How To Upload Preauth

TNNHIS Web-Module Documentation

PROVIDER LOGIN Tamil Nadu Employees Health Insurance Scheme 2012

MDIndia Healthcare Services [TPA] Pvt. Ltd. Page 1

INDEX

1. ABOUT TNNHIS WEB MODULE 02

2. ENTRY LEVEL PROCESS FOR PROVIDERS UNDER TNNHIS 03

3. STEPS TO LOGIN INTO TNNHIS WEB MODULE 05

4. STEPS TO USE PROVIDER LOGIN 07

5. STEPS TO PROCESS FRESH INWARD 09

6. STEP TO PROCESS QUERY REPLY 13

7. STEPS TO APPLY FOR RECONSIDERATION OFDENIAL 17

8. STEPS TO APPLY FOR ENHANCEMENT IN AL 18

9. STEPS TO UPDATE HOSPITAL DETAILS 20

10. STEPS TO CHANGE PASSWORD 22

11. PROCEDURE TO CHECK AUTHORISATION DOCUMENT SUMMARY 23

12. PROCEDURE TO CHECK REQUEST FOR AUTHORISATION LETTER 24

13. PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED IN AUTHORISATION 25

14. PROCEDURE TO CHECK AUTHORISATION LETTERS DENIED DETAILS 26

15. PROCEDURE TO CHECK AUTHORISATION LETTERS ISSUED 27

16. PROCEDURE TO CHECK TOTAL INWARD DONE 28

17. PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED 32

18. PROCEDURE TO CHECK PROCESS CLAIM DETAILS 33

19. PROCEDURE TO CHECK PAID CLAIM DETAILS 36

20. PROCEDURE TO CHECK PACKAGE RATE LIST 37




ABOUT TNNHIS WEB MODULE:

TNNHIS web module is for managing the data online. Here we have provided the following list of Logins

to the end users:

1. PROVIDER LOGIN

2. MDININDIA LOGIN

The web module is for representing all the information of Inward / Claims and Authorization handled by

Provider.

Hospital Transactions include:

• Fresh Inward

• Query Reply

• Reconsideration of Denial

• Enhancement in AL

• Update Hospital Details

• Change Password

Claims Status Includes:

• Under Process Claims Detail

• Additional Document Requested

• Processed Claims Details

• Paid Claims Details

• Repudiated Claims Details

Authorisation Status Includes:

• Authorisation Document Summary

• Requests for Authorisation Letter

• Additional Documents Requested in Authorisation

• Requests for Authorisation Letter Denied

• Authorisation Letter issued

• Total Inward Done

Package Rate List includes:

• Package Rate List details




ENTRY LEVEL PROCESS FOR PROVIDERS UNDER TNNHIS:

1. When a patient approaches a TNNHIS empanelled Hospital for treatment, the provider needs to

ensure the following:

• The patient is a valid beneficiary of the scheme and fulfills the definition of “employee”

or “family” of the scheme.

(a) “Employee” means an Employee of the Government of Tamil Nadu, State Public

Sector Undertakings, and Local Bodies in Tamil Nadu, State Government Universities

and Statutory Boards under the control of the Government of Tamil Nadu.

(b)"Family” includes the Employee, and the members of his or her family who are

eligible for assistance under the Scheme as detailed below:

(i) Legal spouse of the Employee.

(ii)Children of the Employee - till they get employed or married or attain the age

of 25 years whichever is earlier and dependent on the Employee;

(iii) The parents of the Employee, in the case of unmarried employee until the

Employee gets married

• Documents that confirm eligibility should be verified:

i. A photo I-Card issued by the State Authorities and

ii. The health card issued by insurance company (United India Insurance Company)

with a family photograph of the beneficiaries.

2. When the beneficiary is enrolled in the Third Party Administrator Database, on entering the Card

No issued by the Insurance Company, the details of the beneficiary would get populated in the

login screen as shown below

TNNHIS

PROVIDER LOGIN

MDIndia Healthcare Services [TPA] Pvt. Ltd.

3. In case the beneficiary is valid but not enrolled in TPA database, the provider can proceed with

Authorization request for treatment, but the documents that would be sent for Authorization,

should also include a signed copy of Annexu

Authorization Letter is issued.

HIS Web-Module Documentation

Tamil Nadu Employees Health Insurance Scheme 2012


Login Screen

In case the beneficiary is valid but not enrolled in TPA database, the provider can proceed with


should also include a signed copy of Annexure E (Form 20) for enrollment by the TPA before the

Authorization Letter is issued.

Module Documentation


Page 4

In case the beneficiary is valid but not enrolled in TPA database, the provider can proceed with


re E (Form 20) for enrollment by the TPA before the




STEPS TO LOGIN USING TNNHIS WEB MODULE

STEP- 01

Login to http://www.mdindiaonlilne.com

Refer Screenshot – [01]

Screenshot – [01]

The above screenshot – [01] contains the “TN Employee Scheme Tab”, click on this Tab to proceed.

Click on My Account Tab

TNNHIS

PROVIDER LOGIN


STEP- 02

After clicking the above My Account

1. OBJECTIVE

2. ONLINE STATUS

a. PROVIDER LOGIN

b. MDINDIA LOGIN

3. POLICY INFORMATION

4. PREMIUM INFORMATION

5. CONTACT US

6. PROVIDER MANAGEMENT




My Account Tab the below mentioned ‘options’ will appear



Page 6

Screenshot – [02]

will appear

TNNHIS

PROVIDER LOGIN


STEPS TO USE PROVIDER LOGIN

STEP- 03

To begin the process of Inward –

STEP- 04

a. Select the Hospital Name

b. Click Login tab

Refer Screenshot – [04]

Note: If the login details are correct it will redirect you to Pr

Details .




OGIN

– Click on My Account �Provider Login

Hospital Name from the dropdown list and enter the password

: If the login details are correct it will redirect you to Provider’s Homepage with Hospital



Page 7

Screenshot – [03]

and enter the password

ovider’s Homepage with Hospital

TNNHIS

PROVIDER LOGIN







Page 8

Screenshot – [04]

Screenshot – [05]

TNNHIS

PROVIDER LOGIN


STEPS TO PROCESS FRESH INWARD

When the beneficiary visits the provider for availing treatment the following steps to be followed:

a. Click on � Hospital Transaction

b. The request for Pre-Authorization would appear. In case of fresh Inward the Provider will have

to complete the information in the below mentioned Tab:

i. Patient Information

ii. Complaint Details




NWARD


Hospital Transaction�Fresh Inward – Refer Screenshot [06]

Authorization would appear. In case of fresh Inward the Provider will have

to complete the information in the below mentioned Tab:

Patient Information

Complaint Details



Page 9


Screenshot – [06]

Authorization would appear. In case of fresh Inward the Provider will have

TNNHIS

PROVIDER LOGIN


iii. Treatment Details

iv. Hospital Information (Auto Populated)




Treatment Details

Hospital Information (Auto Populated)



Page 10

Screenshot – [7]

TNNHIS

PROVIDER LOGIN


Note: Where procedure/package is not mentioned

the value of the treatment in the

v. Past History/Bill Particulars




Where procedure/package is not mentioned, select Package Type as Non-

value of the treatment in the Total Amount Tab.

Past History/Bill Particulars



Page 11

Screenshot – [8]

Screenshot – [9]

-Package and mention

TNNHIS

PROVIDER LOGIN


vi. Previous Policy Information

vii. Upload Scanned Document

Note: 1. Browse and Upload the documents to proceed further to the terms and

2. For not enrolled cases only .tiff




Previous Policy Information

Upload Scanned Document and Terms & Conditions

Browse and Upload the documents to proceed further to the terms and

tiff images would be acceptable.



Page 12

Screenshot – [10]

Browse and Upload the documents to proceed further to the terms and conditions.

Screenshot – [11]

TNNHIS

PROVIDER LOGIN


c. Tick on “I accept the terms and conditions”

d. Click on Save

Note: Incase any information is missed a Dialog box with the error would

e. Save action would generate the ‘

STEPS TO PROCESS QUERY REPLY

a. Go to �Hospital Transactions

b. Enter either of the following information to retrieve




Tick on “I accept the terms and conditions” [Refer Screenshot 11]

: Incase any information is missed a Dialog box with the error would pop up.

Save action would generate the ‘Inward No’

EPLY

Hospital Transactions � Query Reply

Enter either of the following information to retrieve patient query details



Page 13

pop up.

Screenshot – [12]

Screenshot – [13]

patient query details

TNNHIS

PROVIDER LOGIN


i. CCN Number

ii. MDID Number

iii. Patient Name

Note: The Patient Query details




he Patient Query details are can be viewed on the dashboard



Page 14

Screenshot – [14]

TNNHIS

PROVIDER LOGIN


c. Click on View to see the Additional Document Request form received from TPA.




to see the Additional Document Request form received from TPA.



Page 15

to see the Additional Document Request form received from TPA.

Screenshot – [15]

TNNHIS

PROVIDER LOGIN


d. To reply to the ADR click on

e. Browse and Upload the required documents

The documents uploaded will be




To reply to the ADR click on Details.

Browse and Upload the required documents

The documents uploaded will be forwarded to the Authorization department for further processing.



Page 16

Screenshot – [16]

Screenshot – [17]

forwarded to the Authorization department for further processing.

TNNHIS

PROVIDER LOGIN


STEPS TO APPLY FOR RECONSIDERATION


b. Enter either of the following information to retrieve

iv. CCN Number

v. MDID Number

vi. Patient Name




ECONSIDERATION OF DENIAL

Hospital Transactions � Reconsideration of Denial

Enter either of the following information to retrieve denial case



Page 17

Screenshot – [18]

Screenshot – [19]

TNNHIS

PROVIDER LOGIN


Click on the Detail to upload the necessary documents required during reconsideration of AL.

On uploading the document an Inward number which is alpha

STEPS TO APPLY FOR IN AL

c. Go to �Hospital Transactions

d. Enter either of the following information to

vii. CCN Number

viii. MDID Number

ix. Patient Name




to upload the necessary documents required during reconsideration of AL.

On uploading the document an Inward number which is alpha-numeric is generated

Hospital Transactions � Enhancement in AL

Enter either of the following information to request for Enhancement of AL



Page 18

Screenshot – [20]

to upload the necessary documents required during reconsideration of AL.

numeric is generated.

Screenshot – [21]

request for Enhancement of AL

TNNHIS

PROVIDER LOGIN


e. Click on View to see the AL’s received

f. Click on Details for requesting enhancement in AL amount.

g. Browse and Upload the required documents (only .




to see the AL’s received

for requesting enhancement in AL amount.

and Upload the required documents (only .tiff images would be acceptable)



Page 19

Screenshot – [22]

Screenshot – [23]

images would be acceptable)

TNNHIS

PROVIDER LOGIN


On uploading the document an Inward number which is alpha

STEPS TO UPDATE HOSPITAL





On uploading the document an Inward number which is alpha-numeric is generated

OSPITAL DETAILS

Hospital Transactions � Update Hospital Details



Page 20

Screenshot – [24]

Screenshot – [25]

numeric is generated.

TNNHIS

PROVIDER LOGIN


b. Provider can make the following changes;

i. Contact Person

ii. Landline No.

iii. Mobile No.

iv. Email Id

v. Fax No.




Provider can make the following changes;



Page 21

Screenshot – [26]

Screenshot – [27]

TNNHIS

PROVIDER LOGIN


STEPS TO CHANGE PASSWORD


b. Provider can change the password.

END OF ACTIVITY – HOSPITAL

The Inward Number generated would be




ASSWORD

Hospital Transactions � Change Password

Provider can change the password.

OSPITAL TRANSACTIONS

Inward Number generated would be alpha-numeric; this number would be used for further process.



Page 22

Screenshot – [28]

Screenshot – [29]

this number would be used for further process.

TNNHIS

PROVIDER LOGIN


DETAILS TO CHECK AUTHORISATION

The below mentioned steps will provide the different status in the Authorisation Process

i. Authorisation Document Summary

ii. Request for Authorisation Letter

iii. Additional Document Requested in Authorisation

iv. Request for Authorisation Letters

v. Authorisation Letter Issued

vi. Total Inward Done

PROCEDURE TO CHECK AUTHORISATION

a. Go to �Authorisation Status �




UTHORISATION STATUS

The below mentioned steps will provide the different status in the Authorisation Process

Authorisation Document Summary

Request for Authorisation Letter

Additional Document Requested in Authorisation

Request for Authorisation Letters Denied

Authorisation Letter Issued

UTHORISATION DOCUMENT SUMMARY

�Authorisation Document Summary



Page 23

The below mentioned steps will provide the different status in the Authorisation Process:

Screenshot – [30]

Screenshot – [31]




b. Enter Credentials �Click Search

Screenshot – [32]

c. This would give the summary in a tabular format [Refer Screenshot 31]

PROCEDURE TO CHECK REQUEST FOR AUTHORISATION LETTER(RAL)

a. Go to �Authorisation Status �Request for Authorisation Letter

Screenshot – [33]

b. Enter the CCN number/MDID number�Click Search




Screenshot – [34]

c. This would give the summary in the tabular format [Refer Screenshot 33]

PROCEDURE TO CHECK ADDITIONAL DOCUMENT REQUESTED IN AUTHORISATION

a. Go to� Authorisation Status � Additional Document Requested in Authorisation

Screenshot – [34]

b. Enter Credentials –CCN Number, MDID Number or Patient Name to Check query for a particular patient

Screenshot – [36]

TNNHIS

PROVIDER LOGIN


c. The Additional Documents Requested details can also be viewed on

consolidated details of total ADR raised

d. Click on View to see the ADR raised by TPA(Refer Provider Login process

Reply �Point ‘C’)


a. Go to �Authorisation�




Documents Requested details can also be viewed on the dashboard which gives the

consolidated details of total ADR raised

to see the ADR raised by TPA(Refer Provider Login process�Steps to Process Query

UTHORISATION LETTERS DENIED DETAILS

�Request for Authorisation Letter Denied



Page 26

the dashboard which gives the

Screenshot – [37]

Steps to Process Query

Screenshot – [38]

TNNHIS

PROVIDER LOGIN


b. Enter Credentials –CCN Number, MDID Number or Patient Name to Check Details. Click Search

c. The details will appear in a tabulated format


a. Go To �Authorisation Status

b. Enter Credentials–CCN Number, MDID Number or Patient Name to Check Details of AL I

c. The details of Authorisation Letter Issued can also be checked on the dashboard.




CCN Number, MDID Number or Patient Name to Check Details. Click Search

The details will appear in a tabulated format

UTHORISATION LETTERS ISSUED

Authorisation Status�Authorisation Letter Issued

CCN Number, MDID Number or Patient Name to Check Details of AL I

The details of Authorisation Letter Issued can also be checked on the dashboard.



Page 27

CCN Number, MDID Number or Patient Name to Check Details. Click Search

Screenshot – [39]

Screenshot – [40]

CCN Number, MDID Number or Patient Name to Check Details of AL Issued

Screenshot – [41]

The details of Authorisation Letter Issued can also be checked on the dashboard.

TNNHIS

PROVIDER LOGIN


d. Choose a case –Click View to see the AL raised by the TPA for the concerned patient

Refer Hopital doc preared.

e. Click on Details to see the details of Authorisation Details.

Note:Basis Authorisation Status the Provider will act accordingly

PROCEDURE TO CHECK TOTAL INWARD

a. Go to� Authorisation Status




Click View to see the AL raised by the TPA for the concerned patient

Refer Hopital doc preared.

Details to see the details of Authorisation Details.

Basis Authorisation Status the Provider will act accordingly

NWARD DONE

Authorisation Status�Total Inward Done



Page 28

Screenshot – [42]

Click View to see the AL raised by the TPA for the concerned patient

Screenshot – [43]

TNNHIS

PROVIDER LOGIN


b. Enter Credentials–CCN Number, MDID Number or Patient Name to Check Details of Inward

Done

c. The details of Total Inward Done will appear on a Dashboard.This Screen will give the details in a

consolidated format




Number, MDID Number or Patient Name to Check Details of Inward

The details of Total Inward Done will appear on a Dashboard.This Screen will give the details in a



Page 29

Number, MDID Number or Patient Name to Check Details of Inward

Screenshot – [44]

The details of Total Inward Done will appear on a Dashboard.This Screen will give the details in a

Screenshot – [45]

TNNHIS

PROVIDER LOGIN


d. Click on View to see the request for Pre Authorisation raised by the Provider




see the request for Pre Authorisation raised by the Provider



Page 30

see the request for Pre Authorisation raised by the Provider

Screenshot – [46]

TNNHIS

PROVIDER LOGIN


e. Click on Details to check the Inward Details

END OF ACTIVITY – AUTHORISATION

DETAILS TO CHECK CLAIMS STATUS

The below mentioned steps will provide the different status in the

i. Under Process Claims Details

ii. Additional Documents Requested

iii. Processed Claims Details

iv. Paid Claims Details

v. Repudiated Claims Details

a. Go to �Claim Status �Under Process Claim Details




to check the Inward Details

UTHORISATION STATUS

TATUS

The below mentioned steps will provide the different status in the Claims Process:

Under Process Claims Details

Additional Documents Requested

Processed Claims Details

Repudiated Claims Details

Under Process Claim Details



Page 31

Screenshot – [47]

Claims Process:

Screenshot – [48]

TNNHIS

PROVIDER LOGIN


b. Enter the Credentials-CCN Number or Patient Number and Search

c. The Under Process Details for the specific patient will appear with status of the Claim

PROCEDURE TO CHECK ADDITIONAL

a. Go to �Claim Status �Additional Document Requested




CCN Number or Patient Number and Search

The Under Process Details for the specific patient will appear with status of the Claim

DDITIONAL DOCUMENT REQUESTED

Additional Document Requested



Page 32

Screenshot – [49]

Screenshot – [50]

The Under Process Details for the specific patient will appear with status of the Claim

Screenshot – [51]

TNNHIS

PROVIDER LOGIN


b. Enter the Credentials-CCN Number or Patient Number and Search

c. The Additional Document Request Details for the specific patient will appear

other details that resulted in ADR being raised.

PROCEDURE TO CHECK PROCESS

a. Go to Claim Status�Processed Claim Details




CCN Number or Patient Number and Search

The Additional Document Request Details for the specific patient will appear

other details that resulted in ADR being raised.

ROCESS CLAIM DETAILS

Processed Claim Details



Page 33

Screenshot – [52]

The Additional Document Request Details for the specific patient will appear with reason and

Screenshot – [53]

TNNHIS

PROVIDER LOGIN


b. Enter the Credentials –CCN Number or Patient Details and Search

c. The Settled Claim Details can also be viewed on the Dashboard.




CCN Number or Patient Details and Search

The Settled Claim Details can also be viewed on the Dashboard.



Page 34

Screenshot – [54]

Screenshot – [55]

TNNHIS

PROVIDER LOGIN


d. Click on Details. This will open the Screen giving

Sheet, Payment Details

e. Click on View Claim Payment Sheet to see the details of payments




Click on Details. This will open the Screen giving Patient Details, AL Details

Click on View Claim Payment Sheet to see the details of payments



Page 35

AL Details, Claim Payment

Screenshot – [56]

Screenshot – [57]

TNNHIS

PROVIDER LOGIN


PROCEDURE TO CHECK PAID C

a. Go to �Claim Status�Paid Claim Details

b. Enter Credentials-CCN Number or Patient Details

c. The details of the Claim Paid will appear for the specific patient

END OF ACTIVITY – CLAIMS S




CLAIM DETAILS

Paid Claim Details

CCN Number or Patient Details�Click Search

details of the Claim Paid will appear for the specific patient

STATUS



Page 36

Screenshot – [58]

Screenshot – [59]

TNNHIS

PROVIDER LOGIN


PROCEDURE TO CHECK PACKAGE

a. Provider can click on the Package Rate list to see the details of the agreed rate lis

One can search the details by the

� Package Code

� Package Name

END OF THE PROVIDER LOGIN




ACKAGE RATE LIST

Provider can click on the Package Rate list to see the details of the agreed rate lis

h the details by the

OGIN PROCESS



Page 37

Provider can click on the Package Rate list to see the details of the agreed rate list.

Screenshot – [60]