Integrated NHIS Health Facility Claims Management and Fraud Control System (CMFCS)

The integrated OSL claims management and fraud control system package consists of 5 key systems. The systems include;

  1. Health Facility Claims Management and fraud control system and its application software to be installed in all NHIS accredited health facilities.
  2. NHIA District Claims Confirmation and Validation System and its application software to be installed in all NHIA claims vetting office.
  3. NHIS Claims Management Referral Tracking and fraud control system and its application software to be installed in all NHIs accredited health facilities
  4. Health Facility and Community Drug Dispensing Claims Reconciliation System and its application software to be installed in all NHIA claims vetting office
  5. Address-based disease prevention and control system and its application software to be installed in all NHIS defined communities and NHIA district offices.

The diagram below briefly outlines the components of the integrated NHIS Health Facility Claims Management and Fraud Control System


BRIEF OUTLINE OF OSL’S CLAIMS SYSTEMS’ CONTROL TOOLS

Briefly illustrated below are the key system control tools and how they are applied to enable the reduction of NHIS claims bills.

1. OSL’s Real time health facility claims processing

2. Health Facility Attendance Card (HFAC) Application


3. Provider Treatment Options Library (OPD - PTOL)


4. Chronic disease Certification Module


5. Chronic and Non-Chronic Patients Attendance Review Control module


6. Mobile Inpatient Attendance Control Tool


7. Surgical operations confirmation receipts