The Ethiopian National Health Insurance System (EtNHIS) is an IT system, that encompasses an android and a web app, to support that core community based health insurance (CBHI) business processes. The system is aimed at enabling more efficient management of insurance pool, increasing visibility, and generating evidence needed to improve the CBHI business process. EtNHIS is a very versatile, user friendly and efficient as it addresses the key bottlenecks identified in the manual paper based system.

EtNHIS connects members, providers, payer and concerned stakeholders through an integrated IT platform that consists of android based enrollment app for use in the Kebeles, hybrid (web and android based) claim submission app in health facilities, web based claim submission and reimbursement app for the payers, and interactive reporting and analytics platform for all stakeholders. It allows on the spot member enrollment, near real time claim submission and online adjudication and processing. In addition, the system provides high quality data, as there are inbuilt robust data validation checks and provides visibility and fraud prevention platforms.

EtNHIS has three core modules those are enrollment, claim submission and claim submission/processing. The system is designed to connect patients, providers and payer through an integrated enrollment, claim submission, claim processing, reimbursement, and reporting platforms.

Enrollment is a periodic event that provides an opportunity for new members to be enrolled into the CBHI schemes, existing members to renew their CBHI memberships and existing members to update their demographic information.

Enrollment is typically carried out once a year during the enrollment window. The membership is typically valid for one year and is called coverage period. A member may be a paying member (pays a certain amount of premium to be a member) or indigent member (pays no premium to be a member). The member may have other dependents in the household who will be beneficiaries of the membership.