HMO & NHIA Claims Software
Built for Nigerian Healthcare
Get paid faster — HMO and NHIS/NHIA claims, pre-authorisation, batch submission and reconciliation, built into your hospital workflow
DawaHQ turns HMO and NHIA billing from a revenue leak into a system. Configure any scheme with its tariffs, caps and co-pay rules; capture pre-authorisations; generate batch claims per scheme; record responses and rejections; reconcile payments and bill shortfalls — every claim linked to the patient invoice, across the whole hospital from the front desk to the ICU.
Everything your hmo & nhia claims needs
Purpose-built features, not generic add-ons.
Any HMO or NHIS/NHIA scheme
Configure each scheme with its own tariffs, service caps, benefit limits and co-pay rules — Hygeia, Avon, Axa Mansard, Leadway, Reliance, NHIS/NHIA and more.
Pre-authorisation workflow
Raise and track pre-auth requests before service, so claims are not rejected for missing authorisation.
Claims linked to invoices
Every HMO claim is tied to the patient invoice and encounter — no parallel spreadsheets, no lost charges.
Batch claim generation
Generate and submit claims in batches per HMO scheme, with claim-aging visibility so nothing sits unpaid unnoticed.
Capitation & fee-for-service
Bill each scheme on capitation or fee-for-service — whichever the contract uses.
Tariff mapping
Map your services to each scheme tariff so claim amounts are correct the first time.
Responses & rejection tracking
Record HMO approvals, part-payments and rejections against each claim to see exactly what is outstanding and why.
Reconciliation & shortfall billing
Reconcile HMO payments additively against invoices (never overwriting prior payments) and bill patient shortfalls — recover revenue that usually leaks.
HMO dashboard & reports
A live HMO dashboard plus claim-aging and reconciliation reports with PDF export for your finance team.
Who uses DawaHQ for hmo & nhia claims?
Connected to your entire hospital
Your hmo & nhia claims module doesn't work in isolation. Every feature connects to DawaHQ's full platform.
Patient Records
Shared EMR across departments
Queue Management
Real-time patient flow
Pharmacy
Prescriptions & dispensing
Laboratory
Orders, results & alerts
Billing & Payments
Invoicing + Paystack
HMO Claims
Batch claim submission
Appointments
Scheduling & reminders
Reports & Analytics
Revenue & clinical insights
Why DawaHQ vs. generic software?
Built for Nigerian healthcare from day one.
| Feature | DawaHQ | Others |
|---|---|---|
| Built for Nigerian healthcare | ✓ | ✗ |
| Specialty-specific modules | ✓ | ✗ |
| Naira billing + Paystack | ✓ | ✗ |
| HMO claim submission | ✓ | ✗ |
| NDPA compliant | ✓ | ✗ |
| Role-based access (14 roles) | ✓ | ✗ |
| Real-time queue management | ✓ | ✓ |
| AI clinical decision support | ✓ | ✗ |
Frequently asked questions
Does DawaHQ support NHIA / NHIS claims?
Yes. HMO scheme setup is fully configurable, so you can run NHIS/NHIA alongside private HMOs (Hygeia, Avon, Axa Mansard, Leadway, Reliance and others), each with its own tariffs, caps and co-pay rules.
Can I submit HMO claims in batches?
Yes — DawaHQ generates and submits claims in batches per scheme and tracks claim aging so unpaid claims are visible.
How does DawaHQ reduce HMO claim rejections?
Pre-authorisation capture, benefit-limit and service-cap enforcement, and tariff mapping mean claims go out authorised and correctly priced. Recorded responses show exactly why any claim was rejected so you can fix and resubmit.
Does it handle capitation and fee-for-service?
Both. Each scheme can be billed on capitation or fee-for-service.
Can I reconcile HMO payments and bill shortfalls?
Yes. HMO payments are reconciled additively against the patient invoice (prior payments are never overwritten), and any shortfall can be billed to the patient.
Is HMO billing included in the price?
HMO management is a core DawaHQ module, included in the plans. Pricing starts at ₦25,000/month — request a custom quote for your hospital.
Ready to digitise your hmo & nhia claims?
Join healthcare teams across Nigeria running their hmo & nhia claims on DawaHQ. Get started in minutes.