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User-Manual-TMS-for-CAPF

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User-Manual-TMS-for-CAPF

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  1. Ayushman CAPF - TMS Module User Manual - MEDCO

  2. Transaction Management System (TMS) Transaction Management System (TMS) Transaction Management System (TMS) allows for capturing of in-patient or out-patient data on admission, treatment, discharge, and hospital claims. It is integrated with source bank account of NHA for release of payment electronically to hospital bank accounts. URL: https://ayushmancapf.nha.gov.in Overall work process on TMS is depicted below. Exhibit 1: Treatment and Claims Processing Workflow Summary MEDCO’s roles and responsibilities MEDCO’s roles and responsibilities a.Register the patient on TMS referred by CGHS Wellness Centre or Govt. hospital b.Raise the intimation request within 12 hours of registration, by registering the patient as in- patient (IP) or out-patient (OP) and updating necessary referral details related to admission and treatment as per diagnosis c.Block package as recommended on referral letter by the Specialist, CGHS Wellness Centre/Govt. hospital or as per the additional diagnosis recommended by the Specialist at Empaneled HCO d.Upload the mandatory diagnostics/documents as per the package e.Update patient treatment/discharge summary upon completion of consultation services, investigations, or discharge f.Initiate the claim request for the OP/IP package/procedure and upload mandatory diagnostics/documents as per the package within 7 days of service completion or discharge g. Submit response to queries. 1 | P a g e

  3. Details of activities are given below. 1. Logging in to the portal 1. Go to TMS (Transaction Management System) portal (https://ayushmancapf.nha.gov.in/) and enter Username and Password received for the MEDCO Account. 2. Click on proceed and then click “Ok”. 3. Enter the password, captcha details and check “Terms” statement. Click “Ok” 2 | P a g e

  4. 4. On logging in, as in CGHS TMS, a ticker message with concerned timelines/ announcements will appear. Please read through the same – and click “Close”. 2. Patient Registration 1. Click on “Patients” > “Register Patient”. 3 | P a g e

  5. 2. The following screen would appear. 3. Please use any one of the “ID type” to retrieve beneficiary details. 4 | P a g e

  6. 4. In the following example – registered mobile number is being used to retrieve beneficiary details. To retrieve details by using registered mobile number click “Mobile No.” in “ID Type” section and write concerned mobile number in “ID Number”. Click “Retrieve”. 5. Registered patient details are retrieved. 5 | P a g e

  7. 6. Click on the concerned beneficiary name and click “Proceed” 7. Concerned beneficiary details will be retrieved. 6 | P a g e

  8. 8. Scroll down to “Communication Address”. If the “Communication Address” and “Card Address” are the same for a beneficiary – then click on the check box with the statement “If Card and Communication Address are Same”. If this is not the case, then please fill the concerned details in “Communication Address”. In the example below, card and communication address are marked as same. 7 | P a g e

  9. 9. Date of registration would by default be set to present date. You may please select concerned back- date – as available on the portal. Check on Consent statement as well. 10. Click “Ok” 11. A registration ID would be generated – click “Ok” 8 | P a g e

  10. 12. Registration details of the patient would be auto filled in the next screen. If the patient is an out- patient/ has come for consultation/ investigation – please check “OP” option. If it is an in-patient case/ emergency case – check “IP” option. 9 | P a g e

  11. 3. OP patient 3.1 Raise Intimation 1. First, select “OP” and click “Submit”. Click “Ok” on the following notification. 2. First, select applicable “Primary Diagnosis” under “Diagnosis” section. 10 | P a g e

  12. 3. Fill “Referral Details” section Referral number/ Prescription number Type of referral hospital. Name of referring hospital/ Wellness Centre Date of Referral Referral Type Remarks 4. Next, fill “Treatment Protocol” section: - Procedure Specialty 11 | P a g e

  13. Doctor/ Radiotherapist Quantity/ No. of days 5. Once a procedure has been added successfully – it would appear as a line item in a tabulated format 6. Similarly, any other procedure added would be depicted in a tabulated format in “Treatment Protocol” section. 12 | P a g e

  14. 7. Once all procedures/ investigations are booked under “Treatment Protocol” section – please fill “Visit Details” section: - “OPD Number” Visit Type Date of OP/ Investigation/ Collection Procedure Consent Medico legal case, if any Remarks. Here, two fields would be pre-filled as per procedures booked under “Treatment Protocol” section: - Total Package Amount Admissible under the Entitlement The Amount Liable by the Trust 13 | P a g e

  15. 8. Next, click on “Add/ View Attachments” 9. As a mandatory requirement – please upload: - “Dependents Card/ Force ID/ CGHS card 14 | P a g e

  16. Referral Slip Please upload all other applicable documents as well. 10. Next, click on “Action Type” and click “Submit”. 11. Click “Submit” to raise intimation for OP case 15 | P a g e

  17. 12. Click “Ok” to the pop up asking, “Do you want to submit?” 13. A case number would be generated – click “Ok”. 16 | P a g e

  18. 14. Now, a claim can be initiated. Click “Ok” on the pop-up asking, “Do you want to proceed to claim?” 15. The page would be redirected to “Claim Initiation” tab once PPD has approved the same. 3.2 Claim Initiation 1. At this stage, if required, quantity booked can only be decreased. Following is an example of decreasing quantity. i. Click on the quantity field. ii. Here the quantity booked is 2. To reduce it to 1, clear the quantity mentioned and write 1. Before proceeding further, a pop-up would ask “Do you want to change quantity to 1”. Click “Ok”. 17 | P a g e

  19. iii. Corresponding amount in “Claim Details” section would be changed as well. 2. Once quantity is adjusted (if required) – select “Primary Diagnosis” from the dropdown in “Diagnosis” section. 3. Next, select “Bill Date”, and enter “Remarks”. 4. Next, click on “Add/ View Attachments” 18 | P a g e

  20. 5. Upload required documents and click “Close”. 6. Next, click on “Initiate Claim” from the “Action Type” dropdown and click “Submit”. 19 | P a g e

  21. 7. Click “Ok” to the pop-up : “Do you want to initiate?” 8. Claim would be initiated. 20 | P a g e

  22. 4. IP patient 4.1 Raising Intimation 1. Registration details of the patient would be auto filled in the next screen. In case of an in-patient case/ emergency case – check “IP” option. 2. Click “Ok” 3. Here, submit details on two sections mandatorily – “General Findings” and “Past and Family History”. 4. Accordingly, fill “General Findings” for the concerned patient. 21 | P a g e

  23. 5. Also, fill “Past and Family History” for the concerned patient. 6. Next, fill “Primary Diagnosis” (as applicable) under “Diagnosis” section. 22 | P a g e

  24. 7. Next, please fill “Referral Details”. Referral number/ Prescription number Type of referral hospital. Name of referring hospital/ Wellness Centre Date of Referral Referral Type Remarks 8. Next, fill “Treatment Protocol” section: - Procedure Specialty Treating Doctor Treatment Start Date Quantity/ No. of days 23 | P a g e

  25. 9. Once a procedure has been added successfully – it would appear as a line item in a tabulated format. 24 | P a g e

  26. 10. Similarly, any other procedure added would be depicted in a tabulated format in “Treatment Protocol” section. 11. In case any procedure requires stratification to be added – then please click on the first icon in “Action” Column in the table. 12. Click on appropriate option from the dropdown “Stratification Options. 25 | P a g e

  27. 13. Click on “Add” button in “Action” column. 14. Click “Ok”. 26 | P a g e

  28. 15. Next, fill “Admission Details” section: - IP Number Admission Type Proposed Surgery/ Treatment Date Patient Diagnosed By Doctor Name Admission Date Procedure Consent Medico legal case, if any Total Package Amount Admissible Under the Entitlement The Amount Liable by Trust Remarks 27 | P a g e

  29. 16. Click on “Add/ View Attachments” 17. Upload attachments in appropriate field(s) 28 | P a g e

  30. 18. Select “Raise Intimation” from “Action Type” option. Click “Submit”. 19. Click “Ok” 29 | P a g e

  31. 20. Once a case is intimated – it will be sent for PPD approval. 4.2 Enhancement •Enhancement option can be used when for a particular case – number of days of stay is to be extended, quantity is to be reduced, a procedure/ investigation/ consultation is to be added etc. •Please note that an enhancement cannot be raised if the case has been discharged. 1.To enhance a particular case, please click “Intimation” > “Cases for Enhancement/ Discharge”. 30 | P a g e

  32. 2. Click on the concerned claim number. 3. The page would open on “Discharge” tab – please click on “Intimation/ Enhancement” to proceed to enhance the claim. 31 | P a g e

  33. 4. Scroll the page down and click “Enhancement”. 5. Click “Ok”. 32 | P a g e

  34. 6. Click “Ok” - the enhancement request would be opened accordingly. 7. The case would be transferred back on “Raise Intimation” bucket. 33 | P a g e

  35. 8. Here, required procedure/ investigation can be added in the “Treatment Protocol” section. 9. Once the required procedure is added – please upload suitable justification for enhancement in using “Add/View Attachments” option. 34 | P a g e

  36. 10. Once again, click on “Raise Intimation” as “Action Type”. Click “Submit”. 11. The enhanced claim would be sent to PPD for acknowledgement. 35 | P a g e

  37. 12. The page would be redirected to “Claim Initiation” tab once PPD has approved the same. 4.3 Discharge 1.Click on “Intimation” > “Cases for Enhancement/ Discharge”. 2. Click on the concerned claim number 36 | P a g e

  38. 3. Fill “Surgeon Details”. Doctor Type Regn No. Qualification Contact No. 37 | P a g e

  39. 4. Fill “Treatment/ Surgery Date” and “Discharge Summary” sections. 5. Fill “Discharge” section with required details and click on “Add/View Attachments”. 6. Upload required documents. 38 | P a g e

  40. 7. Once required files are uploaded, click “Submit”. 8. Click “Ok”. 39 | P a g e

  41. 9. Click “Yes”. 10. Once the case is discharged – the page would be re-directed to “Claim Initiation”. 40 | P a g e

  42. 11. Please refer to section 3.2 for further steps involved in claim initiation. 4.4 Claim Initiation •The MEDCO will initiate the claim request for the OP/IP package/procedure and upload mandatory diagnostics/documents as per the package within 7 days of completion of health service or discharge. •There will be an option to enter the amount for drugs and consumables, in case medical per day package was booked at the time of raising intimation for medical management. Consumable’s document will be uploaded as a mandatory attachment in such cases. Below steps are to be followed to initiate the claim: - 1.Once approved by the PPD – a claim can be initiated. 2.The page would be redirected to “Claim Initiation” tab once PPD has approved the same. 3.Please refer to section 3.2 of this document for further required steps. 5. Query Responses 5.1 PPD Query Response •Queries can be assigned to MEDCO by CEX, CPD and Director Medical. •Below are the steps to be followed to respond to the queries raised by PPD. 1. Click on “Intimation” > “Intimation Query Updation”. 2. Click on the concerned case ID/ case number. 41 | P a g e

  43. 3. The page would be redirected to “Intimation/ Enhancement” tab. 4. Scroll below to “Work Flow” section to find query raised by PPD. 42 | P a g e

  44. 5.2 CPD Query Response •Queries can be assigned to MEDCO by CEX, CPD and Director Medical. •Below are the steps to be followed to respond to the queries raised by CPD. 1. Click on “Claims” > “Claim Query Updation” tab. 2. Click on the concerned case number. 43 | P a g e

  45. 3. The page would be redirected to “Claims” section. 4. Scroll below to “Work flow” section to find the query raised. Click on “Add/ View Attachments” to upload required document(s). 44 | P a g e

  46. 5. An “Attachments” window would appear. Please uplaod required documentation in respective heads. 45 | P a g e

  47. 6. Once required document(s) are uploaded – click “Close”. 7. Select “Update” from “Action Type” dropdown. 8. Click “Submit”. 46 | P a g e

  48. 9. Click “Okay”. 10. By following the above process, query is responded to. 47 | P a g e

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