Claims management in health insurance involves receiving, validating, and processing claims for medical services covered under an insurance policy. It is crucial for ensuring efficient cost control for operators, timely payments for providers, and fair reimbursement for beneficiaries. openIMIS supports claims management across nine countries.

In the Bhela call on 30 April 2025, Purushottam Sapkota (GIZ Nepal) and Saurav Bhattarai (openIMIS Coordination Desk) will share real-world insights from Nepal, where openIMIS is used for both formal sector (Social Security Fund) and informal sector (Health Insurance Board) health insurance. To highlight the scale: the Health Insurance Board manages around 40,000 claims daily.

In the exchange you will also hear about the added functionalities provided by the AI module in openIMIS for claims management from Dragos Dobre, and how it can be implemented and extended for various use cases in health insurance.

Co-ordinates

Date: 30 April 2025

Time: 10.00 AM (UTC +1)

Room: Jitsi Meet (https://meet.jit.si/openIMISImplementers)

Participants: (kindly only add yourself, not others):

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Schedule

When (CET)	Duration	What & Who	Documentation

When (CET)	Duration	What & Who	Documentation
10.00	5 Min	Introduction by openIMIS Coordination Desk
10.05	15-20 Min	Claims management insights from Nepal by Purushottam Sapkota, Support to the Health Sector Strategy / GIZ Nepal & Saurav Bhattarai, openIMIS Coordination Desk	Presentation: Recording:
10.25	10-15 Min	Extended functionality with AI claims adjudication module by Dragos Dobre, Swiss TPH	Presentation: (part of PDF file above) Recording: https://youtu.be/mSuR8CO0xF0
10.40	15 Min	Q&A, discussion
10.55		Wrap-up

Q&A:

Question

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2025-04-30: Bhela Discussion: openIMIS claims management & AI module

Co-ordinates

Schedule

Q&A:

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