Batch run page under Claims) where reports at regular intervals (eg. monthly) can be run which accumulates each claims in Valuated state to calculate the total amount that the insurer would need to pay the respective health facility for the given time frame.