BAHMNI → openIMIS - eClaiming Workflow

This page documents the interoperability process between Bahmni and openIMIS for the purpose of electronic insurance claiming (eClaiming). The workflow leverages FHIR-based APIs and the openHIM interoperability layer to automate the transmission of clinical encounter data from Bahmni to openIMIS, enabling real-time claim submission and adjudication. Upon processing, claim responses are routed back to Bahmni, allowing providers to update medical and billing records promptly. This setup illustrates how integrated digital health and insurance systems can reduce administrative burdens, improve financial transparency, and ensure timely reimbursement for services delivered at the point of care—fully aligned with openHIE architectural principles and Digital Convergence Initiative (DCI) standards.

Purpose

This use case demonstrates an integrated e-claiming workflow where clinical data captured in Bahmni—a comprehensive open-source hospital information system—triggers the automated generation and submission of an insurance claim to openIMIS via openHIM, the interoperability middleware. It serves as a proof-of-concept aligned with the openHIE architecture and Digital Convergence Initiative (DCI) standards, showcasing how structured health data can seamlessly feed into health financing workflows.

The main objective is to:

• Enable real-time, automated submission of FHIR-based claims,

• Improve claim accuracy and adjudication times,

• Reduce administrative overhead in health facilities.

Trigger

A patient receives healthcare services in a facility using Bahmni.

Workflow

1. Clinical Encounter in Bahmni

   1. A patient is treated and a clinical encounter is recorded in Bahmni using OpenMRS core services.

   2. The encounter captures key FHIR-aligned entities: Patient, Encounter, Condition, Procedure.

2. FHIR Claim Generation

   1. Based on the recorded data, Bahmni’s backend or a dedicated service composes a FHIR Claim resource.

   2. Optional FHIR resources such as Coverage, Practitioner, and Location are also included to enrich the claim.

3. Transmission to openHIM

   1. The FHIR Claim is POSTed to an endpoint exposed by openHIM, which acts as the interoperability mediator.

   2. openHIM validates the payload (including digital signatures or JWT authentication) and orchestrates processing via configured mediators.

4. Forwarding to openIMIS

   1. openHIM routes the validated Claim to the appropriate openIMIS FHIR API endpoint for adjudication.

5. Adjudication in openIMIS

   1. openIMIS processes the claim and generates a ClaimResponse (with adjudication status, amount approved, etc.).

   2. Policy and benefit rules are applied per country-specific configurations.

6. Response Routing Back to Bahmni

   1. openHIM relays the ClaimResponse back to Bahmni.

   2. Bahmni updates billing records and flags the clinical encounter as reimbursed (or denied, if applicable).

FHIR Resources: Patient, Encounter, Claim, ClaimResponse, Coverage, Practitioner, Location

Diagram

Open

Updates

2025-09-23 Developers Deep Dive Call: Solutions & Sandbox | m4h [inlineCard]Preview

Belha Présentation 2026-01-28

Open