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Policymakers and technical experts who are grappling with implementing national health insurance information systems should read the following pages with interest. This document was created as a tool to bridge the language and discipline of global health with the language and discipline of software and system engineering. This report provides a set of practical common information, tools, and resources, which country decision-makers can access as they develop national-level health insurance information system plans.
Produced for the Joint Learning Network Information Technology Track under Phase 1 of a grant from The Rockefeller Foundation, this document and the accompanying tools it contains are a set of insurance process models, diagrams, and requirements that were produced as a result of CRDM being applied to health insurance and more specifically to enrollment, eligibility checking, claims processing, and preauthorization. These artifacts are intended to be useful in discussions between health professionals and developers of health insurance information systems. This document is not intended to be a definitive authority on the discipline of health insurance, nor does is it intended to provide guidance on how to design, organize, or manage health insurance functions within a country. This work was informed by health insurance experts from around the globe. The references and additional resources section of this report present some of the work of these experts in the health insurance domain.