INDEX. TNNHIS Web-Module Documentation 1. ABOUT TNNHIS WEB MODULE ENTRY LEVEL PROCESS FOR PROVIDERS UNDER TNNHIS 03

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1 TNNHIS Web-Module Documentation INDEX 1. ABOUT TNNHIS WEB MODULE ENTRY LEVEL PROCESS FOR PROVIDERS UNDER TNNHIS STEPS TO LOGIN INTO TNNHIS WEB MODULE STEPS TO USE STEPS TO PROCESS FRESH INWARD STEP TO PROCESS QUERY REPLY STEPS TO APPLY FOR RECONSIDERATION OFDENIAL STEPS TO APPLY FOR ENHANCEMENT IN AL STEPS TO UPDATE HOSPITAL DETAILS STEPS TO CHANGE PASSWORD PROCEDURE TO CHECK AUTHORISATION DOCUMENT SUMMARY PROCEDURE TO CHECK REQUEST FOR AUTHORISATION LETTER PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED IN AUTHORISATION PROCEDURE TO CHECK AUTHORISATION LETTERS DENIED DETAILS PROCEDURE TO CHECK AUTHORISATION LETTERS ISSUED PROCEDURE TO CHECK TOTAL INWARD DONE PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED PROCEDURE TO CHECK PROCESS CLAIM DETAILS PROCEDURE TO CHECK PAID CLAIM DETAILS PROCEDURE TO CHECK PACKAGE RATE LIST 37 Page 1

2 TNNHIS Web-Module Documentation ABOUT TNNHIS WEB MODULE: TNNHIS web module is for managing the data online. Here we have provided the following list of Logins to the end users: MDININDIA LOGIN The web module is for representing all the information of Inward / Claims and Authorization handled by Provider. Hospital Transactions include: Fresh Inward Query Reply Reconsideration of Denial Enhancement in AL Update Hospital Details Change Password Claims Status Includes: Under Process Claims Detail Additional Document Requested Processed Claims Details Paid Claims Details Repudiated Claims Details Authorisation Status Includes: Authorisation Document Summary Requests for Authorisation Letter Additional Documents Requested in Authorisation Requests for Authorisation Letter Denied Authorisation Letter issued Total Inward Done Package Rate List includes: Package Rate List details Page 2

3 TNNHIS Web-Module Documentation ENTRY LEVEL PROCESS FOR PROVIDERS UNDER TNNHIS: 1. When a patient approaches a TNNHIS empanelled Hospital for treatment, the provider needs to ensure the following: The patient is a valid beneficiary of the scheme and fulfills the definition of employee or family of the scheme. (a) Employee means an Employee of the Government of Tamil Nadu, State Public Sector Undertakings, and Local Bodies in Tamil Nadu, State Government Universities and Statutory Boards under the control of the Government of Tamil Nadu. (b)"family includes the Employee, and the members of his or her family who are eligible for assistance under the Scheme as detailed below: (i) Legal spouse of the Employee. (ii)children of the Employee - till they get employed or married or attain the age of 25 years whichever is earlier and dependent on the Employee; (iii) The parents of the Employee, in the case of unmarried employee until the Employee gets married Documents that confirm eligibility should be verified: i. A photo I-Card issued by the State Authorities and ii. The health card issued by insurance company (United India Insurance Company) with a family photograph of the beneficiaries. 2. When the beneficiary is enrolled in the Third Party Administrator Database, on entering the Card No issued by the Insurance Company, the details of the beneficiary would get populated in the login screen as shown below Page 3

4 TNNHIS Web-Module Documentationn Login Screen 3. In case the beneficiary is valid but not enrolled in TPA database, the provider can proceed with Authorization request for treatment, but the documents that would be sent for Authorization, should also include a signed copy of Annexure E (Form 20) for enrollment by the TPA before the Authorization Letter is issued. Page 4

5 TNNHIS Web-Module Documentation STEPS TO LOGIN USING TNNHIS WEB MODULE STEP- 01 Login to Refer Screenshot [01] Screenshot [01] The above screenshot [01] contains the TN Employee Scheme Tab, click on this Tab to proceed. Click on My Account Tab Page 5

6 TNNHIS Web-Module Documentationn Screenshot [02] STEP- 02 After clicking the above My Account Tab the below mentioned options will appear 1. OBJECTIVE 2. ONLINE STATUS a. b. MDINDIA LOGIN 3. POLICY INFORMATION 4. PREMIUM INFORMATION 5. CONTACT US 6. PROVIDER MANAGEMENT Page 6

7 STEPS TO USE STEP- 03 To begin the process of Inward Click on My Account Provider Login Screenshot [03] STEP- 04 a. Select the Hospital Name from the dropdown list and enter the password b. Click Login tab Refer Screenshot [04] Note: If the login details are correct it will redirect you to Provider s Homepage with Hospital Details. Page 7

8 TNNHIS Web-Module Documentationn Screenshot [04] Screenshot [05] Page 8

9 STEPS TO PROCESS FRESH INWARD When the beneficiary visits the provider for availing treatment the following steps to be followed: a. Click on Hospital Transaction Fresh Inward Refer Screenshot [06] Screenshot [06] b. The request for Pre-Authorization would appear. In case of fresh Inward the Provider will have to complete the information in the below mentioned Tab: i. Patient Information ii. Complaint Details Page 9

10 Screenshot [7] iii. iv. Treatment Details Hospital Information (Auto Populated) Page 10

11 Screenshot [8] Screenshot [9] Note: Where procedure/packagee is not mentioned, select Package Type as Non-Package and mention the value of the treatment in the Total Amount Tab. v. Past History/Billl Particulars Page 11

12 vi. Previous Policy Information Screenshot [10] vii. Upload Scanned Document and Terms & Conditions Note: 1. Browse and Upload the documents to proceed further to the terms and conditions. 2. For not enrolled cases only.tiff images would be acceptable. Screenshot [11] Page 12

13 c. Tick on I accept the terms and conditions [Refer Screenshot 11] d. Click on Save Note: Incase any informationn is missed a Dialog box with the error would popp up. e. Save action would generate the Inward No Screenshot [12] STEPS TO PROCESS QUERY REPLY a. Go to Hospital Transactions Query Reply Screenshot [13] b. Enter either of the following information to retrieve patient query details Page 13

14 i. CCN Number ii. MDID Number iii. Patient Name Note: The Patient Query details are can be viewed on the dashboard Screenshot [14] Page 14

15 c. Click on View to see the Additional Document Request form received from TPA. Screenshot [15] Page 15

16 d. To reply to the ADR click on Details. Screenshot [16] Screenshot [17] e. Browse and Upload the required documents The documents uploaded will be forwarded to the Authorization department for further processing. Page 16

17 STEPS TO APPLY FOR RECONSIDERATION OF DENIAL a. Go to Hospital Transactions Reconsideration of Denial b. Enter either of the following information to retrieve denial case iv. CCN Number v. MDID Number vi. Patient Name Screenshot [18] Screenshot [19] Page 17

18 TNNHIS Web-Module Documentationn Screenshot [20] Click on the Detail to upload the necessary documents required during reconsideration of AL. On uploading the document an Inward number which is alpha-numeric is generated. STEPS TO APPLY FOR IN AL c. Go to Hospital Transactions Enhancement in AL Screenshot [21] d. Enter either of the following information to request for Enhancement of AL vii. CCN Number viii. MDID Number ix. Patient Name Page 18

19 Screenshot [22] e. Click on View to see the AL s received Screenshot [23] f. Click on Details for requesting enhancement in AL amount. g. Browse and Upload the required documents (only.tiff images would be acceptable) Page 19

20 TNNHIS Web-Module Documentationn Screenshot [24] Screenshot [25] On uploading the document an Inward number which is alpha-numeric is generated. STEPS TO UPDATE HOSPITAL DETAILS a. Go to Hospital Transactions Update Hospital Details Page 20

21 TNNHIS Web-Module Documentationn b. Provider can make the following changes; i. Contact Person ii. Landline No. iii. Mobile No. iv. Id v. Fax No. Screenshot [26] Screenshot [27] Page 21

22 STEPS TO CHANGE PASSWORD a. Go to Hospital Transactions Change Password b. Provider can change the password. Screenshot [28] Screenshot [29] END OF ACTIVITY HOSPITAL TRANSACTIONS The Inward Number generated would be alpha-numeric; this number would be used for further process. Page 22

23 TNNHIS Web-Module Documentationn DETAILS TO CHECK AUTHORISATION STATUS The below mentioned steps will provide the different status in the Authorisation Process: i. Authorisation Document Summary ii. Request for Authorisation Letter iii. Additional Document Requested in Authorisation iv. Request for Authorisation Letters Denied v. Authorisation Letter Issued vi. Total Inward Done Screenshot [30] PROCEDURE TO CHECK AUTHORISATION DOCUMENT SUMMARY a. Go to Authorisation Status Authorisation Document Summary Screenshot [31] Page 23

24 TNNHIS Web-Module Documentation b. Enter Credentials Click Search c. This would give the summary in a tabular format [Refer Screenshot 31] Screenshot [32] PROCEDURE TO CHECK REQUEST FOR AUTHORISATION LETTER(RAL) a. Go to Authorisation Status Request for Authorisation Letter b. Enter the CCN number/mdid number Click Search Screenshot [33] Page 24

25 TNNHIS Web-Module Documentation Screenshot [34] c. This would give the summary in the tabular format [Refer Screenshot 33] PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED IN AUTHORISATION a. Go to Authorisation Status Additional Document Requested in Authorisation Screenshot [34] b. Enter Credentials CCN Number, MDID Number or Patient Name to Check query for a particular patient Screenshot [36] Page 25

26 c. The Additional Documents Requested details can also be viewed on the dashboard which gives the consolidated details of total ADR raised Screenshot [37] d. Click on View to see the ADR raised by TPA(Refer Provider Login process Steps to Process Query Reply Point C ) PROCEDURE TO CHECK AUTHORISATION LETTERS DENIED DETAILS a. Go to Authorisation Request for Authorisation Letter Denied Screenshot [38] Page 26

27 b. Enter Credentials CCN Number, MDID Number or Patient Name to Check Details. Click Search c. The details will appear in a tabulated format Screenshot [39] PROCEDURE TO CHECK AUTHORISATION LETTERS ISSUED a. Go To Authorisation Status Authorisation Letter Issued Screenshot [40] b. Enter Credentials CCN Number, MDID Number or Patient Name to Check Details of AL Issued Screenshot [41] c. The details of Authorisation Letter Issued can also be checked on the dashboard. Page 27

28 TNNHIS Web-Module Documentationn Screenshot [42] d. Choose a case Click View to see the AL raised by the TPA for the concerned patient Refer Hopital doc preared. e. Click on Details to see the details of Authorisation Details. Note:Basis Authorisation Status the Provider will act accordingly PROCEDURE TO CHECK TOTAL INWARD DONE a. Go to Authorisation Status Total Inward Done Screenshot [43] Page 28

29 b. Enter Credentials CCN Number, MDID Number or Patient Name to Check Details of Inward Done Screenshot [44] c. The details of Total Inward Done will appear on a Dashboard.This Screen will give the details in a consolidated format Screenshot [45] Page 29

30 d. Click on View to see the request for Pre Authorisation raised by the Provider Screenshot [46] Page 30

31 e. Click on Details to check the Inward Details Screenshot [47] END OF ACTIVITY AUTHORISATION STATUS DETAILS TO CHECK CLAIMS STATUS The below mentioned steps will provide the different status in the Claims Process: i. Under Process Claims Details ii. Additional Documents Requested iii. Processed Claims Details iv. Paid Claims Details v. Repudiated Claims Details a. Go to Claim Status Under Process Claim Details Screenshot [48] Page 31

32 Screenshot [49] b. Enter the Credentials-CCN Number or Patient Number and Search Screenshot [50] c. The Under Process Details for the specific patient will appear with statuss of the Claim PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED a. Go to Claim Status Additional Document Requested Screenshot [51] Page 32

33 TNNHIS Web-Module Documentationn b. Enter the Credentials-CCN Number or Patient Number and Search Screenshot [52] c. The Additional Document Request Details for the specific patient will appear with reason and other details that resulted in ADR being raised. PROCEDURE TO CHECK PROCESS CLAIM DETAILS a. Go to Claim Status Processed Claim Details Screenshot [53] Page 33

34 TNNHIS Web-Module Documentationn b. Enter the Credentials CCN Number or Patient Details and Search c. The Settled Claim Details can also be viewed on the Dashboard. Screenshot [54] Screenshot [55] Page 34

35 d. Click on Details. This will open the Screen giving Patient Details, AL Details, Claim Payment Sheet, Payment Details e. Click on View Claim Payment Sheet to see the details of payments Screenshot [56] Screenshot [57] Page 35

36 TNNHIS Web-Module Documentationn PROCEDURE TO CHECK PAID CLAIM DETAILS a. Go to Claim Status Paid Claim Details b. Enter Credentials-CCN Number or Patient Details Click Search Screenshot [58] c. The details of the Claim Paid will appear for the specific patient Screenshot [59] END OF ACTIVITY CLAIMS S STATUS Page 36

37 PROCEDURE TO CHECK PACKAGE RATE LIST a. Provider can click on the Package Rate list to see the details of the agreed rate list. One can search the details by the Package Code Package Name Screenshot [60] END OF THE PROCESS Page 37