The verdict in three sentences
A small health insurer or mutual with 25,000 members that still processes provider invoices by hand pays twice: in slow settlement (around 45 days) and in undetected fraud. Custom direct-billing software links members, plans, benefit limits and 70 network providers in one database, with automatic duplicate checks. At Kolonell this kind of project falls in the medium application bracket, 4,000,000 to 7,000,000 FCFA (6,100 to 10,670 EUR), delivered in 4 to 6 months, and usually pays back within 18 months.
What the manual process really costs
The typical manual flow, whether at a niche insurer in London or a TPA in Dubai: the clinic treats the member on presentation of a card, collects pre-authorisations, sends a monthly batch, then a claims handler rekeys each line before the medical officer approves it. Every step adds days and mistakes.
| Item (2026 estimate) | Manual process | With direct-billing software |
|---|---|---|
| Average provider settlement time | 45 days | 10 to 15 days |
| Claim lines rekeyed per month | 6,000 to 8,000 | 0, entered by the provider |
| Claims handlers needed | 5 | 2 |
| Duplicates and over-limit claims caught | 20 to 40 % | over 95 % |
| Estimated fraud, waste and error share | 4 to 8 % | 1 to 2 % |
| Time to produce monthly loss ratios | 5 days | instant |
For an insurer paying around £4 million (about $5 million) of claims a year, cutting fraud and error from 6 % to 2 % saves roughly £160,000 a year, before counting happier providers who get paid faster. In Dubai, where DHA and DOH rules push e-claims, the manual route is also a compliance risk.
The modules you actually need
Health claims software is not a generic CRM. It must encode your plan rules (coverage rates, annual limits, waiting periods, exclusions) and each provider agreement.
| Module | Key function | Complexity |
|---|---|---|
| Members and dependants | Families, QR-coded cards, premiums, suspensions for non-payment | Medium |
| Plans and limits | Rate per procedure, annual limit per member, 3-month waiting period | Medium |
| Provider portal | Real-time eligibility check, claim entry, batch submission | High |
| Adjudication and controls | Duplicate rules, incompatible procedures, medical officer alerts | High |
| Payments | Bank transfers, card or open banking payouts | Medium |
| Dashboards | Loss ratio by plan, by provider, by condition | Low |
| Compliance | Audit trail, protected health data, regulator exports | Medium |
The core value is the provider portal: the pharmacy scans the member card and gets an answer in two seconds on coverage, rate and remaining limit. The co-payment is collected on the spot and the balance is billed electronically.
Custom build or off-the-shelf platform?
Commercial claims platforms in the UK or the Gulf typically charge, as a 2026 order of magnitude, £50,000 to £150,000 ($60,000 to $190,000) in licences and setup, then 15 to 20 % a year in support, and assume the processes of a large carrier. A smaller mutual, staff scheme or TPA usually has simpler but very specific rules.
Kolonell's grid for custom applications, quoted in its own currencies:
- Simple: 2,500,000 to 4,000,000 FCFA (3,810 to 6,100 EUR), for example members and premiums only.
- Medium: 4,000,000 to 7,000,000 FCFA (6,100 to 10,670 EUR), the typical case with provider portal and adjudication.
- Complex: 7,000,000 to 15,000,000+ FCFA (10,670 to 22,870+ EUR), for several schemes, a member mobile app and insurer integrations.
Maintenance then runs at 35,000, 75,000 or 120,000 FCFA a month (53, 114 or 183 EUR) depending on service level. Hosting and specific banking integrations are quoted separately.
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Dr Rahman runs a staff health scheme in Dubai: 25,000 members, 70 network providers, about $5 million of claims a year. He picks a medium-bracket project at 6,500,000 FCFA plus 75,000 FCFA a month of maintenance (900,000 FCFA a year).
- Fraud and error avoided: $5M × (6 % minus 2 %) = $200,000 a year.
- Two handler roles redeployed: 2 × $3,500 × 12 = $84,000 a year.
- Total annual gain: $284,000, against a first-year cost of 7,400,000 FCFA including maintenance.
Even if you divide the gains by ten to stay conservative, the project pays back within a year.
FAQ
How long does it take to go live?
Allow 4 to 6 months: one month to map plan rules, three months of development and one to two months of pilot with 10 providers before rolling out to all 70.
Can providers with weak connectivity use it?
Yes, the portal runs on a smartphone browser and accepts deferred entry. In the UK or UAE connectivity is rarely the issue, but the same design keeps the portal fast for 100 % of pharmacies.
How is health data protected?
Sensitive fields are encrypted, access is role-based (the provider sees eligibility, not medical history) and every action is time-stamped in an audit log, in line with UK GDPR or the UAE health data law.
Can it handle premium collection?
Yes, premiums can be tracked by direct debit or card, and benefits suspended automatically after 60 days of arrears if your rules say so.
What happens to our current spreadsheets?
They are migrated: duplicates cleaned, member numbers normalised and imported with checks. For 25,000 members this usually takes 2 to 3 weeks.
Let's scope your project. We map your plans, providers and adjudication flow with you, then deliver a pilot within a few 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.
