Project Analysis Jubilee Insurance And Savannah...

Concept Paper: E-Claims EDI project Background Jubilee Insurance and Savannah Informatics have been involved in a project to automate the transmission of claims data from the health providers directly to Jubilee’s core medical system. The project has been going on for about 18 months. The project is part of an initiative by SHOPS and private health insurers in Kenya who identified the need to develop an industry wide EDI that will enable migration to paperless of claims administration and the insured benefits. of reduced operating costs and increased use of data analytics for business management. The project partners involved in the initial proof of concept phase are mainly Jubilee Insurance, Savannah Informatics and Gertrude’s Children Hospital. If the process is successful for this pilot site, the other health providers will be involved though AKUH has been actively involved. The purpose of this concept paper is to clearly define the project milestones, timelines and Jubilee’s expectation in the eClaims project and define explicitly the engagement with Savannah Informatics as a key partner in the delivery of the product. Purpose Scope The following are limited to the scope of this project: 1. Eligibility checks, Pre-authorization checks in the hospitals. 2. Electronic Claims submission between Jubilee and Gertrude’s Hospital. Description of the EDI Project The overall technical strategy of Jubilee’s partnership with SIL is informed by the following objectives: