For insurers & schemes
Join without rebuilding your systems
WALA does not assume every scheme has an API. Integration sits behind adapters so public and private schemes can participate at whatever level of automation they have today.
Apply as an insurerAdapter architecture
REST, SOAP, secure file exchange, webhooks, CSV and a manual approval portal are all first-class integration modes, starting from sandbox adapters.
- Sandbox and mock adapters for onboarding
- Credentials held server-side only, never in the browser
- Future NHIS/NHIA connection without a platform rewrite
Eligibility and authorisation
Validate members, verify coverage and benefits, check the drug formulary and issue preauthorisations before dispensing begins.
- Co-pay calculation
- Benefit and formulary rules
- Authorisation officer workflow
Claims and settlement
Claims are generated from real fulfilment events, adjudicated, settled and reconciled against immutable ledger entries.
- Claim submission and adjudication
- Remittance and reconciliation
- Exception queues
Fraud monitoring
Rule-based risk scoring flags duplicate claims, excessive quantities, unusual pricing and suspicious substitution, ready for advanced analytics later.
- Configurable risk rules
- Top medicines and facilities
- Audit trail on every access