The Challenge

Medical claims administration is complex, fragmented, and costly

Managed care organisations process large volumes of medical claims across dozens of clinical workflows — pre-authorisation, case management, bill review, pharmacy, fraud detection, and more. These workflows have historically lived in separate systems, creating data silos, manual rework, and compliance gaps.

The Aafiya Platform unifies every clinical workflow on a single cloud-native platform — 23 microservices across 4 service domains, reducing processing time, eliminating rework, and providing a single source of truth for every member journey — from first notification to final settlement.

20 Core Modules

Every clinical workflow, unified on one platform

All 20 modules are fully delivered and production-ready, organised across three service domains with four cross-cutting platform services.

Clinical Domain

Clinical rules engine, pre-authorisation, hospital benefit management, bill review, case management, pharmacy, and more.

12 modules

Clinical Rules Engine General Pre-Authorisation Hospital Benefit Management Medical Bill Review Medical Advisory Process Case Management Serious Injuries Assessment Future Medical Expense Assessment Past Medical Expense Assessment EMS Data Management Pharmacy Benefit Management HPCSA Tribunal Management

Engagement Domain

Provider and member portals, omnichannel communication, business intelligence, and native mobile applications.

5 modules

Provider Portal Member Portal Communication Module Reporting & Business Intelligence Mobile Application

Network Domain

Fraud detection and provider profiling, medical specialties network management, and geo-mapping.

3 modules

Fraud Detection & Provider Profiling Medical Specialties & Networks Geo-Mapping Module

View all 20 modules in detail

Architecture

Cloud-native, built for South African healthcare

A microservices architecture on Google Cloud Platform with 23 independently deployable services, designed for 99% uptime SLA and South African data residency.

Presentation Layer

Four React + TypeScript portals (Provider, Member, Staff, Admin) plus a React Native mobile app with offline-first Redux architecture.

API & Application Layer

Cloud API Gateway with 23 Spring Boot 3 microservices. Pub/Sub event-driven messaging across all domains for async, reliable workflows.

Data & Analytics Layer

Cloud SQL for transactional data, Firestore for documents, Cloud Storage for files, and BigQuery + Looker for advanced analytics and BI.

Compliance & Security

Zero-trust security. South African data residency.

Aafiya was designed from day one for the South African regulatory context — POPIA, HIPAA, and ISO 27001 compliance are built in, not bolted on.

POPIA Compliant

HIPAA Compliant

ISO 27001 Certified

AES-256-GCM Encryption

7-Year Immutable Audit Trail

Zero Trust Architecture

Field-level AES-256-GCM encryption, immutable 7-year audit trail, 0 critical security findings from penetration testing, RTO/RPO ≤ 8 hours, and 500 CCU load-tested at p95 2.3 s. All data remains within South African GCP regions.

Integrations

Connected to South Africa's healthcare ecosystem

Pre-built integrations with every major South African healthcare data network and government system.

🩺 MediKredit 🏥 BHF / PCNS ⚖️ HPCSA 🪪 Home Affairs (DHA) 💬 Twilio / Infobip (WhatsApp + SMS) 📍 Google Maps API 📊 Power BI 🤖 AI Services (Vertex AI + Anthropic) 🔄 Cloud Build / Deploy

Ready to see Aafiya in action?

Schedule a demo or speak to our team about your requirements. We'll show you how Aafiya transforms your managed care operations.

Request a Demo mogammadnoordien@gmail.com

The Complete Managed Care Platform