Automate health insurance claim intake in openIMIS
The insurance reference: a health-facility claim entered once in openIMIS — the open-source system used by national health-insurance schemes — compiled, and replayed with a fresh claim number, with success established only by a direct SQL read of the claim row.
This workflow runs today, end to end, against the named open-source reference application in the openadapt-flow repository. The steps below are the real demonstrated steps and the verification is the real oracle.
Runs on
openIMIS 25.10, run locally from digest-pinned images with the upstream synthetic demo dataset — fictional insurees, facilities, and tariffs; everything binds to localhost. openIMIS is a browser UI over a supported GraphQL API, so a real openIMIS deployment should prefer the API; the browser demonstration stands in for the many commercial claims platforms that expose no such API.
The demonstrated steps
- 1On the blank Health Facility Claim form, enter the insuree number — which resolves the policyholder and her in-force policy
- 2Enter the claim number — a parameter, substituted fresh at every replay
- 3Enter the main diagnosis code
- 4Enter the explanation note — a parameter
- 5Add the service (auto-tariffed by the system)
- 6Save the claim into status “Entered” — the step before checking and adjudication
Parameters: insurance_no · claim_no · explanation — recorded values are the defaults; every replay can override them.
How the outcome is verified
A direct SQL oracle on the claims database: the run is accepted only when exactly one non-voided claim row exists with the replayed claim number, in status Entered, for the demonstrated insuree and health facility. The costly failure in claims operations is not a crash — it is the claim silently entered twice, or against the wrong policyholder, surfacing weeks later in reconciliation. A duplicate or missing row fails this run loudly instead of reporting success.
- direct SQL claim-row oracle (exactly one non-voided row, status Entered, right insuree and facility)
Evidence and scope
A reference environment, deliberately not a benchmark: no timing matrix and no agent arm. Any future reliability claim requires the full matched protocol the Frappe Lending and OpenEMR references define.
Try it from the command line
The compiler and runtime are open source and MIT licensed. Healthy runs are local and make no model calls.
pip install openadapt-flowInstall the open-source compiler and runtime.
openadapt-flow record --url https://your.app --out recOpen a headed browser on your app and demonstrate the workflow once; Ctrl-C to finish.
openadapt-flow compile rec --out bundle --name my-taskCompile the recording into a deterministic bundle with auto-classified risk per step.
openadapt-flow lint bundle && openadapt-flow certify bundle --policy permissiveSurface coverage gaps, then gate the bundle against a policy before it ever deploys.
openadapt-flow replay bundle --url https://your.app --param name=valueReplay against your app; recorded values are defaults and --param overrides them.
Put this workflow into production
Bring your version of this workflow and the record that proves its outcome. We'll map the deployment, verification, shadow run, and supervised rollout.