Software Application. Bhamashah Swasthya Bima Yojana

Transcription

1 Software Application for Bhamashah Swasthya Bima Yojana Training Manual (Version 2.0) RajComp Info Services Limited (RISL) March 2016 Page 1 of 42

2 Contents S. No. Chapter Page 1. Introduction 3 2. Abbreviations 4 3. Services integrated with BSBY Software 5 4. Logging In 6 5. Beneficiary Identification Form Emergency Case Conversion Form Pre-Authorization Request Form Patient Admission Form TID Cancellation Form Patient Discharge and Claim Submission Form Query Panel Case Status Tracker Report Summary Page 2 of 42

3 Introduction Bhamashah Swasthya Bima Yojana (BSBY) was launched in the State of Rajasthan on 13 th December 2015 and a software developed by RISL is in use for providing health insurance coverage to eligible beneficiary families under the scheme. A Training Manual (Version 1.0) was prepared as a guide to the users of the software. In the last two months and a half, the software has undergone major improvements and changes, which necessitated the bringing out of an updated version of the Training Manual for the benefit of software users. It is against this background that Training Manual Version 2.0 has been brought out for the benefit of the users of BSBY software. This Training Manual Version 2.0 is a guide intended to provide you step-by-step guidance on successful use of BSBY software application. Training Manual Version 2.0 contains guidance on the following additional / upgraded features of the upgraded BSBY software application: 1. Merging of Patient Discharge Form and Claim Submission Form into a single Patient Discharge and Claim Submission Form 2. TID Cancellation Form 3. The Query Panel 4. Report Summary It is hoped this updated Training Manual Version 2.0 will be a good and user-friendly guide which will aid in smooth and successful use of BSBY software for providing benefits to beneficiary families. Page 3 of 42

4 Abbreviations used in this Document S. No. Abbreviation Full Form 1. Aadhaar EID Aadhaar Enrolment ID (Enrolment Identification No.) 2. BSBY Bhamashah Swasthya Bima Yojana 3. CEO Chief Executive Officer 4. CRN Central Registration Number 5. DoIT&C Department of Information Technology & Communication 6. FCS Dept Department of Food and Civil Supplies 7. LAMA Left Against Medical Advice 8. M&H Dept Department of Medical, Health and Family Welfare 9. MLC Medico-Legal Case 10. MOIC Medical Officer Incharge 11. MRD No. Medical Record Department No. 12. NHM National Health Mission 13. NIA New India Assurance Company Limited 14. NFSA National Food Security Act 15. OTP One Time Password 16. PDS Public Distribution System 17. RISL RajComp Info Services Limited 18. RSBY Rashtriya Swasthya Bima Yojana 19. SHAA State Health Assurance Agency 20. TID Transaction Identity No. Page 4 of 42

5 Services integrated with BSBY Software The following services have been integrated with BSBY software application: 1. Services with UIDAI for verification of identity of beneficiary family using Aadhaar Card 2. Services with Public Distribution System of Department of Food and Civil Supplies 3. Services with Bhamashah Database Hub (BDH) N.B.: It is to be noted that there is no integration of any kind for capturing photo through web camera web camera is a plug-and-play device that does not require any integration. If you are facing an issue regarding capturing photograph using web camera, you are advised to contact a computer engineer locally and seek his / her support. Page 5 of 42

6 Logging In 1. Software Application The software application site is bsbyapp.health.rajasthan.gov.in. 2. On entering this address on the web page, the following Log-In Screen appears: a. User Name: You need to enter the User ID provided to you by M&H Dept or by NIA. b. Password: Enter the password provided to you by M&H Dept or by NIA. c. Captcha: Enter the captcha that appears on the screen. Please note that the captcha is not case sensitive and you may enter the captcha in lower case in case of alphabets. d. Forgot Password: A facility has been developed within the software for this issue. However, this facility has not been activated because mobile numbers of majority users have not been entered into the database of the software. N.B.: For any issues related to User IDs or Passwords, please contact New India Assurance Company Limited at the landline no or After you have successfully logged in, the following screen appears on your computer: Page 6 of 42

7 Beneficiary Identification Form This is the first form that has to be used for providing benefits to an eligible beneficiary under BSBY. 1. After you have successfully logged in, the following screen appears on your computer: 2. Click on the Beneficiary Identification Form link under Quick Links on the left side of the screen. The following screen appears. 3. Choose Admission Type for the patient from the drop-down menu as shown below: 4. Normal Admission: If you choose Admission Type as Normal, follow the following steps for identification of beneficiary status of a family based on Family ID Type: Page 7 of 42

8 i. Please select the Identity Type by clicking on the appropriate Radio Button; after clicking on a radio button for Identity Type, the box on the right becomes enabled and you can type or paste the family identity number in this box. E.g., if you select Bhamashah Family ID, you need to enter the seven-alphabet Bhamashah Card ID / No. (in upper case) in the text box as shown below: ii. Click on the Search Beneficiary button immediately below the box and the following details about NFSA beneficiary status of the family appear: iii. If you select Ration Card, you need to enter the 12-digit Ration Card No. in the text box: iv. Click on the Search Beneficiary button immediately below the box and the following details about NFSA beneficiary status of the family appear: Page 8 of 42

9 v. If you enter the Aadhaar Card and the Aadhaar Card is available in Bhamashah Database Hub, entering the Aadhaar Card No. in the textbox and clicking the Search Beneficiary button will get the family entitlement status from BDH. If the Aadhaar Card is not available in BDH, the message No records available will appear. vi. After you have entered the family ID no. and clicked on the Search Beneficiary button, you will get either of the following three situations: a. The database tells the Entitlement Type of the family as NFSA as shown above. In this case, if you scroll down, you will find the name, age and gender of the family members on the screen. b. The database tells the Entitlement Type of the family as N/A as shown below (this implies that from the database of Food and Civil Supplies Dept the confirmed NFSA status of the family is Not Available. In such a case, please refer to guidelines of M&H Dept, confirm the NFSA status of the family by seeing the Ration Card (for NFSA status) or RSBY Card (for RSBY status), scan the relevant documents as per directives of M&H Dept and use the MOIC route (while following the MOIC route, please refer to and follow the guidelines / directives of M&H Dept). c. For some Ration Card IDs, you may even get the status as No records found. This implies that this Ration Card no. is not available in the database of Food & Civil Supplies Dept. In this case also, please follow M&H Dept guidelines and directives and follow the MOIC route as mentioned in point 4(v)(b) above. Page 9 of 42

10 vii. MOIC Route: For situations described under point 4(vi)(b) and 4(vi)(c) where the confirmed NFSA status is not available through the software, you need to verify by looking at the Ration Card of the family if the family is an NFSA family (please follow M&H guidelines / directives regarding this). If you are convinced that this family is an NFSA family, please scan the relevant pages of the Ration Card and save it on the system. a. Then click on the MOIC radio button under Identity Type and the following screen appears: b. Enter the name of the patient to be enrolled under BSBY, enter the age of patient, gender of patient, choose Verified Identity Type by using the drop-down menu and enter the Verified Identity Number seven-alphabet ID for Bhamashah Family ID, 12-digit number for Ration Card or 16-digit number for RSBY Family ID. c. Click on Choose button for selecting the document to be uploaded, then click on the Upload button to upload the document and you get the message PDF Uploaded Successfully : Page 10 of 42

11 d. Click on the Submit button and you succeed in generating the TID number for this patient as shown below: e. Not this TID for all future reference of this patient and use this for filling up the Pre-Authorization Request Form. N.B.: On using the MOIC route for identifying the beneficiary status of a family, the MOIC has already verified the family and identified the patient. Please follow the guidelines and directives of M&H Dept in this regard. On generating the TID using MOIC Route under Identity Type, you may go directly to Pre-Authorization Request Form. viii. After you have ensured the entitlement status of the family as a beneficiary family (whether through the software using any of the eligibility cards), you need to establish the genuineness of the family be verifying the identity of the patient. For verification of the genuineness of the patient (or any family member, you are advised to refer to the guidelines / directives issued by M&H Dept and follow them. Here, the alternatives available for verification of the patient (or any family member) are described. a. After you have confirmed the NFSA status of the family, you may see the two radio buttons available under Verify by Aadhaar and MOIC. Page 11 of 42

12 b. First we describe the scenario of Verification by Aadhaar. Until this point, you may see in the table below the Verify by button that the buttons in the column titled Verify Aadhaar are not enabled. c. On selecting the Aadhaar button opposite Verify by you can see that the Verify Aadhaar buttons in the table are enabled as shown below. d. Click on the Verify Aadhaar button for the person whose Aadhaar credentials you want to verify from Aadhaar database (in case a person s Aadhaar number is not appearing on the screen but the person has brought his / her Aadhaar Card, you may enter the Aadhaar number in the box opposite that person s name under the column Aadhaar number and click on Verify Aadhaar button). The following dialogue box opens: e. Fingerprint Verification: You must already have successfully installed and functional Finger Print Reading Device integrated with your computer system. Click on the FMR button and light glows up on your finger print scanning device. Ask the person (whose identity you want to verify from Aadhaar Page 12 of 42

13 database) to provide lay his / her finger or thumb on the glass of the fingerprint scanning device where the light is glowing. And the thumb print of the person appears in the box adjacent to Read Finger Print. Click on Send Request button and the request is sent to UIDAI database to match the fingerprints associated with this Aadhaar Card in UIDAI database. On confirmation of matching of fingerprint, a message Verified appears in the column Verification Status in the row containing the name of the person whose identify has been verified by using Aadhaar Card. Once Verified status appears in the Verification Status column, the radio buttons in the Select Patient column are enabled and you can now select the patient by clicking upon the relevant radio button in the row containing the patient s name. If the message appearing in the Verification Status column is Not Verified, this indicates that the finger print uploaded for this person does not match the finger prints available in UIDAI database for this Aadhaar Card. You may try again by repeating the process with the same or another finger / thumb. In the possibility that despite repeating the process the message Verified does not appear, you have the OTP option as described below. f. OTP: By clicking on the OTP option in the window as described in point 4(vi)(e), an OTP is sent from UIDAI database to the Registered Mobile No. available in UIDAI database for that Aadhaar Card. An SMS containing OTP is received on the patient s Registered Mobile No. please enter this OTP in the box and click on Confirm OTP. Once this goes back to UIDAI database which matches the submitted OTP with the OTP that was sent from UIDAI database. If the two match, the message Verified appears in the column Verification Status in the row containing the name of the person whose identify has been verified by using Aadhaar Card. Once Verified status appears in the Verification Status column, the radio buttons in the Select Patient column are enabled and you can now select the patient by clicking upon the relevant radio button in the row containing the patient s name. In case the OTP does not match, the message appearing in the Verification Status column will be Not Verified and the radio buttons for selection of the patient will not be enabled and you will not be able to select patient. You may like to repeat the process. g. MOIC route for verification of identity of patient: If the patient has an Aadhaar Card or any other photoidentity card (please follow guidelines / directives of M&H Dept on this issue), his / her fingerprints do not match, the person informs that the Registered Mobile No. that is entered in UIDAI database is no longer with him / her and your hospital (through any authorized person as per M&H guidelines) has verified the identity of the patient through some photoidentity card, you have the option of using MOIC route for verification in which you upload scanned copy of verification document of the patient as described below: Page 13 of 42

14 Scan the photoidentity card of the patient that you want to upload for verification of identity of the patient and save it in your computer from where you can select and upload it. Opposite Verify by option, click on the radio button MOIC and the following screen appears: Click on Choose button opposite Upload MOIC Verified Document and select the PDF document to be uploaded. Click on Upload button to upload the document and on successful uploading of document, the Uploaded Successfully message appears as shown below. Once the document has been uploaded successfully, the radio buttons under the column Select Patient are now enabled and you can select the patient by clicking on the appropriate radio button opposite the name of that patient. In this case, mayank has been identified as the patient and the details appear as shown below. Please note that in this case, you used the MOIC route for verification and for this reason, there is no information under Aadhaar Verified by Person Name and Aadhaar Verified by Person ID. In cases where verification has been done Page 14 of 42

15 through UIDAI database using Aadhaar Card of a person, the name of the person and his / her Aadhaar ID appear in these boxes. Please enter the mobile number of the patient or person on which they would like to receive SMS alerts related to this hospitalization episode. In case the person does not have but has applied for Aadhaar Card and has Aadhaar EID, please enter this EID in the appropriate box. Press on the Submit button and a TID will be generated as shown below. You may like to not this TID for future reference. N.B. After having successfully generated the TID for the patient, you can now book packages for this patient by filling the Pre-Authorization Request Form. This TID will not be visible in Case Status Tracker until and unless packages are booked for this TID using Pre-Authorization Request Form. Once you have filled and successfully submitted the Pre- Authorization Request Form, you will be able to see this TID in Case Status Tracker. 5. Emergency Admission: If you choose Admission Type as Emergency, follow the following steps for generating a TID for the patient admitted in emergency and later normalize such a case using Emergency Case Conversion Form as described in a later chapter. i. Choose Emergency from the drop-down menu of Admission Type and the following screen appears: Page 15 of 42

16 ii. A patient can be admitted in emergency either accompanied or not by a person who can identify the patient. If the patient in emergency can be identified by another person, click on the Identified radio button and fill in Patient Details and in case it is an MLC, choose the category of MLC from the drop-down menu as shown below. iii. Thereafter, enter the details of the person identifying the patient and press on Submit button and a TID no. will be generated for the patient. Please note this TID for use in future in Emergency Case Conversion Form. iv. In case a patient has been admitted in emergency and his / her identity cannot be established whether through himself / herself or by any other person, click on the Unidentified radio button and the following screen appears: Page 16 of 42

17 v. Fill up this form and click on Submit button and a TID no. will be generated for the patient. Please note this TID for use in future in Emergency Case Conversion Form. Page 17 of 42

18 Emergency Case Conversion N.B.: This form is to be used only in those cases where a TID was generated for an emergency while using the Admission Type as Emergency from the drop-down menu in Beneficiary Identification Form. This form is not to be filled in case Admission Type was selected as Normal in Beneficiary Identification Form. 1. Click on the Emergency Case Conversion link under Quick Links on the left side of the screen. The following screen appears. 2. A TID no. was generated on submission of Beneficiary Identification Form after selecting Admission Type as Emergency. Enter that TID no. in the TID box provided on this screen and click on any part of the screen outside the TID box. The name of the patient gets populate as shown below: 3. Click on the Radio Button for the Identity Type as you do in Beneficiary Identification Form - whether Bhamashah Family ID or Ration Card or Aadhaar Card or MOIC as shown below: Page 18 of 42

19 4. Click on Search Beneficiary button after having entered the ID no. in the text box and the following screen appears: 5. You must be familiar with this screen that is a common feature when you use Admission Type as Normal in Beneficiary Identification Form. 6. Follow further steps as described in Beneficiary Identification Form. N.B.: After having filled the Emergency Case Conversion Form, you may proceed to fill the Pre- Authorization Request Form Page 19 of 42

20 Pre-Authorization Request Form N.B.: Pre-Authorization Request Form can only be filled after a TID has been successfully generated on successful submission of Beneficiary Identification Form. In case of Normal admissions using Beneficiary Identification Form, once the TID has been generated, the Pre-Authorization Request Form for that TID can be filled. In case of Emergency admissions using Beneficiary Identification Form, once the TID has been generated in an emergency, entitlement of the patient under BSBY needs to be established using Emergency Case Conversion Form and only after this form is filled and successfully submitted can the Pre-Authorization Request Form be filled for this TID. 1. Click on the Pre-Authorization Request Form link under Quick Links on the left side of the screen. The following screen appears. 1. Type or paste the TID in the box for TID provided on this screen. 2. Click on any part outside the TID box. 2. If the TID has been successfully generated on submission of Beneficiary Identification Form, the name of the patient gets auto-populated. 3. You can check the balance amount available in the patient s wallet separately for Secondary (including Government) packages and for Tertiary packages. Page 20 of 42

21 4. The package code for the treatment of the patient must already have been specified by the treating doctor. Click on the radio button Package Code and a textbox appears. You can now start entering the package code in this box and you can see the package codes appear as a drop-down as you proceed typing the code. 5. Click on the Package Code that you want for this TID. 6. Click on the Add Package button to the right of the textbox. You will notice that the package details appear below Package Code, Package Name, Package Category and Package Rate. 7. In case you want to book more packages for this TID, you can do so following the steps described earlier and as shown below: Page 21 of 42

22 8. You can add any number of packages for this TID in this manner. However, please follow guidelines of M&H Dept regarding booking number of packages for a particular TID. 9. In the picture, you can note that the total of packages appears separately for Secondary packages and for Tertiary packages. 10. If you realize you have added a wrong package, you have the option of deleting the package by pressing on the delete / trash button under the heading Delete Record on the extreme right in the row of the package. 11. Wallet: Compare the total rates of packages selected by you with the amount available in patient s wallet. In case the total amount of packages selected by you exceeds the amount available in patient s wallet, you may like to review the situation and delete one or more packages, otherwise the case will go for fund enhancement. N.B.: For additional information on Fund Enhancement, please refer to guidelines issued by M&H Dept. 12. Capturing photograph using web camera: Providing photograph of patient in BSBY software is mandatory. There are two options available for this capturing photograph using web camera or uploading photograph saved in PDF file. N.B.: Please follow guidelines of M&H Dept regarding capturing or uploading photograph. For capturing photograph of patient through the web camera, follow the following steps: i. In the box opposite Patient Photograph there is a dialogue box which has two options Allow and Deny. Click on the Allow button to allow the web camera to take the Page 22 of 42

23 photograph. On clicking the Allow button, adjust the direction of the web camera in such a way that you can have a view of the patient as shown below : ii. Click on the Capture button and you will see a frozen frame with captured photograph of the patient in the box on the right as shown in the picture below: iii. iv. If you observe that the photograph of the patient that has been captured is blurred or not proper, please repeat the process as described above. Uploading photograph in PDF format: An option of uploading photograph of patient as a PDF file has been provided in this form under the Report Document Type heading as shown below: Page 23 of 42

24 v. Select the option prepatientphoto from the drop-down menu under the heading Report Document Type in this form and for uploading the photo of patient in PDF format, please follow the steps as described in the next section of this Chapter. 13. Uploading Doctor s Prescription: Uploading doctor s prescription is a mandatory field in this form. For uploading doctor s prescription, please follow the following steps: i. In the box opposite Doctor s Prescription, click on the Choose button to select an already scanned copy of the prescription in PDF format: ii. Having selected the file, click on Upload button for uploading the document and on successfully uploading the document, you get the message PDF Uploaded Successfully. 14. Attaching Documents: N.B.: Pre-Authorization Request Form is a common form for booking packages for TIDs be it Secondary packages or Government Packages or Tertiary Packages. In case of Tertiary Packages, following successful submission of Pre-Authorization Request Form, the matter is submitted to the Insurance Agency for authorizing / granting approval for initiating treatment of the patient. For this reason mentioned in the box above, you might consider it necessary to attach documents (like investigation reports or past treatment records of the patient) in Pre-Authorization Request Form. You can attach relevant documents using the Report Document Upload menu towards the bottom of Pre-Authorization Request Form. 15. For attaching the documents, please follow the following steps: i. Click on the drop-down menu of Report Document Type as shown below: Page 24 of 42

25 ii. Select the document type from the menu an example has been shown for Electrocardiograph (ECG). You must have an already scanned copy of the document available on your computer ready for uploading. Click on Choose button to select the document and select it. iii. Then click on Upload button to attach the document and note that a message appears Document Attached Successfully. Till this time, the document is not uploaded into the software it has only been attached. Under Report Document Name, it still shows No records found indicating that the document has been attached successfully, but has not yet been uploaded. iv. You have the option of writing brief remarks with regard to the report that you are uploading into the software though this is not mandatory. Click on the Insert Details button on the right and you will see that the document has been uploaded into the software and appears under the section Attach Documents for Claim Submission. Under the Report Type you can see the name of the document and if the document has been uploaded successfully, you will see SUCCESS written under the heading Upload Status. If you have typed something in the Enter Remarks textbox, it appears under the heading Remarks. Page 25 of 42

26 v. This way, you can successfully upload any number of documents in Pre-Authorization Request Form one document at a time. It may also be noted that the document(s) to be attached here must be PDF files, not more than 250 KB in size. vi. Please note that on the extreme right in the picture shown under point 15(iv) is an Action button with sign of trash / delete. In case you realize you have uploaded the wrong document, you may click on the delete icon under the heading Action to delete the document. 16. Press on the submit button and if all requirements have been met and no errors have been committed, you will get the message Your Pre-Authorization Request submitted successfully. After successful generation of a TID, the case does not reflect in the Case Status Tracker until and unless some package(s) is (are) booked for that TID. From this point onwards, after you have successfully submitted the Pre-Authorization Request From, this TID will start showing in the Case Status Tracker. N.B.: On successful submission of Pre-Authorization Request Form, the status will be as follows for different circumstances: i. In case of Secondary / Government Packages where there are adequate funds in beneficiary s wallet, the status will be Pre-Authorization Approved. You will be able to successfully fill Patient Admission Form for this TID. ii. In case of Secondary / Government Packages where there are inadequate funds in beneficiary s wallet, the status will be Fund Enhancement Approval Pending. You will not be able to fill Patient Admission Form for this TID until and unless additional funds are allocated by CEO, SHAA for this TID from the corpus of Rs crore. Once Fund Enhancement Approval is granted and additional funds are allocated, the status will change to Pre-Authorization Approved and you will be able to then successfully fill Patient Admission Form for this TID. iii. In case of Tertiary Packages, the matter goes to Insurance Agency for Pre-Authorization and the status will be Pre-Auth Approval Pending. Once the Insurance Agency approves the preauth request, the status will change to Pre-Authorization Approved and you will be able to then successfully fill Patient Admission Form for this TID. Page 26 of 42

27 Patient Admission Form N.B.: You can fill the Patient Admission Form only if that TID is in Pre-Authorization Approved status. If a particular TID is in Pre-Authorization Pending status or Fund Enhancement Approval Pending status, you will not be able to fill the Patient Admission Form for this TID. 1. Click on the Patient Admission Form link under Quick Links on the left side of the screen. The following screen appears. 2. Type or paste the TID in the box for TID provided on this screen. 3. Click on any part outside the TID box. 4. If the case status for this TID is Pre-Authorization approved, the name of the patient gets autopopulated. 5. Please enter the date of admission for the patient. 6. Once the date of admission has been filled, please fill the time of admission of this patient. 7. MRD No.: This is a non-mandatory field. This is not relevant for private hospitals and they may leave it blank. This is also not relevant for those government hospitals that do not have a functional Aarogya Online system of patient registration. This field is relevant only for those government hospitals that have a functional Aarogya Online system of patient registration. The MRD No. generated through Aarogya Online system needs to be entered in this field by only by those government hospitals that have a functional Aarogya Online system. 8. After having filled the Patient Admission Form, click on the Submit button and the data will be saved. Once the Patient Admission Form has been successfully submitted, the Date and Time of Admission of the patient are visible in Case Status Tracker for that TID. Page 27 of 42

28 TID Cancellation / Edit Form It is important to note that you can Cancel or Edit a TID only if you have selected packages and have not submitted claims for that TID. Once you have submitted claims for that TID, you won t be able to edit the TID. 1. Kindly note the TID no. that you want to edit. 2. In the Quick Links, click on TID_Cancellation_Form and the TID Edit Form opens. 3. Type the TID no. (that you want to edit) in the space for TID on this Form. Alternatively, you may copy the TID from Case Status Tracker Form or from Report Summary and paste the TID in the box in TID_Cancellation_Form or TID Edit Form. 4. After you have typed or pasted the TID no., click the cursor on any part of the screen outside the TID box. 5. Patient s details appear on the screen name, Beneficiary Entitlement Type, Hospital Code, Hospital Name, (Balance) Wallet Details and details of package booked for the patient as shown below. 6. Scroll down and you will see the Submit button. Press this Submit button in case you want to Edit the TID. 7. On pressing the Submit button, you get a Confirmation Message asking you Do you want to edit TID? In case you don t want to edit, press No. Page 28 of 42

29 8. In case you want to edit the TID, press Yes. 9. On pressing Yes a new TID is generated and message appears on the screen which reads Please Note Your TID. Note this TID for all future reference this is the new TID generated in lieu of the older TID that you cancelled / edited. Please note that this is work in progress at present, the new TID is not available in the message. We are working on this and the new TID will soon be available by mid-march 2016 at this place. 10. Please do not click on OK button at this moment since the TID (the new TID generated in lieu of the older TID) is not visible along with the message. Once the TID starts appearing along with this message in this box, you may note the new TID and press OK that can be done only after the new TID is visible in this box. Until such time that the new TID no. is available in the box shown in the previous picture, please do not press on the ok button. 11. Using the vertical bar on the right side of the screen, scroll to the top of the screen. 12. You will see the displayed message Your Request Submitted Successfully. Please Note HRNID T. 13. Note down this number this is the new TID that has been generated in lieu of the older TID which has been deleted. Please Note: The new TID has been generated and the data related to older TID has been retained within the software you have the option of re-entering (or not) the data that has already been generated for the older TID. You need not fill again the Beneficiary Identification Form for this TID. Page 29 of 42

30 14. Now that the new TID has been generated, you may like to book changed packages for this patient within the software. Go to the Pre-Authorization Request Form and paste or type the new TID in the appropriate box and you get the name of the patient. 15. Go ahead and book new packages for this TID. N.B.: This additional feature has been incorporated in BSBY (Bhamashah Swasthya Bima Yojana) software based on request from Medical & Health Department consequent upon requests obtained from hospitals. Page 30 of 42

31 Patient Discharge and Claim Submission Form N.B.: You can fill the Patient Discharge and Claim Submission Form only if that TID is in Pre- Authorization Approved status and Patient Admission Form has been filled and successfully submitted. 1. Click on the Patient Discharge and Claim Submission link under Quick Links on the left side of the screen. The following screen appears. 2. Type or paste the TID in the box for TID provided on this screen. 3. Click on any part outside the TID box. 4. The name of the patient and the date and time of admission get auto-populated on the screen. 5. Please enter the date of discharge for the patient. 6. Once the date of discharge has been filled, please fill the time of discharge of this patient. 7. Click on the drop-down menu for Patient Discharge Status and select the appropriate category of discharge. 8. Capture patient s photograph please follow guidelines of M&H Dept for this. For capturing photograph of patient through web camera, please follow the steps described in Pre-Authorization Request Form. Page 31 of 42

32 9. Attaching documents is necessary for successfully submitting the Patient Discharge and Claim Submission Form. Attach relevant documents as per directives of M&H Dept using the Report Document Upload menu towards the bottom of Patient Discharge and Claim Submission Form. 10. For attaching the documents, please follow the following steps: a. Click on the drop-down menu of Report Document Type as shown below: b. Select the document type from the menu an example has been shown for Detailed Discharge Summary. You must have an already scanned copy of the document available on your computer ready for uploading. Click on Choose button to select the document and select it. c. Then click on Upload button to attach the document and note that a message appears Document Attached Successfully. Till this time, the document is not uploaded into the software it has only been attached. d. You have the option of writing brief remarks with regard to the report that you are uploading into the software though this is not mandatory. Click on the Insert Details button on the right and you will see that the document has been uploaded into the software and appears under the section Attach Documents for Claim Submission. Under the Report Type you can see the name of the document and if the Page 32 of 42

33 document has been uploaded successfully, you will see SUCCESS written under the heading Upload Status. If you have typed something in the Enter Remarks textbox, it appears under the heading Remarks. e. This way, you can successfully upload any number of documents in Patient Discharge and Claim Submission Form one document at a time. It may also be noted that the document(s) to be attached here must be PDF files, not more than 250 KB in size. f. Please note that on the extreme right in the picture shown under point 10(iv) is an Action button with sign of trash / delete. In case you realize you have uploaded the wrong document, you may click on the delete icon under the heading Action to delete the document. 11. After you have followed the above steps and have uploaded the relevant documents, you may press the Submit button and if it is successfully submitted, you will get a message. In case it has not been successfully submitted and an error message appears, please take action to address that error. N.B.: Once the Patient Discharge and Claim Submission Form has been successfully submitted, the Date and Time of Discharge of the patient are visible in Case Status Tracker and the case status for that TID changes to Claim Approval Pending. Page 33 of 42

34 Query Panel 1. Queries to hospitals in BSBY Software application may be related to three situations as follows: 1. Related to Claims (Claim Package Queried) 2. Related to Pre-Authorization (PreAuth Package Query) 3. Related to Fund Enhancement (Fund Enhancement Package Query) 2. For finding out the Query related to your hospital, please click on the reportsummary quick link on the left side of your hospital s screen of BSBY Application. When the reportsummary link opens, click on the claimpackagequery or preauthpackagequery or fundenhancementquery, as the case might be and you will get the list of TIDs for which queries under that category have been raised: 3. You will be able to see the list of TIDs for which there is a query under the respective head as follows: 4. Copy the TID for which you want to see the Query and for which you want to submit reply: Page 34 of 42

35 5. Click on Query Panel in Quick Links on left side of the screen of your hospital for BSBY Software Application. Paste the TID that you had copied from the reportsummary the TID for which there is a query (as identified in Step 4). After pasting / typing the TID, click on any part of the screen and you will see all fields get auto-populated on the screen. 6. Scroll the horizontal bar to the right and you will be able to see the status as claimpackagequery : 7. On the extreme right you will be able to see the query that has been posted for your hospital: Page 35 of 42

36 8. Having noted the query in the Query Panel, you may now go ahead with replying to the query by attaching the documents in a single PDF file or a zip folder of size not more than 1 MB. You may also like to type remarks in the textbox titled Remarks prior to pressing the Submit button. N.B.: Once you have replied to the query through the Query Panel, the query will no longer be visible in the Query Panel of your hospital and the status available in Case Status Tracker for this TID will be queryreplybyhospital. Page 36 of 42

37 Case Status Tracker You are encouraged to use the Case Status Tracker for finding out the status of a TID. Alternatively, you may go to the reportsummary page and get the list of TIDs under different case statuses like Pre-Auth Approved, Claim Approval Pending, Claim Package Approved, Fund Enhancement Pending, etc. 1. Click on the Case Status Tracker link under Quick Links on the left side of the screen. The following screen appears. 2. You have the option of using the following search criteria for searching a TID in the Case Status Tracker: i. TID searching using a TID ii. Select Package searching by type of package Secondary or Tertiary or All iii. Case Status searching by the status of different TIDs Page 37 of 42

38 3. TID searching using a TID i. Type a TID in the Textbox provided for it; or paste the TID if you have already copied it from somewhere else. ii. Then click on Search Criteria button. You will get this TID summary as shown below: iii. You may then click over the TID no. marked in the Red box under and some details for this TID appear as shown below: iv. The details available are TID No., Name of Patient, Case Type, Hospital Name, Hospital Type, Identity Type and No., Admission Date, Discharge Date, Package(s) booked for this TID, Package Rate(s), Wallet Details and Package Status. In addition, you can also view the query raised related to that TID under Package Remarks or the reason for rejection. N.B.: The feature of Package Remarks has been added for your convenience and shows the latest query or reason for rejection for this TID (as applicable). If there is a remark under the Package Remarks box and the status is queryreplybyhospital, etc., you need not worry. Please give priority to Package Status over Package Remarks in the Case Status Tracker. Page 38 of 42

39 4. Searching by Type of Package i. From the drop-down menu as shown below, you can filter the TIDs based on the type of package as shown below: ii. In case you want to select TIDs for which Tertiary packages have been selected, please select Tertiary from the drop-down menu and click on Search Criterion. You will get the list of TIDs for which Tertiary packages have been booked by your hospital: iii. In case you want to select only TIDs for which Secondary packages have been selected, please select Secondary from the drop-down menu and click on Search Criterion. You will get the list of TIDs for which Secondary packages have been booked by your hospital: 5. Searching by Status of TID You can refine your search by the status of TID: i. As an example, if you want to get the list of TIDs for which you have queries to the claims submitted by your hospital, click on the drop-down menu of Case Status and select the status Claim Package Queried and press the Select Criteria button. ii. You will get the list of TIDs for which Claim Package Query has been raised. Page 39 of 42

40 iii. Alternatively, you may use the reportsummary page under Quick Links of your screen and get the list of TIDs for which Claim Package Query has been raised. 6. By default, the Case Status Tracker screen is designed to show 20 TIDs in one page. In case you want to see more TIDs in one page, please follow the following steps: i. On the lower part of this screen, please note 20 in the box along with a drop-down arrow as shown in the red box in above picture and select the number of TIDs you would like to see in one page. Click on that number and allow some time for the system to load the data on the page you will get those many TIDs on a single page. Page 40 of 42

41 Report Summary Report Summary provides a snapshot of the packages booked by the hospital and the status of those packages. This feature has been added in the software to facilitate the work of hospitals for BSBY. You are encouraged to use the Report Summary for finding out a summary of the performance of the hospital under BSBY. It provides you the live list of packages (and amounts) under different statuses. You may use the reportsummary page to get the list of TIDs under different case statuses like Pre- Auth Approved, Claim Approval Pending, Claim Package Approved, Fund Enhancement Pending, etc. 1. Click on the Case Status Tracker link under Quick Links on the left side of the screen. The following screen appears: 2. You can see the summary for this hospital in a snapshot. It shows that a total of 92 packages have been booked by this hospital, amounting to a total of Rs. 2,87,150. Out of these, there is a Claim Package Query for 21 packages, amounting to a total of Rs. 29,000 and so on. 3. In case you want to get the list of TIDs under different case statuses, click on that status under Pkg Status as shown in the red box in the picture above. On clicking on claimpackage Query, you get the list of TIDs with this status as shown below: Page 41 of 42

42 4. By default, the Report Summary screen is designed to show 20 TIDs in one page. In case you want to see more TIDs in one page, please follow the following steps: i. On the upper part of this screen, please note 20 in the box along with a drop-down arrow as shown in the red box in the picture under point 3 and select the number of TIDs you would like to see in one page. Click on that number and allow some time for the system to load the data on the page you will get those many TIDs on a single page. 5. You can download a PDF file of this report on your computer by clicking upon the link provided for download towards the bottom of the screen as shown in the blue box in the picture above. Alternatively, you can select the portion and copy these TIDs in a file at your end. Page 42 of 42