End-to-End Digital Health Insurance for Government Schemes
StateHIS and AIMS together — from biometric enrolment and AI fraud detection to hospital facility management and actuarial sustainability.
This integrated solution combines StateHIS's health insurance scheme management with AIMS's healthcare facility asset management — creating a complete digital health ecosystem that covers every enrollee, provider, claim, and hospital facility in a unified platform.
The Challenge
Government health insurance schemes face multiple, interconnected problems: enrollee registration backlogs, fraudulent claims draining funds, provider payment delays causing hospital refusal of scheme patients, and no data to project financial sustainability. Meanwhile, the hospitals serving these patients struggle with equipment maintenance, facility management, and compliance — issues that directly impact quality of care.
The Outcome
A complete digital health ecosystem where enrollees are biometrically registered and verified at point of care, claims are auto-adjudicated and paid within days, AI flags fraud before payment, actuaries have real-time data for sustainability modelling — and hospitals have the tools to maintain their facilities and equipment at the standard patients deserve.
Products in This Solution
Health Insurance Scheme Platform
StateHIS (coming soon)
Enrollee management, biometric deduplication, claims processing, AI fraud detection, provider network management, actuarial modelling, and enrollee mobile app.
Healthcare Facility Management
AIMS
Hospital facility and medical equipment asset management — condition monitoring, preventive maintenance, compliance tracking, and capital planning.
How It Works
Enrol the Population
Mass biometric registration captures fingerprint and facial data. AI deduplication ensures one person, one record — eliminating ghost enrollees. Digital cards issued instantly.
Connect the Providers
Accredited hospitals submit claims digitally. Eligibility verified in real-time at point of care. Pharmacy benefits checked against formulary before dispensing.
Process Claims Intelligently
Auto-adjudication engine processes clean claims in real time. AI flags suspicious patterns — upcoding, phantom procedures, duplicate claims — for manual review.
Pay Providers Promptly
Clean claims paid within 7 days. Provider satisfaction drives scheme participation. Payment history and performance scoring visible to both scheme and provider.
Manage Facilities & Ensure Sustainability
AIMS tracks hospital equipment condition and maintenance. Actuarial dashboard projects scheme liabilities 5 years forward. Benefit packages adjusted based on utilisation data.
Benefits
Fraud eliminated
AI fraud detection recovers $3.2M+ in first year — identifying ghost claims, upcoding, and provider anomalies
7-day payments
Claims paid within 7 days — down from 90 days. Provider participation exceeds 90%
94% compliance
Preventive maintenance compliance for hospital equipment — reducing downtime and improving care quality
Scheme sustainability
Actuarial models provide 5-year financial projections — enabling evidence-based premium setting and benefit design
Architecture
StateHIS manages the insurance ecosystem. AIMS manages the healthcare facilities. Together, they provide a complete picture — from population health to hospital operations.
Enrollees + Providers → StateHIS (Insurance + Claims + Fraud + Actuarial) + AIMS (Facilities + Equipment + Compliance) → Unified Health Ecosystem
Build Your Digital Health Ecosystem
Discuss your health insurance scheme digitisation with our health-tech specialists.