The verdict in three sentences
A health insurer or third-party administrator in Dubai covering 45,000 members and 120 network providers loses 3 to 6% of benefits paid every year to fraud, duplicates and keying errors when claims still move on paper. Claims management software at EUR 30,500 to 58,000 (20 to 38 million FCFA, our reference scale for West African clients) brings provider reimbursement from 45 down to 10 days and makes controls systematic. The project typically pays back in 18 to 30 months, from lower fraud and processing costs alone.
What the software changes in the claims circuit
| Step | Current paper circuit | With the software |
|---|---|---|
| Eligibility check at reception | Phone call or printed list | QR card scan, answer in 3 seconds |
| Direct billing approval | Signed paper form, validated afterwards | Real-time electronic approval, limit checked |
| Claim submission | Weekly courier | Entered by the provider on tablet or mobile |
| Medical review | Sample of 10% of claims | 100% rule-checked, 5 to 8% reviewed by the medical officer |
| Fraud detection | Rare, on tip-off | Automatic alerts: repeated procedures, prescriptions, shared cards |
| Provider payment | 45 days, manual transfer | 10 days, batch bank transfer or mobile payment |
| Reporting to management and regulator | Monthly Excel files | Real-time dashboard |
The QR member card is the most profitable lever: it costs EUR 0.75 to 1.80 per member to print and removes most identity misuse, the leading source of fraud in health schemes.
Detailed budget
| Module | Content | 2026 budget (estimate) |
|---|---|---|
| Scoping and benefit setup | Tables of benefits, limits, co-payments, procedure codes | EUR 3,000 to 5,300 |
| Members and QR cards | Families, premiums, card printing | EUR 4,600 to 7,600 |
| Provider portal | Eligibility, approvals, procedure entry | EUR 7,600 to 13,700 |
| Adjudication and control | Business rules, medical officer, fraud detection | EUR 6,900 to 13,700 |
| Payments and accounting | Payment batches, transfers, mobile payment, accounting export | EUR 3,800 to 7,600 |
| Dashboard and reporting | Loss ratio, usage per provider, regulatory reports | EUR 2,300 to 5,300 |
| Provider rollout | Training for 120 sites, starter tablets, support | EUR 2,300 to 4,600 |
Yearly costs to plan: hosting and maintenance of EUR 380 to 900 a month, and about EUR 60 to 120 of mobile data per equipped provider.
Off-the-shelf package or custom build
| Criterion | Imported insurance package | Custom software by Kolonell |
|---|---|---|
| Initial licence | EUR 38,000 to 91,500 | Included in the build |
| Yearly cost | 15 to 22% of the licence | EUR 4,600 to 11,000 |
| Fit with your benefit rules | Costly, external consultants | Native |
| Offline mode at provider sites | Rarely | Yes, syncs when the network returns |
| Mobile payment of providers | Custom development | Included |
| Rollout time | 9 to 15 months | 5 to 7 months |
Mini case study
Karim, CTO of a health insurance administrator in Dubai, manages 45,000 members for EUR 2.7 million of yearly benefits. An audit estimated fraud and duplicates at 4%, or EUR 110,000 a year. The software, budgeted at EUR 46,000 plus EUR 7,600 a year of maintenance, halves these losses in year one: EUR 55,000 saved. On top of that, two data-entry roles move to claims control, and providers paid in 10 days renew their contracts without a rate increase. Payback comes in about 12 months.
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FAQ
Does the software work in clinics without a stable connection?
Yes, the provider app stores checks and procedures locally and syncs as soon as the network returns. An entry-level tablet at EUR 140 to 230 per site is enough.
Can providers be paid by mobile money?
Yes, validated payment batches can be settled by bank transfer or batch mobile payment. Business transfer fees are usually negotiated between 0.5 and 1% of the amount.
How does the system detect fraud?
Through rules: same procedure billed twice within 7 days, prescriptions above the limit, visits in two cities on the same day, provider 30% above the average. Each alert is reviewed by the medical officer before rejection.
Is medical data protected?
The software enforces role-based access, encryption and an access log, in line with local health data rules such as those of the Dubai Health Authority. Hosting can be in-country or in a regional cloud, for EUR 230 to 610 a month.
Do we need to roll everything out at once?
No, we recommend a 3-month pilot with 15 to 20 providers, then rollout in waves of 30 sites. The pilot represents about 40% of the total budget.
Let's scope your project. Share your member count, provider network and benefit rules: we will price software between EUR 30,500 and 58,000 with a working pilot in 4 months. Detailed quote within 48 h. WhatsApp +221 77 596 93 33.
Mohamed Bah
Fondateur, Kolonell
Passionate about digital and entrepreneurship in Africa, Mohamed has been helping Sénégalese businesses with their digital transformation since 2020. Founder of Kolonell, he believes every SME deserves a professional and accessible online présence.
