ETHIOPIAN NATIONAL HEALTH INSURANCE SYSTEM

ABOUT ETNHIS

The Ethiopian National Health Insurance System (EtNHIS) is an IT system, that encompasses an android and a web app, to support that core community based health insurance (CBHI) business processes. The system is aimed at enabling more efficient management of insurance pool, increasing visibility, and generating evidence needed to improve the CBHI business process. EtNHIS is a very versatile, user friendly and efficient as it addresses the key bottlenecks identified in the manual paper based system.

EtNHIS connects members, providers, payer and concerned stakeholders through an integrated IT platform that consists of android based enrollment app for use in the Kebeles, hybrid (web and android based) claim submission app in health facilities, web based claim submission and reimbursement app for the payers, and interactive reporting and analytics platform for all stakeholders. It allows on the spot member enrollment, near real time claim submission and online adjudication and processing. In addition, the system provides high quality data, as there are inbuilt robust data validation checks and provides visibility and fraud prevention platforms.

EtNHIS has three core modules those are enrollment, claim submission and claim submission/processing. The system is designed to connect patients, providers and payer through an integrated enrollment, claim submission, claim processing, reimbursement, and reporting platforms.

USER MANUALS

• MEMBERSHIP ENROLLMENT (የተጠቃሚ ማስገቢያ)
• ABOUT ENROLLMENT
  • WHAT IS ENROLLMENT?
  • ENROLLMENT IN ETNHIS & KEY USERS
  • HOW WILL THIS APPLICATION HELP?
• 1. GETTING STARTED
  • HELP CORNER
  • TIPS
• 2. KNOWING YOUR HOME SCREEN
• 3. ENROLL A NEW MEMBER
• 4. RENEW A HOUSEHOLD
• 5. AMEND BENEFICIARY DETAILS
• 6. ENROLLMENT REPORTS
• 7. TECHNICAL SUPPORT
• CONTACT
• CLAIMS SUBMISSION
• ABOUT CLAIMS SUBMISSION
  • WHAT IS CLAIMS SUBMISSION?
  • CLAIM SUBMISSION IN ETNHIS
  • WHO ARE THE MAIN USERS?
  • HOW WILL THIS APPLICATION HELP?
• 1. GETTING STARTED
  • HELP CORNER
  • TIPS
• 2. KNOWING YOUR HOME SCREEN
• 3. IDENTIFY A MEMBER
• 4. CHECK IN A MEMBER
• 5. PREPARE A CLAIM
• 6. FACILITY HEAD APPROVAL
• 7. RESUBMIT A RETURNED CLAIM
• 8. CLAIMS REPORTS
• 9. TECHNICAL SUPPORT
• CONTACT
• CLAIMS ADJUDICATION
• ABOUT CLAIMS ADJUDICATION
  • CLAIM ADJUDICATION IN ETNHIS
  • CLAIM PROCESSING
  • RECORDING PAYMENT (REIMBURSEMENT)
  • WHO ARE THE MAIN USERS?
  • HOW WILL THIS APPLICATION HELP?
• 1. GETTING STARTED
• 2. REVIEWING A CLAIM
• 3. ADJUDICATING A CLAIM
• 4. ENROLLMENT TAB
• 5. MEMBERS TAB
• 6. REVIEWING A MEMBER [TO BE COMPLETED]
• 7. REIMBURSEMENTS TAB
• 8. REPORTING TAB
• CONTACT
• FAQ

CONTACT

For updates and corrections, contact mailto:sysadmin@etnhis.org