1

Hkkek'kkg LokLF; chek ;kstuk

fn'kk funsZ'k

,oa

lkW¶Vos;j ;wtj xkbZM

Hkkek'kkg LokLF; chek ;kstuk

jktLFkku LVsV gsYFk ,';ksjsUl ,tsUlh

2

Hkkek'kkg LokLF; chek ;kstuk

v- ;kstuk ls lEcfU/kr fn'kk funsZ'k

1. izLrkouk% 4

2. ;kstuk ds eq[; mn~ns'; ,oa y{; 4

3. ;kstuk ds ik= ykHkkFkhZ 4

4. ;kstuk doj@ykHk 6

5. dkWilZ Q.M 6

6. ykHkkFkhZ dks ;kstuk dk ykHk ikus gsrq vko’;d nLrkost 6

7. chek ds vUrxZr nh tkus okyh lqfo/kk,¡ 6

8. ;kstuk ds vUrxZr lsok iznkrk 8

9. futh fpfdRlk laLFkkuksa dks lwphc+) djuk 8

10. f'kdk;r fuokj.k 9

11. ;kstuk dk fØ;kUo;u ¼vkbZ Vh IysVQkWeZ ds ek/;e ls½ 10

12. LokLF; ekxZn'kZd 11

i. LokLF; ekxZn'kZd dh U;wure 'kS{kf.kd ;ksX;rk 11

ii. LokLF; ekxZn'kZdksa dh la[;k ds ekin.M 11

iii. LokLF; ekxZn'kZd dk ekuns;A 11

iv. LokLF; ekxZn'kZd ds dk;Z 11

c- lkW¶Vos;j ;wtj xkbZM

I. LokLF; ekxZn'kZd ds fy, lkW¶Vos;j ,Iyhds'ku ;wtj xkbZM 14

II. Beneficiary Identification Form 16

A. ejht ds ifjokj ds ykHkkFkhZ gksus dh igpku rFkk ejht dh igpku 16

i Hkkek'kkg dkMZ ls 17

ii ifjokj ds jk'ku dkMZ ls 18

iii vk/kkj dkMZ ls 19

iv MOIC Route ls 20

B. ejht dh igpku lqfuf'pr djuk 22

C. Emergency Admision 25

III. Emergency Case Conversion 27

IV. Pre Authorization Request Form 29

V. Fund Enhancement 32

VI. ejht dh QksVks ysuk 34

VII. nLrkost viyksM djuk 36

VIII. Patient Admission Form 39

IX. TID Cancellation / Edit Form 40

X. Patient Discharge and Claim Submission Form 43

XI. Query Panel 47

XII. Case Status Tracker 49

XIII. Report summery 53

3

Hkkek'kkg LokLF; chek ;kstuk

fn'kk funsZ'k

4

1. izLrkouk%

jkT; ds xjhc vkSj oafpr turk dks xq.koÙkkiw.kZ lewfpr LokLF; lsok fu%'kqYd miyC/k djk;s tkus

ds mn~ns'; ls ekuuh; eq[;ea=h egksn;k }kjk o"kZ 2014&15 dh ctV esa fuEukuqlkj ?kks"k.kk dh

xbZ%&

“...........;g vko';d gS fd insurance ds ek/;e ls jkT; dh xjhc vkSj oafpr turk dks futh

vLirkyksa esa Hkh mipkj dh lqfo/kk miyC/k djokbZ tk;sA vr% eSa jkT; esa [kk| lqj{kk vf/kfu;e ds

varxZr ik= lHkh ifjokjksa ds fy, LokLF; chek ;kstuk ykxw djus dh ?kks"k.kk djrh gw¡A bl ;kstuk dk

ykHk Hkkek'kkg dkMZ feyus ds lkFk lkFk feyus yxsxkA bl ;kstuk ds varxZr jkT; ds yxHkx 67

izfr'kr ifjokj ykHkkfUor gks ldsaxs vkSj ;s jktdh; vkSj accredited futh vLirkyksa esa Indoor

patient ds :i esa Hkh viuk mipkj djk ldsaxsA lkekU; chekfj;ksa ds fy, izfr ifjokj 30 gtkj #i;s

rFkk fpfUgr xaHkhj chekfj;ksa ds fy, 3 yk[k #i;s rd dk insurance coverage gksxkA ,sls ifjokjksa dks

OPD jksxh ds :i esa fu%'kqYd nok;sa vkSj tk¡p dh lqfo/kk,sa Hkh iwoZ dh HkkWfr feyrh jgsxhA“

?kks"k.kk dh vuqikyuk esa jkT; ds xjhc vkSj oafpr turk dks xq.koÙkkiw.kZ lewfpr LokLF; lsok fu%'kqYd

miyC/k djkus gsrq Hkkek’kkg LokLF; chek ;kstuk 13 fnlEcj] 2015 ls ykxw dh xbZA

2. ;kstuk ds eq[; mn~ns'; ,oa y{; %&

i. jktLFkku dh turk ds }kjk LokLF; ij fd;s tk jgs [kpZ dks de djukA

ii. jktLFkku ljdkj ds fpfdRlk ij O;; dks chek ds ek/;e ls jf{kr djukA

iii. xjhc O;fDr ds mPp futh fpfdRlky;ksa esa Hkh lqfo/kk izkIr djus ds volj c<+kukA

iv. jktLFkku dh turk ds LokLF; esa vko';d lq/kkj ykukA

v. jktLFkku esa LokLF; ds {ks= esa ,d ubZ ØkfUr dk lapkj djuk rFkk bl ;kstuk ds ek/;e ls

futh fpfdRlk laLFkkuksa dks Hkh lqnwj xzkeh.k {ks=ksa esa igqWpdj xq.koÙkkiw.kZ lsok eqgS;k djokus gsrq

izsfjr djukA

vi. ljdkjh laLFkkuksa ds lqn`<+hdj.k esa lg;ksx iznku djukA

vii. LokLF; ds {ks= esa egRoiw.kZ uhfrxr fu.kZ;ksa gsrq MsVkcsl rS;kj djukA

3. ;kstuk ds ykHkkFkhZ &

i. Hkkek'kkg LokLF; chek ;kstuk ds vUrxZr flQZ jktLFkku dh turk dks gh ykHk izkIr gksxkA

;kstuk ds vUrxZr jktLFkku jkT; ds jk"Vªh; [kk| lqj{kk vf/kfu;e ¼NFSA½ o jk"Vªh; LokLF;

chek ;kstuk ¼RSBY½ esa vkus okys ik= ifjokjksa dks gh bldk ykHk fn;k tk,xkA

ii. blds vUrxZr jkT; ds yxHkx ,d djksM+ ifjokj ykHkkfUor gksaxsA

iii. ;kstukUrxZr vkus okys ykHkkFkhZ ds ikl Hkkek'kkg dkMZ gksuk okaNuh; gSA Hkkek'kkg dkMZ uk gksus

dh fLFkfr esa chek ykHk NFSA vFkok RSBY ls lacaf/kr igpku nLrkost izLrqr djus ij Hkh fn;k

tk ldsxkA

iv. ;kstuk ds vuqlkj ykHkkFkhZ ifjokj dh ifjHkk"kk ds vUrxZr ykHkkFkhZ ifjokj ds eqf[k;k ds jk’ku

dkMZ@Hkkek’kkg dkMZ esa vafdr ifjokj ds lHkh lnL; vkrs gSaA

v. NFSA ykHkkfFkZ;ksa dh igpku dEI;wVj lkW¶Vos;j ls dh tk;sxhA lkW¶Vos;j ls izekf.kr u gksus

dh fLFkfr esa LokLF; ekxZn'kZd }kjk jksxh ds NFSA ;k RSBY ls lEcfU/kr nLrkostksa ;Fkk

jk"Vªh; [kk| lqj{kk vf/kfu;e ds vUrxZr tkjh jk'ku dkMZ vFkok RSBY dkMZ dh dkWih ,oa

5

MOIC }kjk lR;kfir ljdkjh vFkok v)Z ljdkjh laLFkkvksa }kjk izekf.kr QksVks igpku i= tSls

¼oksVj vkbZMh@MªkbZfoax ykbZlsal@vk/kkj dkMZ@iSu dkMZ@dksbZ vU; igpku i=½ dks Ldsuj ds

ek/;e ls lk¶Vos;j esa viyksM+ djsxkA

vi. lkW¶Vos;j ls izekf.kr u gksus dh fLFkfr esa LokLF; ekxZn'kZd jk'ku dkMZ ls ;g lqfuf'pr djsxk

fd ykHkkFkhZ us vDVwcj] 2015 ls [kk|ku izkIr fd;k gS D;ksafd vDVwcj] 2015 ;k mlds ckn

jk'ku dkMZ ls xsgw`Wa dsoy jk"Vªh; [kk| lqj{kk vf/kfu;e ¼NFSA½ ds vUrxZr ykHkkFkhZ ifjokjksa dks

gh fn;k tkrk gS vr% ;fn fdlh ifjokj us vDVwcj] 2015 ;k mlds ckn jk'ku dkMZ ls xsgw`Wa

fy;k gS] rks mls NFSA dk ykHkkFkhZ ekuk tk;sxkA ;g izekf.kr gksus ij jk'kudkMZ dh izekf.kr

Nk;kizfr ¼rhu i"B igyk eq[; i"B ftl ij eqf[k;k dk QksVks yxk gks] nwljk vfUre i`"B ftl

ij ifjokj dk fooj.k gS] rFkk rhljk ftl ij xsgw`Wa ysus dk fooj.k vafdr gks½ lkW¶Vos;j esa

viyksM dj vkSj mls NFSA dk ykHkkFkhZ eku dj mls ;kstuk dk ykHk iznku fd;k tk;sxkA

;gka ;g /;ku j[kk tkuk pkfg, fd jk’kudkMZ ds xsgw`Wa ysus okys i`"B rFkk vfUre i`"B ij Hkh

jk’kudkMZ dk uEcj fy[kk tkosA

jk'ku dkMZ esa uke ntZ uk gksus dh fLFkfr esa nks rjg ds yksxksa dks ykHk %&

i. 'kknh ds ckn ifjokj esa vkbZ L=h dk uke jk’ku dkMZ esa uk gksus ¼ifr dk uke jk’ku dkMZ esa

gksuk pkfg,½ dh fLFkfr esa esMhdy vkWQhlj bapktZ lacaf/kr ykHkkFkhZ dk lR;kiu dj mlds QkWVks

igpku i= dks SOFTWARE esa viyksM dj ykHkkFkhZ dks ;kstuk dk ykHk iznku djsxkA ;fn

fdlh cPps dk QksVks igpku i= miyC/k ugha gS] rks eka vFkok cki dh QksVks vkbZ Mh yxkbZ tkos]

ijUrq ml fLFkfr esa MOIC dks QksVks vkbZ Mh ij izekf.kr dj fy[kuk gksxk fd cPps dh QksVks

vkbZ Mh miyC/k ugha gksus ij eka&cki dh izekf.kr QksVks vkbZ Mh yxkbZ tk jgh gSA

ii. ;fn fdlh cPps dk QksVks igpku i= miyC/k ugha gS] rks eka vFkok cki dh QksVks vkbZ Mh yxkbZ

tk ldrh gS ijUrq ml fLFkfr esa MOIC dks QksVks vkbZ Mh ij izekf.kr dj fy[kuk gksxk fd

cPps dh QksVks vkbZ Mh miyC/k ugha gksus ij eka cki dh izekf.kr QksVks vkbZ Mh yxkbZ tk jgh

gSA

iii. ;fn fdlh cPps dk QksVks igpku i= miyC/k ugha gS] rks eka vFkok cki dh QksVks vkbZ Mh yxkbZ

tk ldrh gS ijUrq ml fLFkfr esa MOIC dks QksVks vkbZ Mh ij izekf.kr dj fy[kuk gksxk fd

cPps dh QksVks vkbZ Mh miyC/k ugha gksus ij eka cki dh izekf.kr QksVks vkbZ Mh yxkbZ tk jgh

gSA

iv. ifjokj esa tUes cPps dk uke jk’ku dkMZ esa ntZ uk gksus dh fLFkfr esa cPps dk tUe izek.k i=

;k Ldwy dk QksVks igpku i= ftl ij ekrk ;k firk dk uke vafdr gks ;k u;s tUes cPps dh

fLFkfr esa ekrk ;k firk dk QksVks igpku i= MOIC ROUTE ls viyksM dj cPps dk uke

BABY OF ( ekrk@firk dk uke ) fy[k dj SOFTWARE esa ntZ djsaxsA

4. ;kstuk doj@ykHk &

i. ik= ifjokjksa dks lkekU; chekfj;ksa ds fy, izfr ifjokj izfr o"kZ rhl gtkj :i;s rFkk fpfUgr

xaHkhj chekfj;ksa ds fy, rhu yk[k :i;s rd dk chek doj gksxkA

ii. bl ;kstuk ds vUrxZr ykHkkFkhZ dks orZeku esa 432 jktdh; fpfdRlk laLFkkuksa rFkk lwphc) 453

futh fpfdRlky;ksa ds ek/;e ls LokLF; lqfo/kk,¡ iznku dh tk jgh gSa

iii. bl ;kstuk ds rgr leLr lqfo/kk,¡ iw.kZr% dS'kysl gksxhA

iv. chfer ifjokj ds lHkh lnL;ksa dh chek ls iwoZ dh Hkh leLr chekfj;k¡ doj gksxhA

6

v. o"kZ dh lekfIr ij miyC/k doj esa ls mi;ksx esa u ykbZ xbZ jkf'k Lor% fujLr gks tk;sxhA

vi. ;kstukUrxZr vLirky esa HkrhZ fd;s tkus ls iwoZ lkr fnu rFkk vLirky ls NqV~Vh ds 15 fnu ds

i'pkr~ dh fpfdRlk doj gksxhA

vii. ;kstukUrxZr ân; jksx rFkk vR;f/kd vk?kkr ¼Poly-trauma) dh fLFkfr esa ;k=k HkÙkk dk Hkh

izko/kku gSA ;g HkÙkk izfr fMLpktZ 100@& :- gS tks o"kZ esa vf/kdre 500@& :- dh lhek rd

izfro"kZ izfr ifjokj fn;k tk ldsxkA

viii. ftu chekfj;ksa esa jksxh dks dqN le; rd HkrhZ djus dh vko’;drk gS] fdUrq os fMtht iSdst

fyLV esa 'kkfey ugha gSa] mu lwphc) chekfj;ksa ¼'kY; fpfdRlk ds vfrfjDr½ ds fy, tujy

okMZ ^vuLisflQkbZM* ¼Unspecified½ vFkok vkbZ-lh-;w- iSdst dk izko/kku gSA bl gsrq tujy okMZ

ds vUrxZr 750 :- rFkk vkbZ-lh-;w- ds vUrxZr 1500 :- izfrfnu ns; gksxkA izfrfnu ds iSdst esa

24 ?kUVs vLirky esa :duk vko';d gSA

5. dkWilZ Q.M &

i. bl ;kstuk esa vfrfjDr dkWilZ Q.M ds :i esa 10 djksM+ jkf'k dk izko/kku gSA

ii. bl jkf'k dk mi;ksx ykHkkFkhZ dh lEiw.kZ chek jkf'k lekIr gks tkus vFkok vko';d bykt esa

jkf'k de iM+ tkus dh fLFkfr esa jktLFkku LVsV gsYFk ,’;ksjsla ,tsUlh (SHAA) ls vuqeksnu ds

mijkUr fd;k tk ldrk gSA

iii. Fund Enhancement ds fy, d`Ik;k ifjf’k"V&1 nsa[ksa (LINK)

6. ykHkkFkhZ dks ;kstuk dk ykHk ikus gsrq vko’;d nLrkost %&

ifjokj dh eqf[k;k dk Hkkek’kkg dkMZ vFkok Hkkek'kkg dkMZ ds lkr v{kjksa dk uacj tks vaxzsth

ds dSfiVy v{kjksa esa gksrk gS vFkok

RSBY dkMZ A

jk"Vªh; [kk| lqj{kk vf/kfu;e ¼NFSA½ ds vUrxZr ifjokj dk cuk gqvk jk’ku dkMZ vFkok

jk’ku dkMZ ds 12 vadkas dk uEcjA

pwafd vDVwcj] 2015 ;k mlds ckn jk'ku dkMZ ls xsgwWa dsoy jk"Vªh; [kk| lqj{kk vf/kfu;e

¼NFSA½ ds vUrxZr ykHkkFkhZ ifjokjksa dks gh fn;k tkrk gS vr% ;fn fdlh ifjokj us vDVwcj]

2015 ;k mlds ckn jk'ku dkMZ ls xsgwWa fy;k gS] rks ,sls izdj.kksa esa jk'ku dkMZ vko’;d :i

ls lkFk ykuk gksxkA

vFkok

jk'ku dkMZ ls xsgwWa ugha ysus dh fLFkfr esa ;fn lEcf/kr jk’ku Mhyj ls jk"Vªh; [kk| lqj{kk

vf/kfu;e ¼NFSA½ ds vUrxZr ykHkkFkhZ gksus dh izekf.kr lwph ysdj vkuh gksxhA

ejht dk vk/kkj dkMZA vFkok

ljdkjh vFkok v)Z ljdkjh laLFkkvksa }kjk izekf.kr QksVks igpku i= tSls ¼oksVj

vkbZMh@MªkbZfoax ykbZlsal@vk/kkj dkMZ@iSu dkMZ@dksbZ vU; igpku i=½

7. chek ds vUrxZr nh tkus okyh lqfo/kk,¡

i. ;g ;kstuk lEiw.kZ lqj{kk iznku djrh gS vr% blesa lkekU; ¼Secondary½ rFkk fpfUgr xaHkhj

¼Tertiary½ nksuksa izdkj dh chekfj;k¡ lfEefyr gSA

ii. vkbZihMh izfØ;k,¡ ¼IPD Procedures½ & bl ;kstuk esa yxHkx 1715 iSdst lfEefyr gSA

7

iii. lkekU; chekfj;ksa gsrq ¼Secondary illnesses½ & bl Js.kh esa 1148 chekfj;ksa dks lwphc) fd;k

x;k gSA

a. fpfUgr xaHkhj chekfj;ksa gsrq ¼Tertiary illness½ & blds vUrxZr 500 chekfj;ksa dh lwph 'kkfey

gS ftuds bykt gsrq Pre-Authorization ¼iwoZfu/kkZfjdj.k ½ ysuk vfuok;Z gSA

b. jktdh; fpfdRlk laLFkkuksa gsrq vkjf{kr iSdst & blds vUrxZr 67 chekfj;ksa dh lwph cukbZ xbZ

gS ftlds bykt ds fy, chek doj flQZ jktdh; fpfdRlk laLFkkuksa esa bykt djkus ij gh

izkIr fd;k tk ldsxkA

uksV% izR;sd izdkj ds iSdst dh lwph www.rajswasthya.nic.in ij miyC/k gSA

iv. ;kstuk ds vUrxZr ykHkkFkhZ ifjokj dks fpfdRlk lqfo/kk;sa lkekU; okMZ esa miyC/k gksaxhA buesa

eq[; :i ls fuEu lfEefyr gS &

a. fcLrj O;; lkekU; okMZ esaA

b. HkrhZ O;; rFkk uflZx O;;A

c. 'kY; fpfdRlk] laosnukgj.k fo'ks"kK rFkk lkekU; fpfdRlk dk ijke'kZ 'kqYdA

d. laosnukgj.k ¼Anaesthesia½] vkDlhtu bR;kfn O;;A

e. 'kY; midj.kksa rFkk vkS"kf/k;ksa dk O;;A

f. osUVhysVj 'kqYd] 'kY; midj.kksa] vkS"kf/k;ksa] vkWDlhtu] izR;kjksi.k midj.k] ,Dl&js rFkk

vU; tk¡pksa ij O;; vkfnA

g. vU; lHkh O;; tks jksxh ds bykt ds nkSjku vLirky ds }kjk ogu fd;k x;k gSA

v. ;fn fdlh jksxh dks bykt gsrq fdlh vf/kdr laLFkku ij yk;k x;k rFkk 'kq:vkrh bykt ds

ckn mls vU; fdlh mPp laLFkku esa jsQj dj fn;k x;k] rks ftl laLFkku esa izfØ;k gqbZ gS]

mls gh Dyse dh jkf'k dk Hkqxrku fd;k tk,xk rFkk nwljk laLFkku izfr fnu ds fglkc ls gh

Dyse dj ldsxkA

vi. fMtht iSdst ds vUrxZr iSdst dh dhers A, B ,oa C Js.kh esa ckaVh xbZ gSA

;g fuEu rkfydk vuqlkj fpfdRlk laLFkkuksa ij ykxw gksxh &

A State HQ Hospital, Medical College Hospital ;fn dksbZ futh vLirky lwnwj xzkeh.k

{ks= esa vLirky [kksyrk gS rks mls A Js.kh dk Lrj fn;k tk ldsxkA

B District Hospital, Sub District Hospital, Satellite Hospital, Dispensaries.

C CHC's & Pvt. Hospital at Block HQ.

vii. Essential Drug List rFkk eq[;ea=h fu%'kqYd nok ;kstuk@eq[;ea=h thou j{kk dks"k ds vUrxZr

uk vkus okyh nokbZ;ka@t:jh midj.k@bEIykUV bR;kfn tks fMtht iSdstst esa lfEefyr gS ds

fy, fpfdRlk laLFkku {ks=h; Lrj ij vfxze vkns'kksa rd mudh [kjhn djsxk ,oa bldh

tkudkjh jkT; Lrj dks nsxkA

viii. ;g ;kstuk ykHkkFkhZ gsrq iw.kZr% fu%'kqYd gSA vr% fdlh Hkh fLFkfr esa ykHkkFkhZ dks ckgj ls bykt

ls lacaf/kr dksbZ Hkh lkeku ykus gsrq ugha dgk tk;sxkA uk gh mlls dksbZ ’kqYd fdlh Hkh izdkj

ls ugha fy;k tk,xkA

8

ix. lacaf/kr fpfdRlk laLFkku }kjk Hkkek'kkg LokLF; chek ;kstuk ds vUrxZr vkus okys fMtht

iSdst esa ls muds laLFkku ij miyC/k iSdstkas dh tkudkjh jkT; Lrj dks iszf"kr dh tk;sxhA

x. ;fn orZeku esa fdlh laLFkku ij buesa ls fdlh fMtht iSdstksa dh lqfo/kk miyC/k ugha gS ijUrq

Hkfo"; esa miyC/k gksrh gS rks og fMtht iSdst Hkh ml laLFkku esa miyC/k fMtht iSdst dh

fyLV esa lfEefyr dj fy;k tk;sxkA blds mldks CEO, SHAA dks fyf[kr esa lwpuk izsf"kr

djuh gksxhA

xi. fMtht iSdst ds vUrxZr 7 fnu Pre-Hospitalization ,oa 15 fnu Post-Hospitalization dk [kpkZ

Hkh iSdst esa lfEefyr gSA ftlds fy, jksxh dks bLrseky gksus okyh nokbZ;k¡ ,oa bUtsD'kUk jksxh

dks vLirky ls fMtht iSdst ds vUrxZr eqgS;k djkbZ tk;sxhA

xii. tujy okMZ@vkbZ-lh-;w- iSdst dk izko/kku mu fofHkUu chekfj;ksa ¼;nk VkbQkbM] eysfj;k] Msaxw]

Mk;fj;k vkfn½ ds fy, fd;k x;k gS] ftuesa jksxh dks HkrhZ djus dh vko';drk gS fdUrq os

fMtht iSdst fyLV esa Hkh 'kkfey ugha gSA

xiii. bZykt ds nkSjku vxj jksxh dks fdlh vU; fMtht iSdst dh vko';drk bZykt djus okys

fpfdRld dks eglwl gksrh gS rks og vfrfjDr iSdst Hkh jksxh dh QkbZy ij vafdr dj ,oa

bUpktZ }kjk lR;kfir dj LokLF; ekxZn'kZd }kjk bUnzkt djk ldrk gSA bl rjg fdlh vU;

fMtht iSdstks dks Hkh bykt ds nkSjku tksM+k tk ldsxkA

xiv. dksbZ Hkh Dyse vutLVhQkbZM dkj.kksa ls chek dEiuh fujLr ugha dj ldsxh vkSj ,slh fLFkfr

ik;s tkus ij dEiuh ds f[kykQ dk;Zokgh dh tk;sxhA

8. ;kstuk ds vUrxZr lsok iznkrk &

i. lwphc) lkeqnkf;d LokLF; dsUnz rFkk buls mPp Lrjh; lHkh jktdh; fpfdRlk laLFkku dqy

432A ¼lwph layXu½

ii. jkT; ljdkj rFkk chek dEiuh }kjk lfEefyr :i ls iwoZ fu/kkZfjr ekin.M+ksa ds vk/kkj ij

lwphc) 453 futh fpfdRlky;A ¼lwph lyaXu½

9. futh fpfdRlk laLFkkuksa dks lwphc) djuk

jktdh; fpfdRlk laLFkku rFkk lwphc) futh fpfdRlk laLFkku&nksuksa rjg ds fpfdRlk laLFkku

bl dk;ZØe ds vUrxZr lwphc) (Empanel) fd;s x;s gSA jktdh; fpfdRlk laLFkku Lor% gh

lwphc) (Empanelled) ekus x;s gS] tcdh futh fpfdRlk laLFkkuksa dk lwphdj.k (Empanelment)

xzsfMax ds vk/kkj ij gksxkA U;wure vgZrk (Eligibility) izkIr djus gsrq vLirky esa fuEu lqfo/kk,sa

gksuk vko';d gSA

i. ;g 15 fcLrj dk gksuk pkfg,A ftyk Lrjh; xfBr lfefr blesa NwV iznku dj ldrh gSA

ii. ;g lHkh midj.kksa ls iw.kZr;k lqlfTtr gksuk pkfg, rFkk blesa lkekU; fpfdRlk 'kY;

fpfdRlk rFkk jksx tkap gsrq vko’;d lqfo/kk,sa miyC/k gksuh pkfg,A

iii. lkekU; okMZ efgyk rFkk iq:"k okMZ ds vyx&vyx gksus pkfg,A

iv. vLirky tks isdst ysrk gS] muds fy, lHkh midj.kksa ls iw.kZr;k lqlfTtr vkWijs'ku fFk;sVjA

vLirky viuh bPNk vuqlkj isdst pqu ldrk gSA

v. tks vLirky vf/kd mIk;qDr gksaxs mUgsa lwphc) fd;k tk;sxkA

9

vi. vLirkyksa ds vlkekU; forj.k dks jksdus gsrq {ks= ds HkkSxksfyd fLFkfr dk Hkh /;ku j[kk

tk;sxkA

vii. ftyksa gsrq vLirkyksa esa vf/kdre rFkk U;wure fcLrjksa dh la[;k dk fu/kkZj.k ml {ks= dh

tula[;k ds vk/kkj ij fd;k tk;sxkA

viii. vLirkyksa dh NaVuh Performance ds vk/kkj ij vuojr :Ik ls dh tk;sxhA

ix. lwphdj.k izfØ;k dks ,l-,p-,-,- ls ekU;rk izkIr djuh vko';d gksxhA

x. RSBY esa Empanelled vLirkyksa dks chek daiuh iqu% Re-Empanelled djsxhA

xi. futh fpfdRlk laLFkkuksa dks lwphc) djus gsrq ,d ftyk Lrjh; lfefr dk xBu ftys ds

eq[; fpfdRlk ,oa LokLF; vf/kdkjh dh v/;{krk esa fd;k x;k gSA LINK

10. f'kdk;r fuokj.k %&

i. ljdkj ds fu;a=.k esa LFkkfir dkWy lasVj ua- 1800 180 6127 ij f'kdk;rksa dks fuokj.k fd;s

tkus gsrq ntZ fd;k tk ldrk gSA

ii. ;g f'kdk;rsa ftyk Lrj ij f'kdk;r fuokj.k gsrq xfBr desVh dks ftysokj izfr fnu ¼Daily

Basis½ ij izsf"kr dh tk,xhA

iii. f'kdk;r fuokj.k lfefr (Grievance redressal committee) ykHkkFkhZ dks iw.kZr;k izkFkfedrk nsxh

rFkk izkIr f'kdk;r ij ftyk Lrj ij ;FkklaHko fu.kZ; ysdj dkWy lsUVj ij lwfpr djsaxh rFkk

vfxze vko';d dk;Zokgh izkjEHk djsxhA

iv. dky lsaVj esa dks xbZ f'kdk;rksa dh ftyk f'kdk;r fuokj.k (District grievance redressal

committee) lfefr dks Hkstk tk;sxkA vxj dksbZ i{k blls lger ugha gS rks f'kdk;r dks

jkT; f'kdk;r fuokj.k (State grievance redressal committee) lfefr dks Hkstk tk;sxkA jkT;

f'kdk;r fuokj.k lfefr bl ij fu.kZ; ysdj dkWy lsUVj ij Hkstsxh rFkk vfxze vko';d

dk;Zokgh izkjEHk djsxhA

v. jkT; f'kdk;r fuokj.k lfefr ds f[kykQ visysV vFkksfjVh esa vihy dh tk ldsxhA

vi. f'kdk;r fuokj.k izfØ;k ij lHkh lEcfU/kr fu;e rFkk dkuwu ykxw gksxsA

vii. fu;fer :Ik ls f'kdk;r lek/kku dk fooj.k cuk;k tk;sxk rFkk mlesa f'kdk;r ds fuokj.k

gsrq fd;s x;s iz;klksa dk fooj.k gksxk rFkk izkFkhZ dks rnkuq:i lwfpr fd;k tk,xkA

i. ftyk Lrj rFkk jkT; Lrj ij xfBr lfefr;ka fuEukuqlkj gksxh %&

1. jkT; Lrjh; desVh

bl ;kstuk ds laca/k esa izkIr gksus okyh ifjosnukvksa ds fuLrkj.k gsrq jkT; Lrj ij desVh dk xBu

fuEukuqlkj fd;k x;k gS %

jkT; Lrjh; ifjosnuk fuLrkj.k desVh

1- lh-bZ-vks-] LVsV gSYFk ,';kjsUl ,tsUlh & v/;{k

2- vfrfjDr fe'ku funs'kd] ,u-,p-,e- & lnL; lfpo

3- funs'kd ¼tu LokLF;½] fpfdRlk ,oa LokLF; lsok;sa & lnL;

4- fizflaiy] jktdh; esfMdy dkWyst] t;iqj & lnL;

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5- izfrfuf/k] ,’;ksjsUl dEiuh ¼ljdkj }kjk vf/kdr½ & lnL;

6- CEO, SHAA }kjk ukfer O;fDr & lnL;

2. ftyk Lrjh; desVh

bl ;kstuk ds laca/k esa izkIr gksus okyh ifjosnukvksa ds fuLrkj.k gsrq ftyk Lrj ij desVh dk

xBu fuEukuqlkj fd;k x;k gS %&

ftyk Lrjh; ifjosnuk fuLrkj.k desVh

1- ftyk dyDVj & v/;{k

2- eq[; fpfdRlk ,oa LokLF; vf/kdkjh & lnL; lfpo

3- ljdkj }kjk vf/kdr ,’;ksjsUl dEiuh }kjk euksuhr lnL; & lnL;

4- lh-bZ-vks- ,l-,p- ,-,- }kjk ukfer lnL; & lnL;

3. vihysV vkWFkksfjVh &

bl ;kstuk ds laca/k esa izkIr gksus okyh ifjosnukvksa ds fuLrkj.k gsrq jkT; Lrj ij desVh dk

xBu fuEukuqlkj fd;k tkrk gS %&

vihyh; izkf/kdj.k desVh

1- izeq[k 'kklu lfpo] fpfdRlk ,oa LokLF; foHkkx] jktLFkku & v/;{k

2- lh-bZ-vks- LVsV gsYFk ,’;ksjsal ,tsUlh & lnL; lfpo

3- lfpo@la;qDr lfpo] fpfdRlk f'k{kk foHkkx] jktLFkku & lnL;

4- lfpo@la;qDr lfpo] fpfdRlk ,oa LokLF; foHkkx] jktLFkku & lnL;

5- lnL; SHAA }kjk ukfer & lnL;

11. ;kstuk dk fØ;kUo;u ¼vkbZ Vh IysVQkWeZ ds ek/;e ls½

i. jkT; ljdkj }kjk Hkkek'kkg LOkkLF; chek ;kstuk ds lQy fØ;kUo;u ds fy;s lwpuk ,oa

izkS|ksfxdh foHkkx ¼RISL½ }kjk vkbZ Vh IysVQkWeZ rS;kj fd;k x;k gSA

ii. vkbZ Vh IysVQkWeZ ds ek/;e ls ;kstuk ds fØ;kUo;u esa lqxerk] n{krk rFkk ikjnf'kZrk jgsxh

rFkk ykHkkfFkZ;ksa dks LOkkLF; lsok;sa Rofjr xfr ls miyC/k gks ldsaxhA

iii. ykHkkfFkZ;ksa ls visf{kr gS fd os fdlh Hkh ¼Empanelled½ vf/kdr vLirky ¼ljdkjh vFkok futh½

esa vius ykHkkFkhZ gksus dk izek.k Hkkek'kkg dkMZ ,oa ;Fkk lEHko jk’ku dkMZ vo’; lkFk ysdj

tk;saA vkbZ Vh lks¶Vos;j ds ek/;e ls ykHkkFkhZ dh ik=rk lqfuf'pr dh tkosxhA

iv. vkikrdkyhu fLFkfr esa jksxh ds mipkj dks izkFkfedrk nh tk;sxh rFkk bl gsrq izek.khdj.k dh

izrh{kk ugh dh tk;sxhA ;|fi vko';d izek.khdj.k gsrq jksxh ds ifjtuksa dks le; fn;k

tkosxkA

v. ykHkkFkhZ ds izek.khdj.k ds i'pkr~ lkekU; chekfj;ksa gsrq mipkj izkjEHk dj fn;k tk;sxkA

p;fur xaHkhj chekfj;ksa gsrq chek daiuh ls Pre-Authorisation Approval ds mijkUr mipkj

izkjEHk fd;k tk;sxk ijUrq vkikydkyhu fLFkfr;ksa esa ¼tc jksxh dh tku dks [krjk gks½ loZizFke

mipkj dks izkFkfedrk nh tk;sxhA 'ks"k vko';d dk;Zokgh ckn esa vey esa ykbZ tk;sxhA

vi. chek dEiuh }kjk vf/kdre 48 ?k.Vs esa Pre-Authorisation Approval iznku fd;k tk;sxkA

,slk uk djus dh fLFkfr esa Lor% Approval ekuk tk;sxk rFkk jksxh dk bZykt izkjEHk dj fn;k

tk;sxkA

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vii. vLirky dks jksxh ds HkrhZ gksus ds oDr fpfdRlk dk vuqekfur [kpZ crkuk gksxk ysfdu

vLirky }kjk jksxh ls fpfdRlk lqfo/kk dk dksbZ 'kqYd ugha fy;k tk;sxkA

viii. bZykt ds i'pkr~ vLirky }kjk jksxh ds bZykt ls lacaf/kr lHkh nLrkost lkW¶Vos;j ds ek/;e

ls chek dEiuh dks iquZHkj.k gsrq izLrqr fd;s tk,axsA

ix. chek dEiuh }kjk iquZHkj.k dk vuqeksnu Hkh lkW¶Vos;j ds ek/;e ls gh fd;k tkosxkA

x. lkW¶Vos;j esa eksckbZy ,i dk Hkh izko/kku fd;k tk jgk gS& vke turk ds fy;s vLirky

laca/kh rFkk iSdst laca/kh lwpuk mUgsa eksckbZy Qksu ij miyC/k gks ldsxhA lHkh Lrj ds

vf/kdkfj;ksa dks eksckbZy ,Ii ds ek/;e ls MIS miyC/k gksxh rkfd ;kstuk dh izHkkoh ekWfuVfjax

gks ldsA

12. LokLF; ekxZn'kZd &

i. bl ;kstuk ds vUrxZr izR;sd LokLF; laLFkku ij jksxh dh lgk;rk gsrq LokLF; ekxZn'kZd

miyC/k jgsaxsA

ii. LokLF; ekxZn'kZd }kjk jksxh dh igpku] miyC/k chek jkf'k dh tkudkjh] djk;s tkus okys

mipkj gsrq vf/kdr djokus] LokLF; laLFkku esa jksxh dks mipkj djkus esa lgk;rk djus rFkk

jksxh ds fMLpktZ o QkWyksvi vkfn dk;Z esa lg;ksx fd;k tk;sxkA

iii. ljdkjh rFkk izkbZosV vLirkyksa dks vkSlr buMksj jksfx;ksa dh la[;k ds vuqlkj LokLF;

ekxZn'kZd fu;qDr djus gksaxsA LokLF; ekxZn'kZd dh U;wure 'kS{kf.kd ;ksX;rk fuEufyf[kr gSa%&

a. og Lukrd gksuk pkfg,A

b. og lEcfU/kr {ks= dk fuoklh gksuk pkfg,A

c. mlesa vPNk laokn dkS'ky gksuk pkfg,A

d. og vklikl ds xk¡oksa esa tkus ds fy, rS;kj gksuk pkfg,A

e. mls dEI;wVj dk dk;kZRed Kku gksuk pkfg,A

iv. LokLF; ekxZn'kZd fpfdRlk laLFkku ij vkbZ-ih-Mh- Hkkj ds fglkc ls yxk, tk ldsxsaA izfr

fnu 50 vkSlr vkbZ-ih-Mh- rd ,d LokLF; ekxZn'kZd yxk ldsxsaA

v. izfr fnu 50 ls vf/kd dh vkbZihMh ij izfr 50 vkbZihMh ij ,d LokLF; ekxZn'kZd vFkok

vLirky dh vko’;drkuqlkj vfrfjDr ekxZn’kZd yxk;s tk ldsxsaA

vi. LokLF; ekxZn'kZd RTPP fu;eksa rFkk bl laca/k esa foÙk foHkkx ds vU; fu;eksa ds vuq:i

yxk;s tk;saxs] buds ekuns; dk Hkqxrku lacaf/kr RMRS }kjk fd;k tk;sxkA

12

fdlh Hkh vLirky ds fy, fuEu rhu izdkj dh Queries izkIr gks ldrh gS %

1. Pre Authorization ls lacaf/kr Query: (Pre Auth Package Query-U;w bafM;k ,';ksjsal daiuh }kjk

dh xbZ Dosjh½

2. Fund Enhancement ls lacaf/kr Query :(Fund Enhancement Package Query-CEO RSHAA }kjk

dh xbZ Query)

3. Claim ls lacaf/kr Query: Claim Package Query- U;w bafM;k ,';ksjsal }kjk dh xbZ Dosjh½A

Query Panel esa mijksDr rhuksa izdkj dh Query fuEu izdkj ls ,d rkfydk esa fn[kkbZ nsuh pkfg,

Query Type No of Queries Pending

At Hospital for

reply

At NIA for approval AT CEO, RSHAA for

approval

Pre Auth Package Query X

Claim Package Query X

Fund Enhancement

Package Query

X

Drop Down iqu% fDyd ij bl rjg fn[ksa

List of Pending Queries of ………………………………………

S.N TID No Name of

Package

Package

Sum

Pending from

hospital

Pending at

NIA

Pending at

CEO

Date Time Date Time Date Time

iqu% fDyd ij fuEu LØhu vkuh pkfg,

Query Trail of the TIDNo…………………..

Query

i. {Table to be made]

13

Hkkek'kkg LokLF; chek ;kstuk

lkW¶Vos;j ;wtj xkbZM

14

I. LokLF; ekxZn'kZd ds fy, lkW¶Vos;j ,Iyhds'ku ;wtj xkbZM

i. lcls igys LokLF; ekxZn'kZd dks dEI;wVj ij lkW¶Vos;j ,Iyhds'ku ds fy;s ykWfxu djuk

gksxk] blds fy;s internet explorer vFkok google chrome esa osc ,MªSl

^^bsbyapp.health.rajasthan.gov.in** VkbZi djsa A

vFkok

http://www.rajswasthya.nic.in/ VkbZi djsa] Home page ij weblink for BSBY software ij

fDyd djsA

ii. vkidks fuEu LØhu fn[kkbZ nsxhA bl LØhu ij vkidks fuEukafdr ,aVªh djuh gSA

a) User Name : chek daiuh vFkok foHkkx }kjk miyC/k djk;k x;k user ID fy[kuk gSA user ID

dk izFke v{kj dsihVy words esa gksxkA

b) Password: vkidks miyC/k djk;k x;k ikloMZ Hkjuk gSA ;fn vkius ikloMZ cny fy;k gS

rks cnyk gqvk ikloMZ VkbZi djsaA izkjEHk esa lHkh dks ikloMZ Admin@123# fn;k x;k gSA

c) Captcha: lkeus LØhu esa fn[kkbZ ns jgs captcha dks Hkjsa ¼ ;g case sensitive ugha gSA capital

vFkok small letters esa Hkjk tk ldrk gS½A

d) Forgot Password: ;fn vki xyr ikloMZ vFkok user name ls ikap ls vf/kd ckj ykWfxu

djus dk iz;kl djsxas rks vkidh user ID CykWd gks tk;sxhA bls iqu% pkyw djus ds fy;s

fuEukuqlkj lEidZ dj ldrs gSaA

S.No Contact Person Phone No Mobile No Email

1. Toll Free call centre Number

1800 180 6127

2. Mr. Lalit Jain New India Assurance Company

0141-2693814 0141-2643815

9829123223 lalit.jain69@gmail.com

3. Mr. Roshan Singh, Medical and Health Department

9649331550 bsbycsr@gmail.com

15

iii. ;fn vki bl lEcU/k esa bZ esy djrs gS rks bZ esy izsf"kr djrs le; vkids vLirky dk uke]

vLirky dk dksM l[;k] vkidk Loa; dk uke ,oa eksckbZYk uEcj rFkk vkidh leL;k dk iw.kZ

fooj.k vko';d :Ik ls fy[ksaA

iv. lQyrk iwoZd ykWfxu djus ij vkidks fuEu LØhu fn[kkbZ nsxhA

v. vc vkidks mijksDr LØhu esa ckbZ rjQ Quick Links ds uhps fn;s x;s modules ds vuqlkj

,d&,d djds ,UVªh djuh gSA

16

II. Beneficiary Identification Form

1) lcls igys Quick Links esa Beneficiary Identification Form ij fDyd djsaA fDyd djus ij vkidks

fuEUk LØhu fn[kkbZ nsxhA

2) vc vkidks lcls igys "Admission Type" ds Dropdown menu esa nks fodYiksa esa ls ,d fodYi

fuEu izdkj ls pquuk gSA

a) Normal : ;fn jksxh dh ifjfLFkfr lkekU; gS rFkk xaHkhj fLFkfr esa ugha gS rks vkidks Normal

fodYi gh pquuk gSA

b) Emergency: ;fn jksxh dks vLirky esa xaHkhj fLFkfr esa yk;k tkrk gS rFkk mls rqjar bykt dh

vko';drk gSA ,slh ifjfLFkfr esa Emergency fodYi dks pquuk gksxkA

3) vc vkidks ejht ds ifjokj ds ykHkkFkhZ gksus dh igpku rFkk ejht dh igpku djuh gSA blds fy;s

fuEu izdkj ls fn'kk funsZ'kksa dk ikyu fd;k tkosA

4) ‘Normal’ Admission: ;fn jksxh dh ifjfLFkfr lkekU; gS rFkk vkius Normal fodYi pquk gS] rks ejht

ds ifjokj ds ykHkkFkhZ gksus dh igpku rFkk ejht dh igpku fy;s fuEu izdkj ls fn'kk funsZ'kksa dk

ikyu fd;k tkosA

A. ejht ds ifjokj ds ykHkkFkhZ gksus dh igpku &

i. ejht ds ifjokj ds ykHkkFkhZ gksus dh igpku gsrq fuEu pkj fodYi tks Identity Type esa fn;s

x;s gSa] buesa ls jksxh ds ikl miyC/k nLrkcstksa ds vk/kkj ij dksbZ ,d fodYi ds pquuk gS%&

17

Hkkek'kkg dkMZ nks izdkj ds gksrs gS & izFke dkMZ ifjokj dh efgyk eqf[k;k dk gksrk gS] ftlesa ifjokj ds

lHkh lnL;ksa dh tkudkjh miyC/k jgrh gS rFkk nwljk dkMZ O;fDrxr igpku gsrq cuk;k tkrk gS] tks

ifjokj ds izR;sd lnL; dk vyx&vyx gksrk gSA bl ;kstuk esa ifjokj ds igpku gsrq ifjokj dh efgyk

eqf[k;k dk dkMZ] tks iwjs ifjokj ds fy;s cuk;k x;k gS] mlh ls ifjokj dh igpku gksxh uk fd O;fDrxr

igpku okys dkMZ lsA

1- Bhamashah Family Id : ;fn ejht vFkok ejht ds ijhtu ifjokj dh efgyk eqf[k;k ds Hkkek'kkg

dkMZ lkFk yk,a gS vFkok vaxzsth ds dSfiVy v{kjksa esa lkr v{kjksa dk efgyk eqf[k;k ds Hkkek'kkg dkMZ

dk uacj ekywe gSa rks&

i- Bhamashah Family Id ds cVu ij fDyd djsaA vkidks fuEukuqlkj ,d LØhu fn[kkbZ nsxhA

ii- blesa jksxh ds ifjokj dh efgyk eqf[k;k ds Hkkek'kkg dkMZ ds lkr v{kjksa dk uacj lkeus okys

ckWDl esa VkbZi djsaA

iii- Search Beneficiaries ds cVu ij fDyd djsaA vkidks fuEukuqlkj ,d LØhu fn[kkbZ nsxh rFkk

ifjokj dk NFSA vFkok RSBY esa gksus dh fLFkfr esa Entitelment Type ds lkeus NFSA vFkok

RSBY fy[kk gqvk LØhu ij fn[kkbZ nsxkA ;fn N/A ;k Not Record Found fy[kk gqvk LØhu ij

fn[kkbZ nsrk gS rks ykHkkFkhZ ifjokj gksus dh iqf"V ugha gksrh gSA

18

2- Ration Card : ;fn ejht vFkok ejht ds ijhtu ifjokj dk jk'ku dkMZ lkFk yk, gS vFkok

jk'ku dkMZ ds 12 vadksa dk uacj dk uacj ekywe gSa rks&

i- ;fn ejht ds ifjokj dk jk'ku dkMZ miyC/k gS vFkok jk'ku dkMZ ds 12 v{kjksa dk uacj

miyC/k gS rks jk'ku dkMZ ds jsfM;ks cVu ij fDyd dj mlds lkeus okys ckWDl esa 12 vadksa

dk jk'ku dkMZ dk uacj fuEu LØhu ds vuqlkj ,aVªh fd;k tk;sA

ii- Search Beneficiaries ds cVu ij fDyd djsaA vkidks fuEukuqlkj ,d LØhu fn[kkbZ nsxhA

ifjokj dk NFSA vFkok RSBY esa gksus dh fLFkfr esa Entitelment Type ds lkeus NFSA vFkok

RSBY fy[kk gqvk LØhu ij fn[kkbZ nsxkA ;fn N/A ;k Not Record Found fy[kk gqvk LØhu ij

fn[kkbZ nsrk gS rks ykHkkFkhZ ifjokj gksus dh iqf"V ugha gksrh gSA

19

3- Aadhar Card : ;fn ejht dk vk/kkj dkMZ miyC/k gS ,oa ejht ds ifjokj ds Hkkek'kkg dkMZ

cuokrs le; bl vk/kkj dkMZ dks Hkkek'kkg dkMZ ls fyad fd;k x;k gS rks vk/kkj dkMZ ls Hkh

ejht ds ifjokj ds ykHkkFkhZ gksus dh igpku gks ldrh gSA

i- vk/kkj dkMZ ij fDyd djsa rFkk vk/kkj dkMZ ds 12 vadksa dk uacj VkbZi djsaA

ii- Search Beneficiaries ds cVu ij fDyd djsaA vkidks fuEukuqlkj ,d LØhu fn[kkbZ nsxh ifjokj

dk NFSA vFkok RSBY esa gksus dh fLFkfr esa Entitelment Type ds lkeus NFSA vFkok RSBY fy[kk

gqvk LØhu ij fn[kkbZ nsxkA ;fn N/A ;k Not Record Found fy[kk gqvk LØhu ij fn[kkbZ nsrk

gS rks ykHkkFkhZ ifjokj gksus dh iqf"V ugha gksrh gSA

20

mijksDr rhuksa esa ls fdlh Hkh izfØ;k esa NFSA ;k RSBY dk ykHkkFkhZ gksuk ik;k tkrk gS rks vkidks

vxyk izi= vFkkrZ Pre Authorisation Requrest Form Hkjuk gksxkA rFkk jk'ku dkMZ vFkok

Hkkek'kkg dkMZ ds izekf.kr izfrfyfi yxkus dh vko';drk ugha gSA

4- MOIC Route:

i- ijarq mijksDr rhuksa fodYiksa esa ls fdlh Hkh fodYi dks pquus ij NFSA ;k RSBY gksus dk izek.k

ugha vkrk gS rFkk "N/A" vFkok "No Record Found" dk LVsVl vkrk gS rks bldk rkRi;Z ;g

gS fd dEI;wVj }kjk NFSA ifjokj gksuk fuf'pr ugha gqvk gSA ,slh fLFkfr esa MOIC Route ls

tkuk gksxk A

uksV% MOIC Route ls tkus ls igys vkidks lykg nh tkrh gS fd vki ejht ls lacaf/kr fuEu

nLrkost ,d Folder esa ftls ejht dh TID Number ds uke ls vius daI;wVj ij cuk ysa rFkk

mlesa ,d ,d djds fuEu nLrkost PDF File esa Ldsu djds j[k ysaA

;g fo'ks"k /;ku j[ksa fd izR;sd PDF QkbZy dk lkbZt 250 KB ls vf/kd ugha gksA ;fn fdlh

QkbZy dk lkbZt 250 KB ls vf/kd gks jgk gS rks mls 100 DPI ij LdSu djsA

1- fpfdRld dh iphZ ftl ij ejht dks HkrhZ djus dh vuq'kalk ,oa iSdst dksM fy[ks gq;s gSaA

2- ejht dk Indoor Ticket A

3- ejht ds ifjokj ds jk'ku dkMZ dh izekf.kr Nk;kizfr ¼rhu i"B igyk eq[; i`"B ftl ij

eqf[k;k dk QksVks yxk gks] nwljk vfUre i"B ftl ij ifjokj dk fooj.k gS] rFkk rhljk

ftl ij xsgw`Wa ysus dk fooj.k vafdr gks@jk’ku Mhyj dh izekf.kr lwph A

4- ejht ds bykt dh tkap fjiksVZ ftuds vk/kkj ij iSdst pquk x;k gS ¼;fn V'kZjh isdst pquk

tkrk gS ,oa izdj.k pre-authourasatioon ds fy, chek dEiuh dks izsf"kr gksus dh fLFkfr esa½

5- ejht dk QksVks ¼;fn QksVks web came ds lkeus ugha ysdj bed side (conditions) fy;k x;k

gS½A bl lEcU/k esa tkjh fd;s x;s fn'kk funsZ'k ifjf'k"B&1 ij layXu gSA

6- ejht dk QksVks igpku i=A

ii- ;fn ejht ds ifjokj lkWQ~Vos;j ds ek/;e ls lR;kiu ugh gksrk gS] Rkks fuEu izfØ;k viukbZ

tk,xh %&

LokLF; ekxZ nZ'kd dks ejht ds ifjokj ds jk'ku dkMZ dh t¡kp dj fuEu esa ls dksbZ ,d

fodYi lqfuf'pr djuk gSA

a) jksxh ds ifjokj dk jk'ku dkMZ jk"Vªh; [kk| lqj{kk vf/kfu;e ¼NFSA½ ds vUrxZr cuk

gqvk gS] vFkkZr jk'ku dkMZ ij jk"Vªh; [kk| lqj{kk vf/kfu;e ¼NFSA½ dh lhy yxh gqbZ

gSA rks jk'kudkMZ ds nks i`"Bksa dh MOIC ls izekf.kr Nk;kizfr igyk eq[; i"B ftl ij

eqf[k;k dk QksVks yxk gks] nwljk vfUre i"B ftl ij ifjokj dk fooj.k gS] lkW¶Vos;j esa

viyksM djuk gSA

b) ;fn jk'ku dkMZ ij jk"Vªh; [kk| lqj{kk vf/kfu;e ¼NFSA½ dh lhy ughsa yxh gqbZ gS] rks

;g lqfuf’pr djuk gksxk fd D;k ifjokj us vDVwcj] 2015 ;k mlds ckn jk'ku dkMZ ls

xsgwWa fy;k gS D;ksafd vDVwcj] 2015 ;k mlds ckn jk'ku dkMZ ls xsgwWa dsoy jk"Vªh; [kk|

lqj{kk vf/kfu;e ¼NFSA½ ds vUrxZr ykHkkFkhZ ifjokjksa dks gh fn;k tkrk gS A vr% ;fn

fdlh ifjokj us vDVwcj] 2015 ;k mlds ckn jk'ku dkMZ ls xsgwWa fy;k gS] rks mls NFSA

dk ykHkkFkhZ ekuk tk,xkA vFkok

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c) jk'ku dkMZ ls xsgwWa ugha ysus dh fLFkfr esa ;fn lEcf/kr jk’ku Mhyj ls jk"Vªh; [kk| lqj{kk

vf/kfu;e ¼NFSA½ ds vUrxZr ykHkkFkhZ gksus dh izekf.kr lwph ysdj vkrk gSA rks mls

NFSA dk ykHkkFkhZ ekuk tk,xk

d) jk'kudkMZ dh MOIC ls izekf.kr Nk;kizfr ¼rhu i"B igyk eq[; i"B ftl ij eqf[k;k dk

QksVks yxk gks] nwljk vfUre i`"B ftl ij ifjokj dk fooj.k gS] rFkk rhljk ftl ij xsgwWa

ysus dk fooj.k vafdr gks@jk’ku Mhyj dh izekf.kr lwphss½ lkW¶Vos;j esa viyksM dj vkSj

mls NFSA dk ykHkkFkhZ eku dj mls ;kstuk dk ykHk iznku fd;k tk;sxkA xsgwWa ysus okys

i`"B ij i`"B jk'ku dkMZ dk uEcj vo’; fy[k nsaA

iii- vc vki MOIC jsfM;ks cVu pqudj Search Beneficiary ij fDyd djsaA vkidks fuEu LØhu

fn[kkbZ nsxhA

iv- vc vkidks bl LØhu ij fuEu entry djuh gS %&

a. Patient Name : bl QhYM esa jksxh dk uke vaxzsth esa Vkbi djsaA

b. Age: jksxh dh vk;q iw.kZ c"kksZa esa Hkjuh gS] ,d c"kZ ls de vk;q ds fy, 0

c. Gender : bl QhYM esa Male vFkok Female dk jsfM;ks cVu esa pqusaA

d. Verified Identity Type : bl QhYM esa RSBY Card vFkok jk'ku dkMZ nksuksa esa ls ,d pqus]

ftlls jksxh dk Hkkek'kkg LokLF; chek ;kstuk ds ykHkkFkhZ ifjokj gksus dk izek.k iznZf'kr

gksrk gSA

e. Please Enter Identity Number: mijksDr fcUnq c esa ftl fodYi dks pquk gS mldk uacj

;gka ij ,aVªh djsaA vFkZkr jk'ku dkMZ ds 12 v{kjksa dk uacj] Hkkek'kkg dkMZ ds vaxzsth ds

dSfiVy v{kjksa esa lkr v{kjksa dk uacj vFkok RSBY Card ds 12 v{kjksa dk uacjA ;fn jk'ku

dkMZ iqjkuk gS rFkk mldk uEcj 12 vadks ls de gS rks uEcj ds izkjEHk esa mrus 'kqU; yxk

ys ftlls fd jk'ku dkMZ dk uEcj 12 vadks dk gks tk,A

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f. blds Ik'pkr vkidks MOIC ls izekf.kr fcUnq c esa pqus x;s fodYi dh QksVks izfr MOIC ls

izekf.kr djkdj ,oa lhy yxk dj viyksM djuh gSA blds fy;s vkidks Submit cVu ij

fDyd djuk gS blls LØhu ij ,d ikFk [kqy tk;sxk rFkk tgka vkius ejht ds jk'ku dkMZ]

Hkkek'kkg dkMZ vFkok jk'ku dkMZ izekf.kr izfr;ka "PDF" esa Ldsu djds j[kh gqbZ gS ogka ls

pqudj "Upload" dk cVu nok,a blds Ik'pkr vkidks uhps ,d eslst vk;sxk "PDF

Uploaded Successfully" tSlk fd uhps nh xbZ LØhu ls Li"V gksrk gS %&

g. blds Ik'pkr iqu% jksxh dk fooj.k ,oa Identity Number iqu% check djds submit cVu

nck,a blls ejht dk TID Number fn[k tk;sxkA tSlk fd fuEu LØhu esa yky dyj ls

fn[k jgk gSA

h. bl TID dks vki uksV djysaA bl ejht ds lcaf/kr leLr entry djus ds fy;s ;g TID

dke esa yh tk;sxhA

i. ;fn fodYi 1] 2 vFkok 3 esa ls NFSA ifjokj vFkok RSBY ifjokj dEI;wVj ls vkWuykbZu

osjhQkbZ gks tkrk gS rks ykHkkFkhZ ifjokj ds fpfUgdj.k ds nLrkost ;Fkk jk'ku dkMZ] Hkkek'kkg

dkMZ dh izfr;ka viyksM djus dh vko';drk ugh gS A

B. ejht dh igpku lqfuf'pr djuk &

vc vkidks ejht dh igpku lqfuf'pr djuh gS fd og bl ykHkkFkhZ ifjokj dk okLrfod lnL; gS

vFkok ughsaA ejht dh igpku djus ds fy;s fuEukafdr fodYiksa esa ls dksbZ ,d fodYi ,d&,d djds

pquuk gksxk%&

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i. ykHkkFkhZ ifjokj ds fpfUgdj.k ds fy, miyC/k mijksDr fdlh Hkh fodYi ds ek/;e ls NFSA

ifjokj vkWuykbu izekf.kr gksus ds ckn LØhu ij ifjokj ds fooj.k ds Åij Verify By ds lkeus

nks cVu fn[ksaxsA igyk AADHAR ,oa nwljk MOIC

a) tSls gh vki igyk cVu vk/kkj dks select djsaxs] uhps members details dh rkfydk ds dkWye

la[;k 6 esa ifjokj ds ftu lnL;ksa ds vk/kkj uacj miyC/k gSa muds vk/kkj uacj blesa fn[kkbZ nsaxs

rFkk muds lkeus fy[ks x;s verify aadhar dks fDyd dj ldsaxsA

i. blds ckn ifjokj dk tks lnL; ejht gS mlds lkeus ;fn vk/kkj uacj fn[k jgk gS rks vki

Verify Aadhar ds cVu ij fDyd djsaxsA ;fn vk/kkj uacj fy[kk gqvk ugha gS rFkk ejht dk

vk/kkj uacj Kkr gS rks mls ejht ds lkeus vk/kkj uacj ds [kkyh LFkku ij Hkjdj Verify

Aadhar dk cVu nck;saxs rks vkidks fuEu LØhu utj vk;sxhA

ii. vc vkidks nks fodYi miyC/k gksaxs & 1- Finger Print Verification 2- OTP

iii. Finger Print Cerification & blds fy;s vkids dEI;wVj ij Secugen Pro dk Finger Print

Device lQyrk iwoZd Installed gksuk pkfg;sA lcls igys FMR ds cVu dks fDyd djsa rks

Finger Print Scanner ij Light pedus yxsxhA ftl ejht dh igpku lqfuf'pr djuh gS

mldh fdlh maxyh vFkok fdlh Hkh vaxwBs dks Finger Print Device ds Xykl ij j[kus dks dgsaA

tSls gh maxyh vFkok vaxwBk j[kk tk;sxk] lkeus okys CkkWDl esa maxyh vFkok vaxwBs dk fu'kku

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fn[kkbZ nsxk rFkk FMR ds lkeus Read Finger Print fy[kk gqvk vk;sxkA vc vkidks blds lkeus

fn;s x;s Send Request ds cVu dks fDyd djuk gksxkA vc ;g UIDAI ds MsVkcsl esa tkdj

ml ejht ds maxyh vFkok vaxwBs ds fu'kku dks izekf.kr djsxk rFkk Verification Status ds

dkWye esa nks fLFkfr vk ldrh gSaA ;fn Verified fy[kk gqvk vkrk gS rks Finger Prints ds vk/kkj

ij ml O;fDr dh igpku gks x;h gS rFkk uhps ml O;fDr dk uke Hkh Verified By ds dkWye esa

vafdr gks tkrk gSA ;g uke vkSj ejht dk uke ,d leku gksuk pkfg;s] ;fn VkbZfiax dh NksVh

eksVh xyrh ls uke esa ekewyh varj vkrk gS rks vki vius foosd ij MOIC ls osjhQkbZ djk dj

ejht dh vkbZ Mh Hkh viyksM dh tkuh pkfg;sA ;fn Not Verified fy[kk gqvk vkrk gS rks bl

izfØ;k dks vU; vaxqyh ;k nwljs vaxwBs ds lkFk nksgjk;saA fQj Hkh ;fn not verifyied fy[kk gqvk

vkrk gS rks vxyk fodYi OTP ls ejht dh igpku dh tkuh pkfg;sA

iv. OTP % mijksDr LØhu esa OTP cVu ij fDyd djsasxs rks ml ejht ds eksckby uacj ij ¼vk/kkj

dkMZ cuokrs le; jftLVMZ fd;s x;s eksckby uacj ij½ ,l,e,l ds ek/;e ls ,d OTP vk;sxkA

bl oTP dks lkeus okys ckWDl esa VkbZi djsa rFkk Confirm OTP dk cVu fDyd djsaA ;fn

verification status esa verified vk tkrk gS rks ejht dk lR;kiu eku fy;k tkrk gSA ,oa

ejht ds lkeus okyk Radio Button fn[kkbZ nsus yxrk gS] ogka ij fDyd djds ejht ds uke

dks Select dj ldrs gSaA

v. ijarq ;fn verification status esa not verified vkrk gS rks vc vkidks MOIC Route ls ejht

dk fpUghdj.k djuk gksxkA

b) Moic Route: MOIC okyk jsfM;ks cVu fDyd djsaxs rks fuEu LØhu fn[kkbZ nsxhA

i. "Select Patient" okys cVu ls ejht ds uke ds lkeus okys cVu ls ejht dk uke pqusxsaA

ii. vc vkidks ejht dk QksVks igpku i= yxkuk gksxkA ;fn fdlh ejht cPps dk QksVks igpku

i= miyC/k ugha gS] rks eka vFkok cki dh QksVks vkbZ Mh yxkbZ tk ldrh gS ijUrq ml fLFkfr esa

MOIC dks QksVks vkbZ Mh ij izekf.kr dj fy[kuk gksxk fd cPps dh QksVks vkbZ Mh miyC/k ugha

gksus ij eka cki dh izekf.kr QksVks vkbZ Mh yxkbZ tk jgh gSA

iii. miyC/k QksVks vkbZ Mh dks PDF esa Scan djds dEI;wVj esa fdlh mi;qDr txg Ldsu dj ysaA

iv. blds Ik'pkr "Choose" cVu dks fDyd djsa rFkk Scan QksVks vkbZMh dks select djds

upload cVu fDyd djsaA blds Ik'pkr LØhu ij "upload successfully" dk eSlst fn[kkbZ

nsxkA

25

v. tSls gh uploaded successsfully dk eSlst vk;sxk ejht lysDV dk jsfM;ks cVu fn[kus

yxsaxs rFkk ejht dks select dj ldsaxsA

vi. blds Ik'pkr submit cVu ij fDyd djuk gksxk ftlls ,d TID tujsV gks tk;sxhA bl TID

dks vki uksV djysaA bl ejht ds lcaf/kr leLr entry djus ds fy;s ;g TID dke esa yh

tk;sxhA

C. ‘Emergency’ Admission : ;fn jksxh dks vLirky esa xaHkhj fLFkfr esa yk;k tkrk gS rFkk

mls rqjar bykt dh vko';drk gSA ,slh ifjfLFkfr esasa"Admission Type" esa Emergency fodYi dks

pquuk gksxkA rFkk TID tujsV djus ds fy, fuEu izfd;k viukuh gksxhA rFkk ckn esa bls

‘Emergency Case Conversion’ Form ds }kjk lkekU; djuk gksxkA

i. „Admission Type‟ ds drop-down menu esa ls „Emergency‟ ds fodYi dks pquus ij vkidks

fuEu LØhu fn[kkbZ nsxh%

ii. Emergency esa ,d ejht nks fLFkfr esa HkrhZ fd;k tk ldrk gS izFke fLFkfr ;g gS fd ejht dh

igpku fdlh vU; O;fDr }kjk fd tkrh gS vFkok ejht Lao; viuh igpku crkrk gS ;fn fdlh

vU; O;fDr }kjk igpku fd tkrh gS rks Is the Patient ds lkeus fn, x, jsfM;ks cVu esa ls

„Identified‟ pqus rFkk Patient Details‟ Hkjs rFkk MLC dsl gksus ij MLC Case ds lkeus okys cVu esa

Yes fDyd djsa vkidks fuEukuqlkj LØhu fn[kkbZ nsxh % blds ckn ftl O;fDr us ejht dh igpku

dh gS mldk fooj.k Hkjs ,oa „Submit‟ cVu dks fDyd djus ij ,d TID tujsV gks tk,xh! d`i;k

bl TID dks uksV dj ys ckn esa ;g uEcj „Emergency Case Conversion‟ Form. Hkjus esa iz;ksx esa

yk, tk,xhA

26

iii. ;fn Emergency esa HkrhZ ejht HkrhZ ejht dh igpku fdlh vU; O;fDr }kjk vFkok ejht ds Loa; ds

}kjk ugha dh tk ik jgh gS rks vkidks Is the Patient ds lkeus fn, x, jsfM;ks cVu esa ls

„Unidentified‟ cVu ij fDyd djus ij fuEu LØhu fn[kkbZ nsxh%

vi. blds ckn ejht dk fooj.k Hkjs ,oa „Submit‟ cVu dks fDyd djus ij ,d TID tujsV gks tk,xh!

d`i;k bl TID dks uksV dj ys ckn esa ;g uEcj „Emergency Case Conversion‟ Form. Hkjus esa iz;ksx

esa yk, tk,xhA

27

III. Emergency Case Conversion

;g QkeZ rHkh dke vk,xk tcfd vkius Beneficiary Identification Form esa‘Admission Type’ esa Emergency’

pquk gS ;fn vkius Admission Type’ esa Normal pquk gS rks ;g QkeZ ugh Hkjk tk,xkA

1. LØhu ds ckbZ rjQ fn, x, Quick Links eas ls „Emergency Case Conversion” pqus] vkidks fuEu LØhu

fn[kkbZ nsxh

2. „Beneficiary Identification Form‟esa fn, x, „Admission Type‟ esaas ls Emergency‟. pquus ij tks TID

tujsV dh xbZ Fkh mls „TID‟ box esa VkbZi djsa rFkk bl ckWDl ds ckgj LØhu ij dgha Hkh fDyd djus

ij fuEukuqlkj LØhu fn[kkbZ nsxh:

3. blds i'pkr~ „Identity Type‟ ds uhps fn, x, cVuksa esa ls ,d cVu „Beneficiary Identification Form‟ ds

vuqlkj vFkkZr „Bhamashah Family ID‟ or „Ration Card‟ or „Aadhaar Card‟ or „MOIC‟ dksbZ Hkh ,d

fodYi pquuk gS

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4. ;fn vkius jk'ku dkMZ dk fodYi pqu dj „Search Beneficiary‟ cVu ij fDyd fd;k gS fuEukuqlkj

LØhu fn[kkbZ nsxh%

5. ;g ogh LØhu gS tc vkius Beneficiary Identification Form‟ ds „Admission Type‟ esa „Normal‟ pquus ij

vkbZ FkhA

6. bldh ckn dh izfd;k ogh gS] tks „Beneficiary Identification‟ Form. esa „Normal‟ pquus ij dh xbZ FkhA

N.B.: After having filled the ‘Emergency Case Conversion Form’, you may proceed to fill the

‘Pre-Authorization’ Request Form’

29

IV. Pre Authorization Request Form

i. vc vkidks Quick Link esa ls nwljk module vFkkrZ "Pre Authorization Requrest Form rks

ij fDyd djus ij fuEu LØhu fn[kkbZ nsxh%&

ii. TID ds ckWDl esa iwoZ esa ejht ds fy, tujsV dh xbZ TID dks isLV vFkok VkbZi djsa rFkk TID

ckWDl ds ckgj vkdj dgha Hkh fDyd djsaA

iii. blds Ik'pkr ejht dk uke] vk;q] fyax vius vki LØhu ij vk tk;sxkA

iv. vc vki ejht ds ifjokj ds okWysV esa miyC/k jkf'k dks uhps Wallet Details esa ns[k ldrs gSaA

lsdsaMªh ¼ljdkjh isdst lfEefyr½ rFkk V'kZjh isdst ds okWysV esa vyx vyx miyC/k jkf'k ns[k

ldrs gSaA

v. vc vkidks fpfdRld }kjk iphZ ij fy[ks gq;s isdst dksM+ pquus gSA blds fy;s vkidks Search

Package ds uhps fn, x;s Select Package ds lkeus ds jsfM;ks cVu esa ls isdst dksM dk jsfM;ks

cVu fDyd djuk gksxkA

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vi. isdst dksM ds lkeus okys ckWDl esa ls isdst dksM pquuk gSA iSdst dksM ds laca/k esa fuEu fcUnq

mYys[kuh; gS %&

a. lHkh lsdsaMªh isdstst dh dksM+ la[;k vad ^^1** ls izkjaHk gksrh gSA

b. lHkh V'kZjh isdstst dh dksM+ la[;k vad ^^2** ls izkjaHk gksrh gSA

c. dsoy ljdkjh vLirkyksa ds fy;s vkjf{kr isdstst dh dksM la[;k vad ^^3** ls izkjaHk gksrh

gS vFkkZr vad ^^3** ls izkjaHk gksus okys isdstst futh vLirky ugha pqu ldsxsaA

vii. vc vkidks tks Hkh isdst pquuk gS mlds vad tSls tSls VkbZi djrs tk;saxs isdst dksM mlh ds

vuqlkj fn[krs tk;saxsA

viii. vc vki buesa ls tks isdst pkfg, mls ij fDyd djasA

ix. blds Ik'pkr blds cxyokyk cVu ftl ij "add package" fy[kk gqvk gS fDyd djsaA isdst

dk fooj.k uhps nh xbZ rkfydk esa vk tk;sxkA

x. ;fn vkidks vkSj nwljk isdst ysuk gS rks bl fof/k dks iqu% nksgjk,aA bl izdkj ls vkidks ftrus

Hkh isdst ysus gS ,d ,d djds tksM+rs pys tk;saA

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xi. ;fn xyrh ls dksbZ xyr isdst ys fy;k gS rks uhps dh rkfydk ds vafre dkWye esa "Delete

Record" dk dkWye gS A ml dkWye esa cus fu'kku ij fDyd djus ls og isdst gV tk;sxkA

xii. vc ,d ckj iqu% lqfuf'pr djysa dh vkius MkDVj ds fy[ks vuqlkj gh isdst Enter fd;s gSaA

vc vkidks fuEu LØhu fn[ksxhA ijarq ;g /;ku jgs fd pqus gq;s isdst dh dqy jkf'k okWysV esa

miyC/k jkf'k ls de gksA

32

V. FUND ENHANCEMENT

pqus x;s isdstksa dh dqy jkf'k okWysV esa miyC/k jkf'k ls vf/kd gS] rks vkidks fuEu funsZ’kksa dh ikyuk

lqfuf'pr djuh gS%&A

i. Hkkek’kkg LokLF; chek ;sktuk ds vUrxZr Fund Enhancement dqN fo’ks"k ifjfLFkfr;kas esa gh jksxh

dh xEHkhj fLFkfr dks ns[krs gq, bykt djus okys fpfdRld dh vuq’kalk ds i'pkr fd;k

tk;sxkA

ii. ;fn fdlh ejht ds fy;s iSdst@iSdstt cqd djrs le; ifjokj ds okWYksV esa cdk;k jkf’k c qd

fd;s tkus okys iSdst@iSdstt dh jkf’k ls de gS rFkk bl jkf’k dk varj 500 :Ik;s rd ;k

mlls de gS rks ,sls izdj.k esa bykt djus okys fpfdRld dh vuq’kalk ds i'pkr Lor% gh

Fund Enhancement dks Lohd`fr dEI;wVj }kjk ns nh tk;sxh RkFkk vLirky ejht dk bykt

izkjaHk dj ldsxkA

iii. fuEu ifjfLFkfr;ksa esa ejht ds fy;s iSdst@iSdstst cqd djrs le; okWysV dk Balance lekIr

gksus ij ;k fQj okWysV dk Balance cqd fd;s tkus okys iSdst@iSdstst dh jkf’k ls de gksus

ij] bykt djus okys fpfdRld }kjk vuq’kalk ds Ik’pkr gh dsl dks Fund Enhancement

Approval ds fy;s Hkstk tk ldsxkA

vxj bykt djus okys fpfdRld dks ;g yxrk gs fd lEcfU/kr iSdst cqd djds ejht dks

bykt ugh fn;k x;k rks ejht ds fdlh Hkh vax ;k tku dks [krjk gks ldrk gSA

vkWijs’ku fFk;sVj esa ejht ds fy;s dksbZ ,slk iSdst (Procedure) cqd fd;k tkuk vko’;d gS

tks igys cqd ugh fd;k x;k Fkk rFkk ftlds cqd uk fd;s tkus ij ejht ds fdlh Hkh vax ;k

fQj mldh tku dsk [krjk gks ldrk gS A

ejht bejtsalh es vLirky vk;k gS vkSj mldh chekjh ls lEcfU/kr iSdst rqjUr cqd dj

bykt 'kq: ugha fd;k x;k rks ejht ds fdlh Hkh vax ;k fQj mldh tku dks [krjk gks ldrk

gS A

ejht ds bykt ds fy, vusd iSdst (Multiple) ,d lkFk cqd fd;s x;s gaS rFkk lHkh iSdst dk

;ksx] okWysV es miyC/k dqy jkf’k ls vf/kd cu jgk gSA ,slh fLFkfr es dsl dks rHkh Fund

Enhancement ds fy, Hkstk tk,xk vxj fpfdRld vuq’kalk@izekf.kr djrk gS dh lHkh cqd

fd;s x;s iSdst (Procedure) dks fujarjrk (Continuity) esa fd;k tkuk ejht ds fy, vfuok;Z

gSA

iv. lkekU; ifjfLFkfr;kas esa ejht ds fy;s iSdst cqd djrs le; okWysV dk Balance lekIr gksus ij

;k fQj okWysV dk Balance cqd fd;s tkus okys iSdst ls de gksus ij dsl dks Fund

Enhancement ds fy;s ugha Hkstk tk;sxkA ,slh ifjfLFkfr;ksa esa ejht dk bykt Hkkek’kkg LokLF;

33

chek ;sktuk ds vUrxZr ugha djds lkekU; rjhds ls vU; ;kstukvkas ;Fkk] eq[;ea=h fu%’kqYd nok

;kstuk] eq[;ea=h fu%’kqYd ;kstuk] eq[;ea=h BPL thou j{kk dks"k] eq[;ea=h lgk;rk dks"k bR;kfn

tks Hkh ykxw gks muds vUrxZr fd;k tk;sxkA

v. vxj bykt djus okyk fpfdRld dsl dks Fund Enhancement eas Hkstus dk fu.kZ; ysrk gS rks]

mls vfuok;Z :Ik ls fyf[kr es vuq’k alk djuh iM+sxh fd lacaf/kr iSdst ejht ds fdlh Hkh vax

;k fQj mldh tku cpkus ds fy;s vfr vko’;d gSA ;g vuq’kalk og viuh Prescription Slip

vFkok baMksj iphZ ij nsxk o dsl ds leFkZu es lEcfU/kr nLrkost ;Fkk takp fjiksVZ bR;kfn ds

lkFk Fund Enhancement Approval ds fy;s dsl dks Hkstr s oDr] Hkkek’kkg LokLF; chek ;kstuk

ds lkW¶Vos;j ij vfuok;Z :Ik ls viyskM djsxk A

vi. Fund Enhancement djrs le; mijksDr fn’kk funsZ’kksa dk vko’;d :Ik ls /;ku j[kk tk;s rFkk

bykt djus okys fpfdRld dh vuq’kalk ds Ik’pkr gh vfr vko’;d i zdj.kksa dks gh Fund

Enhancement ds fy;s izsf"kr fd;k tk;sA

34

VI. ejht dh QksVks ysuk

Hkkek'kkg LokLF; chek ;kstuk ds lk¶Vos;j esa ejht dh QksVks viyksM djuk vko’;d gSA ;fn

vkius QksVks viyksM ugha dh rks chek dEiuh Query yxk nsxh rFkk Dyse ikl gksus esa ijs’kkuh vk;sxhA

QksVks viyksM djus ds nks fodYi gS igyk oso dsejk }kjk QksVks ysuk rFkk nwljk PDF file esa QksVks viyksM

djukA

1- oso dsejk }kjk QksVks ysuk

i. Patient Photograph ds lkeus okys ckDl esa ,d Mk;ykx ckDl fuEu LØhu vuqlkj fn[kkbZ nsaxsaA

ii. blesa nks fodYi gS "Allow and Deny" vkidks Allow cVUk nckuk gS rks ejht dks osc dSejk ds

lkeus j[ks rks LØhu ij vkidks ejht dk QksVks fn[kkbZ nsxkA

iii. blds Ik'pkr vkidks "capture" cVu fDyd djuk gS blds ckn nkfgus ckWDl esa ejht dk QksVks

vk tk;sxkA

iv. ;fn vkidks yxrk gS fd ejht dh QksVks /kaq/kyh vFkok lkQ ugha vkbZ gS rks vki mijksDr izfØ;k

dks iqu% nksgjk,aA

35

2- PDF esa QksVks viyksM djuk

ejht dk QksVksxzkQ PDF esa Hkh viyksM fd;k tk ldrk gS blds fy, vkidks "Report

Document Type" ds combo esa ls "Pre Patient Photo pquuk gksxkA

v. MkDVj dh iphZ viyksM djuk% MkDVj dh iphZ viyksM djuk vR;Ur vko';d gS rFkk

lkW¶Vos;j esa bls "mandatory" fd;k x;k gSA vkidks MkDVj }kjk ejht dh MkDVj }kjk fy[kh

xbZ iphZ dks PDF File esa scan djds ,d QksYMj esa j[k ysaA /;ku jgs MkDVj dh iphZ esa isdst

dksM ,oa vHkh rd djkbZ xbZ tkapksa dh iw.kZ summary fy[kh gqbZ gksA

vi. "Doctor's Prescription" ds lkeus "choose button" dks fDyd djsa rFkk path select djds

tgka MkDVj dh iphZ LDsu dh gqbZ File j[kh gS] ogka ls ml Qkby dks pqusA

vii. blds Ik'pkr upload fDyd djsaA tc Qkby lQyrk iwoZd viyksM gks tk;sxh rks uhps ,d

eslst fuEukuqlkj vk tk;sxkA "PDF Uploaded Successfully"

36

VII. nLrkost viyksM djuk

pwafd lsds.Mªh] V'kZjh ,oa dsoy ljdkjh vLirkyksa ds fjtoZ isdst ds fy, Pre Authorization

Request Form lHkh ds common gSA ijarq V'kZjh isdst ds dsl esa gh Pre Authorization

Request U;w bafM;k ,';ksjsal daiuh dks tk;sxkA rFkk bldh Lohd`fr ds fy, ejht }kjk iwoZ esa

fy, x;s bykt dk fooj.k] djk;h xbZ tkap fjiksVZ ftuds vk/kkj ij V'kZjh isdst vFkok isdstst

dks pquus dh vko';drk gqbZ gS oks nLrkost vkidks ;gka yxkus gksxsaA vc vkidks ,d ,d djds

nLrkost yxkus ds fy, fuEu izfØ;k viukuh gksxh%

a. Report Document Type ij fDyd djsa bleas fuEu LØhu ds vuqlkj Drop Down Menu [kqy

tk;sxk

b. vc vkidks tks Hkh Document vFkok fjiksZV viyksM djuh gS] mls pqusaA blds lkeus Choose

button ij fDyd djsa tgka Document scan djds j[ks gq, gSa ogka ls select djsA

c. blds Ik'pkr viyksM cVu dks fDyd djsa] vkidks LØhu ij ,d eslst vk;sxk "Document

Attached Successfully" ;gka /;ku nsa fd vHkh ;g Document lkW¶Vos;j esa viyksM ugha gqvk gS

dsoy Attached gqvk gS vkidks fuEu LØhu fn[kkbZ nsxhA

37

d. ;g /;ku j[ksa fd nLrkost vHkh viyksM ugha gqvk gS] vHkh dsoy Attached gqvk gS rFkk " Report

Document Name" ds uhps No Record Found vk jgk gSA

e. vc vkidks ,d ckWDl "Enter Remarks" dk fn;k gqvk gS bl nLrkost ds lanHkZ esa vki tks Hkh

Remarks fy[kuk pkgs rks ;gka fy[k ldrs gSaA ¼;g dksbZ vko';d QhYM ugha gS½A

f. blds Ik'pkr vki "Insert Detail" cVu ij fDyd djsa] vki ns[ksaxs fd ;g Document vc

lks¶Vos;j esa viyksM gks x;k gS rFkk bldk fooj.k blds Åij cuh gqbZ rkfydk " Report

Document Name" esa fn[kkbZ nsus yxsxkA rFkk Report Type ds uhps fjiksVZ dk uke] upload

status ds uhps success rFkk remarks dkWye ds uhps vkids }kjk vafdr fd;k x;k Remarks

fn[kkbZ nsxkA ¼;fn vkids Remarks dkWye esa dqN fy[kk gS rks½

38

g. bl izdkj vki ,d&,d djds ftrus Documents vko';d gS vkus yxk ldrs gSA izR;sd ckj

vkidks fjiksVZ select djuk gS fQj choose blds ckn upload rFkk blds ckn remarks esa fy[kuk

gS rFkk blds Ik'pkr Insert Details cVu fDyd djuk gSA ;gka ;g /;ku j[kuk gS izR;sd PDF

fjiksZV 250 KB ls T;knk dh ugha gksuh pkfg, ;fn dksbZ fjiksZV cMh gS rks nks VqdM+ksa esa vyx

vyx Ldsu djds yxk,aA ;fn vkidks nwljk nLrkost vkSj viyksM djuk gS] rks blh izfØ;k dks

iqu% nksgjk,aA

h. bl izdkj ls vki ,d ,d djds ftrus Hkh nLrkost viyksM djuk pkgs dj ldrs gSaA

i. PDF esa QksVks Hkh ;gha ls blh izdkj ls viyksM djuk gSA

j. vki ftrus Hkh documents upload djsxsa oks lc blds Åij fn[kkbZ nsuh okyh rkfydk esa Li"V

fn[ksxh rFkk ftl fjiksZV ds lkeus vkius tks remarks fy[ks gS oks Hkh fn[kkbZ nsxsaA

k. ;fn dksbZ Doucment xyr yx x;k gS bl rkfydk ds vfrae dkWye esa Delete Record dk

fodYi fn;k x;k gS vki bls fDyd djsxas rks og fjdksMZ gV tk;sxkA

l. ;gka ;g /;ku j[kuk gksxk fd izR;sd upload djus okyh PDF QkbZy 250 KB ls T;knk ugha gksuh

pkfg,A

m. blds ckn vkidks "submit" cVu nckuk gS ;fn vkius lHkh QhYM lgh rjhds ls Hkjs gSa rFkk dksbZ

xyrh ugha dh gS] rks vkidh LØhu ij ,d eslst vk,xk fd "Your Pre Authorization Requist

Submitted Successfully"

uksV%

1- tc rd fdlh TID ds fy, isdst ugha pqus tk,saxs rc rd og TID Case Status Tracker esa ugha

fn[ksaxsA

2- tc Pre Authoirzation Requiest lQyrk iwoZd Hkj fn;k tk;sxk] ;g TID Case Status Tracker esa

fn[kuk izkjaHk gks tk;sxhA

3- Pre Authorization Request Form ds lQyrk iwoZd Hkjus rFkk Submit djus ds ckn fuEu izdkj

ls fofHkUu ifjfLFkfr;ka gks ldrh gSa %&

a. ;fn vkius ejht ds bykt ds fy, lsds.Mªh@ljdkjh vLirkyksa ds fy, vkjf{kr isdst pqus gSa]

rFkk ykHkkFkhZ ifjokj ds okWysV esa Ik;kZIr jkf'k gS rks bldk Pre Authorization Approved dh

fLFkfr esa gSA vki ejht dk "Pateint Admission Form" Hkj ldrs gSaA

b. rFkk ;fn ejht ds okWysV esa Ik;kZIr jkf'k ugha gS rks ;g Fund Enhancment Approval

Pending dh fLFkfr esa jgsxk vr% isdst pqurs gq, /;ku j[kk tkos fd tgka rd laHko gks ejht

ds ifjokj ds okWysV esa cdk;k jkf'k ls T;knk ds isdst ugha pqusA

c. ;fn vkius V'kZjh isdst pquk gS vFkok lsds.Mªh vFkok ljdkjh ds lkFk&lkFk V'kZjh isdst Hkh

pquk gS rks ,slh fLFkfr esa bldk LVsVl Pre Auth Approval Pending jgsxkA ijarq tSls NIA

bldks Lohd`r dj nsxh rc bldh fLFkfr Pre Authorization Approved dh gks tk;sxhA

d. ;fn NIA ls 48 ?kUVs esa Pre Authorization Approved ugha vkrk gS] rFkk dksbZ Query Hkh

izkIr ugha gksrh gS] rks Hkh fLFkfr Pre Authorization Approved dh gks tk;sxhA

39

VIII. Patient Admission Form

1- fdlh ejht dk Pateint Admission Form rc gh Hkjk tk ldrk gS tc rd ml TID dh fLFkfr

"Pre Authorization Approved" dh gks tk;sxhA

2- ;fn fdlh TID dh fLFkfr ^^ Pre Authorization Approval Pending" vFkok "Fund

Enhancement Approval Pending dh gS rc rd ml TID ds fy, Patient Admission Form

ugha Hkjk tk ldrk gSA

3- LØhu ij ck;ha rjQ fn;s x;s fyad "Pateint Admission Form" ij fDyd djsa] ,d LØhu

fuEukuqlkj fn[kkbZ nsxhA

4- vc ejht dh TID dks VkbZi djsa vFkok dkWih djds TID okys ckWDl esa isLV djsaA

5- vc TID ds ckWDl ds ckgj dgha Hkh fDyd djsa

6- ;fn TID dk case Status "Pre Authorization Approved" dk gS rks ejht dk uke vius vki vk

tk;sxkA

7- vc vkidks ejht dh HkrhZ djus dh fnukad ,oa le; Hkjuk gSA

8- MRD NO % ;g dsoy mu ljdkjh vLirkyksa dks Hkjuk gS ftu vLirkyksa esa vkjksX; vkWu ykbZu

flLVe pkyw gSA ;g vkjksX; vkWuykbu flLVe }kjk l`ftr gksrk gSA futh vLirkyksa ,oa 'ks"k

ljdkjh vLirkyksa dks ;g QhYM [kkyh NksM+uk gSA

9- blds Ik'pkr vkidk Submit cVu ij fDyd djuk gSA ejht dk bl TID ls lacaf/kr leLr MsVk

dEI;wVj ij Save gks tk;sxkA

tSls gh vki Patient Admission Form dks lQyrk iwoZd Hkj dj Submit dj nsaxs] dsl LVsVl Vªsdj

esa ejht dh HkrhZ dk le; ,oa fnukad fn[kkbZ nsuk izkjaHk gks tk;sxkA

40

IX. TID Cancellation / Edit Form

vko’;drk gksus ij pqus x;s iSdst dks CykWd djus rFkk cnyus dh lqfo/kk lks¶Vos;j esa miyC/k djk

nh xbZ gSA ;fn vkius fdlh TID ds fy, isdst pqu fy, gS ,oa vHkh rd Dyse Submit ugha fd;k gS

rFkk bykt ds nkSjku vkidks iSdsr esa ifjorZu vFkok vfrfjDr iSdst pquus dh vko’;drk gksrh gS] rks

vki pqus x;s isdst dks fujLr vFkok muesa la'kks/ku dj ldrs gSaA blds fy, fuEu izfØ;k dk /;ku

j[kuk vko’;d gS %&

i. lkW¶Vos;j ds eq[; i`"B ij ck;ha rjQ QUICK LINK esa vafre fodYi TID Cancellation Form dk

j[kk x;k gSA fuEukuqlkj LØhu fn[kkbZ nsxh

ii. ftl TID dks vki la’kksf/kr djuk pkgrs gSa mls uksV djds j[k ysaA

iii. ftl TID dks vki la’kksf/kr djuk pkgrs gSa mls TID Cancellation Form esa bUnzkt djsa ,oa ckWDl

ds ckgj fDyd djsaA blls lacaf/kr ejht dh tkudkjh LØhu ij vk tk;sxhA

iv. QkWeZ ds uhps SUBMIT cVu dks fDyd djsaA ,slk djus ls LØhu ij ,d Confirmation Message

vk;sxkA ftls lgefr dh voLFkk esa YES djsa vU;Fkk NO fDyd djsaA

41

v. YES fDyd djus ds mijkar LØhu ij ,d lans’k izlkfjr gksxk ftlesa vkids iqjkus TID dks

Software fujLr djrs gq;s u;k TID tujsV djsxk] ftls Hkfo"; ds lkjs TRANSACTIONS ds

fy;s bLrseky fd;k tk;sxkA bl u;s TID dks uksV dj ysaA

vi. ,slk djus ds mijkar LØhu ij lans’k izlkfjr gksxk “YOUR REQUEST SUBMITTED

SUCCESSFULLY, PLEASE NOTE DOWN YOUR NEW HRN ID NO”

vii. blds mijkar iqjkus TID ds lHkh lacaf/kr ewy nLrkost u;s TID ij gLrkarfjr gks tk;saxs ,oa

mUgsa iqu% viyksM djus dh vko’;drk ugha iMsxhA

viii. blds mijkar LokLF; ekxZn’kZd PRE AUTHORIZATION REQUEST FORM ij tkdj u;h TID

banzkt dj la’kksf/kr iSdst ejht ds fy;s CYkkWd dj ldrs gSaA blls vkxs dh izfØ;k iwokZuqlkj

gSA

ix. iSdst cnyrs le; bykt dj jgs MkWDVj }kjk isdst cnyus dh vko’;drk dk mYys[k djrs

gq;s lacaf/kr nLrkost SOFTWARE esa viyksM djus gksaxsA

x. iSdst esa fdlh Hkh izdkj dk la’kks/ku iSdst cqd djus okyh ewy laLFkku }kjk ftlus TID

Generate dh gS mlh laLFkku }kjk fd;k tk ldrk gSA

u;h TID GENERATE djus ds Ik’pkr fuEu izdkj dh fLFkfr gks ldrh gS%&

42

pqus x;s ¼u;s iSdst½ dsoy ljdkjh vLirkyksa ds fy, vkjf{kr ;k lSds.Mªh vFkok nksuksa izdkj ds

gS½ rFkk mlds ifjokj ds okysV esa la’kksf/kr isdst ds vuqlkj jkf’k miyC/k gS] rks la’kksf/kr

iSdst ds vuqlkj bykt izkjEHk fd;k tk ldrk gSA ijUrq ;fn mlds okysV es a mruh jkf’k

miyC/k ugha gS rks izdj.k dh fLFkfr dks ns[krs gq;s bykt djus okys fpfdRld dh vuq’kalk ds

lkFk fund enhancement ds fy, izsf"kr fd;k tk;sxk ,oa fund enhancement dh Lohdfr ds

Ik’pkr gh bykt fd;k tk ldsxkA

;fn pqus x;s u;s iSdst V’kZjh ¼vFkok V’kZjh ds lkFk dsoy ljdkjh vLirkyksa ds fy, vkjf{kr

;k lSds.Mªh ½ izdkj dk gS rFkk ejht dh ubZ TID Hkh lkekU; fLFkfr esa tkjh dh xbZ gS rks ,sls

izdj.k U;w bafM;k ,’;ksjsal dEiuh dks Pre Authorization ds fy, izsf"kr gksxsa rFkk Pre Auth dh

Lohd`fr@Auto Lohd`fr ds Ik’pkr u;s isdstst esa bykt izkjEHk fd;k tk ldrk gSA o’krsZ ds

mlds okWyV esa Ik;kZIr jkf’k gks vU;Fkk izdj.k Fund Enhancement ds fy, Treating Doctor dh

Recommendation ds fy, izsf"kr gksxk RkFkk Lohd`fr Ik’pkr u;s isdstst esa bykt izkjEHk fd;k tk

ldrk gSA

;fn isdst esa ifjorZu ejht dks xEHkhj fLFkfr dks ns[krs gq;s fd;k x;k rks ,slh fLFkfr esa ubZ

TID Emergency ds Through Treating Doctor foLr`r dkj.k n’kkZ dj supporting documents upload

djrs gq, rqjUr bykt izkjEHk djsaxs pkgs u;s isdst lSds.Mªh@V’kZjh dksbZ Hkh gks] pkgs mlds

okWysV esa jkf’k gks vFkok ugha gksA

;gka fpfdRldksa dks ;g lykg nh tkrh gS fd izkjEHk esa gh tgka rd gks lds lgh isdst pqusA

bykt ds nkSjku vko’;d tkap fjiksVZ vFkok ejht dh vU; fLFkfr;ksa dk s ns[krs gq;s iSdst

cnyuk gks] rHkh isdstst esa ifjorZu djsaA bldks lkekU; izSfDVl ugha cuk;sA

iSdst CykWd djuk

;fn fdlh ejht dks fuf’pr iSdst ds rgr HkrhZ fd;k tkrk gS rFkk fdlh Hkh dkj.k ls ml

izfØ;k dh vko’;drk lekIr gks tkrh gS ¼jsQj dsl lfgr½ rks ,slh ifjfLFkfr esa vkidks bl

TID dks CykWd djuk gksxk rFkk vLirky dks dsoy izfrfnu okys isdst ds vuqlkj ftrus fnu

ejht HkrhZ jgk gS] iquZHkj.k fd;k tk;sxkA

iqu% Li"V fd;k tkrk gS fd fdlh isdst dk iquZ% Hkj.k mlh laLFkku dks fd;k tk;sxk tgka

izfØ;k iw.kZ dh xbZ gSA

43

X. Patient Discharge and Claim Submission Form

mipkj lekfIr ds ckn vkidks Patient Discharge and Claim Submission Form Hkjuk gksxkA bl QkeZ dks

Hkjus ds fy, fuEukuqlkj lqfuf'pr dj ysa %&

i- ftl TID dk Claim Submit djuk gS mldk Status Pre Authorization Approved gksuk

pkfg,A

ii- ejht dk Patient Admission Form lQyrkiwoZd Hkj fn;k x;k gSA

iii- ejht ds leLr tkap fjiksVZ Ldsu djds dEI;wVj ij ,d QksYMj esa j[k yh xbZ gSA

iv- ejht dh MkDVj dh iphZ iwoZ esa gh viyksM dj nh xbZ gS ;fn ugha dh xbZ gS rks iqu%

viyksM dj ldrs gSaA

v- ejht dh HkrhZ ds le; QksVks viyksM dj j[kh gSA

vi- ejht ds igpku ds leLr nLrkost tSls jk'kudkMZ dh izekf.kr izfr ejht dk QksVks igpku

i= dh izekf.kr izfr viyksM dj j[kh gSA

vii- mijksDr lqfuf'pr gks tkus ds Ik'pkr vc LØhu ij ck;ha rjQ fn, x;s Quick Link esa ls

Patient Discharge and Claim Submission ij fDyd djsaA fuEukuqlkj ,d LØhu fn[kkbZ

nsxh%

HkrhZ ds le; yxk;s x, nLrkost ;Fkk MkDVj iphZ] ejht dk QksVks] yxkbZ xbZ tkap fjiksVZ Hkh ;gka

fn[kuh pkfg,A

vc fuEu izfØ;k viuk,as%&

1- TID Box esa ejht dh TID VkbZi djsa vFkok dkWih djds Paste djsaA

2- TID Box ds ckgj LØhu ij dgha Hkh fDyd djsaA

3- ejht dk uke] HkrhZ dk fnukad ,oa le; vius vki LØhu ij vk tk;sxkA

4- vc vkidks ejht ds fMLPkktZ dh fnukad ,oa le; Enter djuk gSA

5- vc vkidks Patient Dischazrge Status esa ls ,d fodYi pquuk gSA ;gka ikap fodYi 1- LAMA 2-

Normal Discharged 3- Absconded 4- Death ,oa 5- Case Refered fn;s x;s gSa buesa ls ifjfLFkfr

vuqlkj ,d fodYi pquuk gSA

44

6- Normal Discharge ds le; ejht dk QksVks xzkQ viyksM djuk gS] blesa ogh rjhdk viukuk gS

tks "Pre Authorization Request Form esa fn;k x;k gSA

7- vc blds Ik'pkr ejht ds HkrhZ jgrs le; dh tkap fjiksZVl viyksM djuh gSA

8- 156 isdstt ds fy, "Minimum Document Protocol" ifji= la[;k LINK ds }kjk tkjh fd;k

x;k gS bu isdstt esa dsoy buds lkeus fn;s x;s nLrkost viyksM fd;s tkosA vU; nLrkostksa dh

vko';drk ugha gSA

MDP ds vUrxZr ftu isdst ds fy, U;wure nLrkost yxkuk fuf'pr fd;k x;k gS mu nLrkost

yxkus ds fy, mandatory field LØhu ij gksus pkfg,A

Discharge ticket viyksM djuk vko';d gS vr% blds fy, Hkh vyx ls mandatory field LØhu

ij gksuk pkfg,A

9- vU; isdstst ds fy, HkrhZ ds le; dh xbZ ;k vko';drk gksus ij HkrhZ iwoZ dh tkap fjiksZVl

viyksM dh tkuh gSA

10- X-Ray, MRI, CT-SCAN, Ultra-Sound, Color Dopller bR;kfn dh fQYe yxkus dh vko';drk

ugha gS dsoy budh fjiksZVl yxkosaA

11- ;fn X-Ray Reports miyC/k ugha gS rks MkWDVj dh iphZ ij X-Ray dh Finding vko’;d ,oa

Li"V :Ik ls fy[kh gksuh pkfg,A

lks¶Vos;j esa Reports fuEu izdkj ls viyksM djuh gS %&

1- LØhu esa uhps fn;s x;s Reprot Document Type ds Drop Down Menu ij fDyd djsaA

fuEukuqlkj LØhu fn[kkbZ nsxhA

45

2- vc vki bl esU;w esa ls tks fjiksVZ yxkuh gS mls pqus rFkk Choose dks fDyd djsaA ,d path

[kqysxk rFkk fjiksZVl tgka vkius fjiksVZ dh PDF esa Ldsu dkWih j[kh gqbZ gS mls Select djsaA

3- blds Ik'pkr viyksM cVu dks fDyd djsa] vkidks LØhu ij ,d eslst vk;sxk "Document

Attached Successfully" ;gka /;ku nsa fd vHkh ;g Document lkW¶Vos;j esa viyksM ugha gqvk gS

dsoy Attached gqvk gS vkidks fuEu LØhu fn[kkbZ nsxhA

4- vc vkidks ,d ckWDl "Enter Remarks" dk fn;k gqvk gS bl nLrkost ds lanHkZ esa vki tks Hkh

Remarks fy[kuk pkgs rks ;gka fy[k ldrs gSaA ¼;g dksbZ vko';d QhYM ugha gS½A

5- blds Ik'pkr vki "Insert Detail" cVu ij fDyd djsa] vki ns[ksaxs fd ;g Document vc

lks¶Vos;j esa viyksM gks x;k gS rFkk bldk fooj.k blds Åij cuh gqbZ rkfydk "Attach

Document for Claim Submission" esa fn[kkbZ nsus yxsxkA rFkk Report Type ds uhps fjiksVZ dk

uke] upload status ds uhps success rFkk remarks dkWye ds uhps vkids }kjk vafdr fd;k x;k

Remarks fn[kkbZ nsxkA ¼;fn vkids Remarks dkWye esa dqN fy[kk gS rks½

6- bl izdkj vkidks ,d&,d djds ftrus Documents yxkus vko';d gS] vki yxk ldrs gSA

izR;sd ckj vkidks fjiksVZ select djuk gS fQj choose blds ckn upload rFkk blds ckn remarks

esa fy[kuk gS rFkk blds Ik'pkr Insert Details cVu fDyd djuk gSA ;gka ;g /;ku j[kuk gS

izR;sd PDF fjiksZV 250 KB ls T;knk dh ugha gksuh pkfg, ;fn dksbZ fjiksZV cMh gS rks nks VqdM+ksa esa

vyx vyx Ldsu djds yxk,aA

7- bu nLrkostksa esa gh vkidks discharge ticket t:j ls mijksDrkuqlkj viyksM djuk gSA Hkkek'kkg

LokLF; chek ;kstuk dk QhM+cSd QkeZ Hkh viyksM djuk gSA bl rkfydk ds vafre dkWye esa

"Action" fy[kk gqvk gS] ;fn vkidks yxrk gS fd vkius dksbZ xyr Docuemtnt upload dj fn;k

gS rks mls vki delete vkbZdu ij fDyd djds Delete dj ldrs gSaA

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8- mijksDrkuqlkj lqfuf'pr djus ds mijkUr vFkkZr discharge dk fnukad ,oa le;] discharge

ticket, discharge ds le; dh QksVks viyksM ,oa vko’;d leLr fjiksVZ viyksM gksus dh

lqfuf'prk djus ds ckn lcls uhps fn, cVu "Submit" dks fDyd djus ij ;g claim NIA dks

submit gks tk,xkA lQyrk iwoZd submit gksus ij vkidh LØhu ij ,d eslst vk;sxkA ;fn

lQyrk iwoZd submit ugha gqvk gS rFkk error eslst vkrk gS ml error dks lekIr djs iqu%

dksf'k'k djsaA

tc "Patient Discharge and Claim Submission Form lQyrk iwoZd submit gks tk;sxk

rks case status Tracker esa bldk status claim approval pending gks tk;sxk rFkk ejht

dks discharge dh fnukad ,oa le; fn[kkbZ nsus yxsxkA

vc rd geus ejht dks HkrhZ djus ,oa discharge djus ds rjhds ds ckjs esa ppkZ dh Fkh vc ge dqN

fjiksZV ,oa yxk, vk{ksi ,oa case status tracker ds ckjs esa ppkZ djsxsaA lcls igys Query Panel dh

ppkZ djrs gSaA

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XI. Query Panel

1. vkids vLirky ls lacaf/kr Query dks tkuus ds fy, vkidks ck;ha rjQ fn;s x;s Quick Link

esa ls Report Sumamry ij fDyd djus ij fuEukuqlkj LØhu fn[kkbZ nsxhA

ii. Pkg Status esa ls Claim Package Query, Pre-auth Package Query vFkok Fund Enhancement

Query ftls Hkh ns[kuk gks ml ij fDyd djsaaA

2. bl ij vkidks fuEu rkfydk ds vuqlkj ml Query ls lacaf/kr TIDs dk fooj.k fn[kkbZ nsxkA

3. ftl TID dk fooj.k vkidks ns[kuk gS mldh dkWih djysaA

i. vc vki quick links esa query panel djs fDyd djsa rFkk dkih xbZ TID dks TID box eas

copy djsaA blds i'pkr TID box ds ckgj dgha Hkh fDyd djsxsa] rks bl ejht ls lEcfU/kr

tkudkjh fuEu LØhu vuqlkj vius vki vk tk;sxhA

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ii. vc vki bl TID ij tSls nkbZ rjQ scroll djsxs rks status esa ftl rjg dh query gS] mldk

izdkj vafdr gksxkA vfUre remarks okys colomn esa tks query yxkbZ xbZ og fn[kkbZ nsxhA

iii. vc vki reply box esa esa bl query ds lUnZHk esa tks tokc fy[kuk pkgs fy[k ldrs gS

rFkk query details es vki ,d MB dh single zip file vFkok PDF file yxk ldrs

gSA ;g¡k vki ;g uksV djys dh documents ckjh&2 ls ugha yxkus gS cfYd ,d single

file pkgs zip vFkok PDF yxkuh gS

,d ckj query dk tokc nsus ds ckn query isusy esa ;g TID fn[kkbZ ugha nsxh D;ksafd vc ;g

pending query status esa ugha jgh gSA

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XI. Case Status Tracker

;fn fdlh TID dk states ns[kuk gks rks vki Case Status Tracker esa tkdj ns[kuk gksxk]

fodYi ds :i esa Report Summery esa tkdj Hkh Status ns[kk tk ldrk gSA

1. ok;h rjQ fn, x;s Quick Links esa ls Case Status Tracker ij fDyd djsxsa rks

fuEukuqlkj LØhu fn[kkbZ nsxhA

2. vc vkidks bl Case Status Tracker esa fuEu izdkj ls search djus ds fodYi miyC/k

gS%

i. TID – searching using a TID

ii. Select Package – searching by type of package – Secondary or Tertiary or

All rhuksa esa fdlh Hkh ,d fodYi dks pqussA fuEukuqlkj Ldzhu fn[kkbZ nsxhA

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iii. Case Status – searching by the status of different TIDs fofHkUu izdkj ds status ds

menu esa ls fodYi pqusA fuEukuqlkj Ldzhu fn[kkbZ nsxhA

4. TID – searching using a TID :

i. TID ds lkeus okys okDl TID dk uEcj VkbZi djsa vFkok TID dk uEcj dkih djds

bl okDl eas isLV djsaA

ii. blds i'pkr ^^seareh criteria** ds cVu dks fDyd djsaA vkidks bl TID lEcfU/kr

tkudkjh fuEu Ldzhu ds vuqlkj fn[kkbZ nsxh

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iii. TID okys dkye ds uhps nh xbZ TID ij fDyd djsa bl TID ls lEcfU/kr tkudkjh

fuEu Ldzhu ds vuqlkj [kqysxhA

1. blesa fuEu izdkj ls fooj.k gksxk TID No. ejht dk uke] Case Type, Hospital Name,

Hospital type, Identity Type, Identity number, Admission Date, Discharge Date, Wallet

Details ,Package Status bu lcds vfrfjDr chek dEiuh )kjk dh xbZ query vFkok claims dks

fujLr djus dk dkj.k Hkh package ramarks ds dkye esa package status ds vuqlkj fn[kkbZ nsxkA

5. Searching by Type of Package : Select package ds drop down menu esa ls vki package

pqu ldrs gSA

i. ;fn V'kZjh vFkok lsds.Mh vFkok leLr tSlk Hkh vki pkgs select dj ldrs gS bu rhuksa esa ls vki

tks Hkh select djxsa muls lEcfU/kr TIDs tks vkids vLirky }kjk tujsV dh xbZ gSA fuEukuqlkj

LØhu esa fn[kkbZ nsxhA

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5. TID ds status ds vuqlkj [kkst& fuEu fLdzu ds vuqlkj select stataus ds drop down

ckDl esa fdlh Hkh LVsVl dks pqu dj ml status ls lEcfU/kr tids dh fyLV fuEu Ldzhu vuqlkj

izkIr dj ldrs gSA

6. mnkgj.k ds #i es vkids vLirky ds )kjk submit fd, x;s Dysel ij chek dEiuh }kjk dh

xbZ query dh tkudkjh pkgrs gS rks vkidks select status ds drop down menu ls claim

package query dkss select djds search critera ds cVu dks fDyd djuk gSA

1. vkidks mu TIDs dh fy[k fuEu Ldzhu ds vuqlkj ikzIr gksxh claims ds mij chek dEiuh

}kjk query dh xbZ gSA

2. blds LFkku ij vki Quick Links ij Report Summry esa tkdj Claim Package

Query Select djds Hkh bl list dks izkIr dj ldrs gSA

3. Case States Tracker es ,d ist ij 20 TID utj vk,xh ;fn vki ,d ist ij vf/kd

TID ns[kuk pkgrs gS rks rkfydk esa lcls uhps vkf[kj esa 20 ds lkFk fy[kk gqvk gS tSls gh bl

ij fDyd djsxsa rks og la[;k pqu ldrs ftruh TID vkidks ist ij ns[kuh gS

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XII. Report Summery

bl report ds ek/;e ls vkius ftruh TIDs l`ftr dh gS mudk Status ns[kk tk ldrk gS

1. ck;s rjQ fn, x;s Quick Link esa Report Summery ij fDyd djsA vkidks fofHkUu

isdst LVsVl dh Summary fuEu rkfydk ds vuqlkj fn[kkbZ nsxh%&

2. vkids vLirky )kjk l`ftr dh xbZ leLr TIDS dk Package Status ds vuqlkj rkfydk

fn[kkbZ nsxsaA Package Status fuEukuqlkj gks ldrs gSA

1. Claim Approval Pending

2. Claim Approval Pending At Analyser

3. Claim Package Approved

4. Claim Package Approved And Paid

5. Claim Package Query

6. Claim Package Rejected

7. Claim Query By Analyser

8. Claim Rejected By Analyser

9. Fund Enhancement Approval Pending

10. Fund Enhancement Package Query

11. Fund Enhancement Package Rejected

12. Pre Auth Approval Pending

13. Pre Auth Approved

14. Pre Auth Package Query

15. Pre Auth Package Rejected

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16. 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: