Claimify
Claimify connects state agencies, hospitals, HMOs and enrollees. Enrolment, referrals, claims, payments and telemedicine run in one place, with AI checking every claim and live figures for every decision.
Trusted by state health insurance agencies across Nigeria
Paper forms, lost claims, late payments and guesswork. Claimify replaces them with one connected system, from the day someone enrols to the day their hospital is paid, so every naira is accounted for and every decision rests on evidence.
Register principals and dependants online, offline in the field or by USSD. Photos, fingerprints and ID cards are issued on the spot, and likely duplicates are caught before they are saved.
Facilities verify the enrollee, record the encounter and diagnosis, and keep a health record that follows the patient, in person or by video.
Authorization codes are requested and decided against a turnaround target, with escalation when they wait too long. Corridor referrals let patients get care in another state.
Claims go from submission to vetting, verification and approval. AI checks each one against tariffs, dosage and eligibility, and flags possible fraud.
Payment orders and monthly capitation are prepared by finance, approved by a second person and sent straight to facilities' bank accounts.
Every step feeds live dashboards, forecasts and reports, so leaders see coverage, spend, quality and turnaround while there is still time to act.
AI clinical review checks each claim line against your tariff, the dosage and the patient's cover, then returns PASS, QUERY or REJECT with its reasons. Your vetters spend their time on the claims that need a human, and none slip through unread.
Price against tariff, dosage, eligibility and drug safety on every line, with a verdict and the reason for it.
Duplicate claims, unusual visit patterns and amounts far above the norm are flagged, and every facility gets a risk score each night.
Enrolment, encounters, claims and spend projected 12 months ahead with seasonal models, so budgets and targets are set on evidence.
Track malaria, hypertension or any condition. Spikes above the seasonal norm trigger alerts to the people watching it.
Enrollees are matched by NIN, name, date of birth, phone and how names sound; facilities by name, code and location. Duplicates are stopped before they cost money.
Ask a question in plain English and get the answer from your own data, with smart support for approving authorization codes.
From the state down to a single ward and facility, Claimify turns daily activity into the figures leaders need: who is covered, where money goes, what care is given and where things are slowing down.
Enrolment, claims, referrals and change of facility by programme, gender and LGA, down to wards and communities. Batched loading keeps it fast.
Maps of every LGA and ward show enrollees against population, so you can see who is not covered yet and target outreach there.
Set enrolment or coverage targets and see whether you are on track, at risk or behind.
Authorization codes against a 30-minute target and claims against 30 days per stage, with each staff member's decisions.
Rank facilities by encounters per 1,000 enrollees, referrals, uptake, claim amounts and patient ratings. Spot the best and the outliers.
Monthly renewal and attrition rates. Expiring enrollees go to the call centre as tasks, voluntary contributors first.
Every Monday, the Executive Secretary and Directors get last week in one email: enrolment, claims, codes, tickets and staff activity.
A written Word or PDF report with charts, comparisons and points to note. It's ready for the board in one click.
Each morning, 12 data-quality checks find duplicate IDs, missing details, over-aged dependants and claims waiting too long.
Each person signs in to a workspace built for their job. Agency leaders, vetters, hospitals, HMOs, doctors and enrollees all work from the same records.
Executive Secretaries, Directors and agency admins set the rules, approve payments and steer the scheme with live evidence.
Claims vetters and verifiers, finance, M&E, enrolment officers and the call centre each get their own work queue and the tools for it.
Primary and secondary facilities verify patients, record care, request codes and submit claims, then follow each one through to payment.
HMOs and third-party administrators see their own enrollees, providers and claims in their own dashboard, alongside the agency's.
Doctors join through an agency's invite link, set their consultation hours and see patients by video.
Principals and their dependants can check their cover, renew, change facility and see a doctor online, even without a smartphone.
NHIA and development partners see the national picture. Vendors supply facilities through the marketplace.
Principals and dependants, formal and informal sectors, establishments, biometrics, bulk upload and printable ID cards.
Visits, diagnoses, services and drugs, with a health record that follows the patient between facilities.
Authorization codes with turnaround targets, the full referral chain, and cross-state corridor care.
Vet, verify and approve, with AI review, auto-vetting rules, fraud signals and comments on every claim.
Capitation per facility and programme, payment orders and bank transfers with two-person approval.
Video consultations, doctors' hours and booking slots, calendar invites and a virtual practice network.
Assessment forms, facility visits, aggregate reports and accreditation, with the gaps turned into action.
Agency drug procurement, vendor stock, and a marketplace where facilities order from approved vendors.
Real-time chat that links to records, plus email, SMS and WhatsApp alerts for every status change.
Complaints assigned to staff, renewal call lists and follow-up with enrollees.
Who changed what and when, on every enrollee, claim and code, with a timeline on each record.
Large Excel and CSV exports, saved filters and scheduled exports delivered by email.
Built for Nigeria's realities: rural wards, patchy networks and basic phones.
USSD for enrollees and offline encounter reporting from any phone.
Enrol and record encounters without a network, then sync when you're back online.
A branded portal for every agency, on any device.
Telemedicine consultations by secure video link, no app needed.
Claimify has transformed our claims processing workflow. The automated features have significantly reduced our processing time.
Their team is always available to assist with any questions. They genuinely care about helping us get the most from the software.
I've used Claimify for over five years. The automation has significantly reduced our administrative workload and streamlined our operations.
The dashboard gives real-time updates and analytics, so we manage claims effectively. It has reduced errors in claim submissions.
Real-time updates and robust reporting help us stay organised and informed. Claimify has improved our workflow and our team's productivity.
Want results like these for your agency or facility?
Every agency's records are kept separate, and every request is checked against the signed-in user.
Admins, vetters, finance, M&E and facilities each see only what their role needs.
Changes to enrollees, claims, codes and payments are logged with who made them and when.
Account names are checked before every transfer, two people approve each run, and nothing is ever paid twice.
Tell us about your agency, HMO or facility. We'll show you Claimify on your own workflows and plan a rollout that fits.
Claimify