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Healthcare / InsurancePrymLink product

Receiver

NHIS claims vetting that checks every claim against NHIA rules before it is submitted. [E2E 1791741510660] [E2E 1791741713857]

Visit receiver.prymlink.com
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Reports: vetting status, approval status and problems by rule family
Receiver on mobile
Client
PrymLink (in-house product)
Sector
Healthcare / Insurance
Year
2026
Platforms
Web, PWA
Stack
React 19 · Vite · Tailwind CSS · PHP 8.2 · MySQL · PHPUnit · Dompdf · PhpSpreadsheet

//01 —The challenge

NHIS claims that break NHIA rules get queried or reduced after submission, and the facility often finds out weeks later. Checking every tariff, medicine price, quantity and repeat visit by hand is slow and easy to get wrong.

//02 —What we built

Receiver is a claims workspace for health facilities that submit National Health Insurance (NHIS) claims. Most deductions come from small mistakes repeated across thousands of claims: a quantity that does not match the prescription, a dose written without a unit, a repeat visit, an out-of-date tariff. Receiver finds them automatically on every claim, explains each one, and suggests the fix.

A facility uploads the month's claims as XML from its claims software (or enters them in the app), works through what is flagged, and exports the approved claims as a CLAIM-it file ready for submission to NHIA. Reports show managers where the money is at risk and how each officer is doing.

Public site: every NHIS claim checked before NHIA sees it
01 / 03

Every claim, checked first

Tariffs, medicine prices and quantities, duplicates, repeat visits, clinical fit and clinical safety are vetted against NHIA rules before submission.

My workplace: value vetted per day and the problems still open on an officer's claims
02 / 03

Clean output, ready to submit

Passed claims export as CLAIM-it XML, with vetting reports that show exactly what was flagged and why.

Reports: claim value, type of service and medicines by cost
03 / 03

Many facilities, one admin

Central control of medicines, tariffs and rules, scheduled facility lock dates, and a public page where new facilities request a 14-day free trial.

//03 —How it works

What the system does, module by module.

6 parts working together, each described from the system itself.

  1. 01

    Vetting engine

    91 checks run as officers work, grouped into 11 families: claim format, eligibility, diagnoses and G-DRG, episodes, duplicates, costing, quantities, medicines, clinical fit and more.

    • Errors are what NHIA would reject or deduct; warnings are worth a second look
    • Each flag says what is wrong, why NHIA would deduct it, and how to put it right, often in one click
    • Bulk fixes: replace invalid codes, fix dose units and approve all pending claims
    • Quantities worked out from dose × frequency × days, by strength and pack
    • Every service and medicine priced from the current G-DRG tariff book and NHIS Medicines List for its date
    • Money at risk of adjustment shown for each month
  2. 02

    Clinical intelligence

    Checks that look at the medicine and the patient together.

    • Drug interactions (e.g. warfarin with ibuprofen)
    • Medicines unsafe for a diagnosis, age or sex
    • Doses far from how the facility itself usually prescribes
    • Antibiotics checked against a supporting infective diagnosis
  3. 03

    Claims workspace

    Everything needed to work through a month of claims.

    • Claims grouped by month with outpatient, inpatient and diagnostic counts and approval progress
    • Filters by service type, specialty, attendance type, outcome, status, gender and age
    • Claim editor with member details, clinical entries, medications, vitals and review
    • Auto-save, and 'save place' to resume exactly where you stopped
    • Repeat visits less than 7 days apart linked: keep one, or combine them into an admission
  4. 04

    Reports and workplace

    Numbers for managers and for each claims officer.

    • Vetting and approval status, problems by rule family and the most common problems
    • Money at risk by problem, claim value (services vs medicines) and medicines by cost
    • Patients by age and sex, top diagnoses and specialties
    • My workplace: claims worked on, clean rate, errors, flags ignored, value vetted and likely deductions per officer
    • Monthly PDF vetting reports for management and audit
  5. 05

    Export and file tools

    Getting clean claims out, and messy files in.

    • Approved claims exported as CLAIM-it XML (specification v2.1)
    • Merge several ClaimIt / HMIS XML files into one, removing duplicates
    • Choose which copy wins when the same claim ID differs, and the order of claims
  6. 06

    Privacy and teams

    Claims hold names, NHIS numbers and diagnoses, so access is tight.

    • Each facility sees its own claims and nothing else
    • Personal sign-ins; sessions end when idle and lock after failed attempts
    • Sign-ins, approvals, exports and changes recorded in an audit log
    • System administrators manage accounts and settings, not claims
    • Facilities can request a 14-day free trial from the public site

//04 —Screens

Tap to enlarge

  • 01Public site: every NHIS claim checked before NHIA sees it

  • 02My workplace: value vetted per day and the problems still open on an officer's claims

  • 03Reports: claim value, type of service and medicines by cost

  • 04The 91 checks, grouped into 11 families

  • 05Claims organised by month, with OPD, IPD and diagnostic counts

  • 06Privacy: facility-only data, personal sign-ins and an audit log

//05 —Stack

  • React 19
  • Vite
  • Tailwind CSS
  • PHP 8.2
  • MySQL
  • PHPUnit
  • Dompdf
  • PhpSpreadsheet
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