Up to June, 2014, the National Health Insurance Fund (NHIF) of Tanzania had accredited a total of 6,013 health care facilities throughout the country who lodge claims to the Fund on a monthly basis. Due to the challenges of prolonged claims delays, errors during claims processing and sky-high expenditures on invalid members, the Fund introduced e-claims processing in January 2012. The objectives were to speed up processing hospital bills and to help verify NHIF valid beneficiaries with expectations of eliminating complaints from health facilities regarding delayed payments, saving massive expenditures incurred on invalid members (around USD 8.3 million) and curbing fraudulent practices in health facilities.

 

The innovation involved the instalment of relevant IT systems in the health facilities linked to the Fund membership database and the newly introduced Claims Management Information System. Under this system the laborious data capturing process is eliminated from the NHIF side. The system has already been installed in all facilities that have requisite infrastructures to support these high-tech endeavours. We believe that this is a crucial innovation that other health insurance companies in Tanzania and Africa are yet to pursue.