Universal health coverage only works if a facility can answer one question at the counter: is this person covered, and for what? If that takes a phone call and a paper card, the scheme carries a cost it should not have.
UHC IS handles enrolment, eligibility checking, claims and settlement, so facilities treat with confidence and administrators see what is actually being spent, on whom and where.
Core platform. This is one of the four systems most facilities deploy first.
Households and individuals enrolled with the documentation each scheme requires, and issued a coverage identity linked to their Health ID.
A facility confirms coverage before treating, in seconds, rather than treating and hoping the claim is honoured.
Claims raised from the clinical record rather than re-typed, which removes the most common source of rejection.
Rules applied consistently, exceptions surfaced for human decision, and settlement tracked to the facility.
Duplicate claims, impossible service patterns and outlier facilities flagged for review.
Coverage, utilisation and expenditure by region, facility and service — the numbers a ministry or a donor needs to see.
Scheme administrators, mutual health organisations, regional health delegations and hospitals participating in coverage schemes.
Yes. UHC IS accepts claims from participating facilities regardless of their clinical system. Facilities on OPES systems get the advantage of claims raised automatically from the record.
Through the OPESCare Health ID, with fallback identification for beneficiaries who arrive without their card. Verification is designed for a busy counter, not an office.
Yes. Different schemes with different benefit packages, contribution rules and reporting requirements can run in parallel, which reflects how coverage actually rolls out in practice.
Coverage and utilisation by region, facility and service line, with expenditure tracked against budget. Report formats are configured to what your programme is required to submit.
Every OPES system shares one patient identity through OPESCare, so a patient moving between departments or facilities keeps one record rather than accumulating several.
We will show you the system against your own workflow rather than a generic demonstration. Tell us your facility type and we will tailor it.
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