online claim submission process - vidal health tpa...and upload. > upload photo: user can upload...

ONLINE CLAIM SUBMISSION PROCESS

Vidal Health App

Employee Portal

Online process i.e. via email

ONLINE CLAIM SUBMISSION TO BE DONE IN

3 WAYS

“Self declaration form” is mandatory while submitting online claim forms

VIDAL HEALTH APP

HEALTH CLAIMS

Customers to download the “Vidal Health App” from the play store/Apps

store for Android/iOS applications.

Customers to login to the application using the registered mobile and

email address.

To submit an online claim, policyholders to click on “Health Claims” as

shown in Figure 1: Health Claims

Note:If the registered users have logged in through the registered mobile number, user can easily access Health Claims section without logging in again.If the policy holder has not logged in through the registered mobile, then he/she has to login through the Vidal Health (Username or password) credentials to access Health Claims module.

8:30

Customers to login to the application using the registered mobile and

email address.

To submit an online claim, policyholders to click on “Health Claims” as

shown in Figure 1: Health Claims

Note:If the registered users have logged in through the registered mobile number, user can easily access Health Claims section without logging in again.If the policy holder has not logged in through the registered mobile, then he/she has to login through the Vidal Health (Username or password) credentials to access Health Claims module.

8:30

If the registered users have logged in through the registered mobile number, user can easily access

If the policy holder has not logged in through the registered mobile, then he/she has to login through the Vidal Health (Username or password) credentials to access Health Claims module.





POLICY SELECTION

• User has to select the policy.

• The base policy shall be displayed by default, in case there are multiple

policies available under the same user, the user can select the desired policy

by toggling between the policy numbers.

8:30

• The base policy shall be displayed by default, in case there are multiple

policies available under the same user, the user can select the desired policy

REIMBURSE

• User has to click on Reimburse

8:30

REIMBURSE

• User has to click on Reimburse • User has to click on Reimburse

8:30

REIMBURSE

• Clcik on Add Button (+) as shown in below

8:30

REIMBURSE


8:30


PATIENT PARTICULARS

• Clicking on the Add button (+) the user screen will display the following fields:

A) Patient Particulars:

• Clicking on <Patient Particulars> there will be two fields with a dropdown allowing the user to select the desired with hint text<Patient name>,

• Clicking on the <Patient Name> a dropdown pops up with the entire patient name list, user can select one of the names and automatically the Enrollment ID is fetched according to the patient name.

• The<Next> button is enabled if all the two fields are entered. Clicking on the Next button will move the user to the below fields.

8:30

PATIENT PARTICULARS






PATIENT PARTICULARS






8:30

HOSPITAL DETAILS

B) Hospital Details:

• As the user clicks on the Hospitals details a dropdown opens will follow-ing fields to enter details.

• Hospital Name(Hint Text): As the user has to enter hospital name

• State: Pre filled based on the Geo Location

• City: Pre filled based on the Geo Location.

• <Reset>: Clicking on the reset button will refresh the screen and the entered details will get deleted, user has to fill data gain.

• The <Next> button is enabled if all the fields are entered. Clicking on the <Next> button will move the user to the below fields.

8:30

HOSPITAL DETAILS


• As the user clicks on the Hospitals details a dropdown opens will following fields to enter details.






8:30


• As the user clicks on the Hospitals details a dropdown opens will following fields to enter details.






HOSPITAL DETAILS

• As the user clicks on the Hospitals details a dropdown opens will follow-




HOSPITALIZATION DETAILS

C) Hospitalization Details:

• Policyholders will have to input following fields:

o Date of Admission: User can select date all from the calendar popped out on the screen.

o Time of Admission: User can select date all from the calendar popped out on the screen.

Date of Discharge: User can select date of discharge from the calendar popped out on screen.

o Time of Discharge: User can select date of discharge from the calendar popped out on screen.

o Physician’s Name: User has to enter a Physician’s Name

o Physician’s Phone: User has to enter a Physician’s number.

o Requested Amount: User has to enter Total claim amount.

o Aliment Name: User has to enter the Aliment

o <Reset>: Clicking on the reset button will refresh the screen and the entered details will get deleted, user has to enter data again.

o The <Next> button is enabled if all the fields are entered. Clicking on the <Next> button will move the user to the below fields.

8:30


C) Hospitalization Details:


o Date of Admission: User can select date all from the calendar popped out on the screen.

o Time of Admission: User can select date all from the calendar popped out on the screen.

Date of Discharge: User can select date of discharge from the calendar popped out on screen.

o Time of Discharge: User can select date of discharge from the calendar popped out on screen.

o Physician’s Name:Physician’s Name

o Physician’s Phone:Physician’s number.

o Requested Amount: Total claim amount.

o Aliment Name:Aliment



8:30



User can select date all from the calendar

User can select date all from the calendar

Date of Discharge: User can select date of discharge from the

User can select date of discharge from the

Physician’s Name: User has to enter a Physician’s Name

Physician’s Phone: User has to enter a Physician’s number.

Requested Amount: User has to enter Total claim amount.

Aliment Name: User has to enter the

Clicking on the reset button will refresh the screen and the entered details will get deleted, user has to enter data again.

button is enabled if all the fields are entered. Clicking on the <Next> button will move the user to the below fields.

ACCOUNT DETAILS

D) Account Details:

• User has to enter all the account details to get the reimbursement/claim amount.

o Account Holder Name

o IFSC/RTCG Code

o Bank Name

o Branch MICR

o Account No.

o Branch Address

8:30o Remark



ACCOUNT DETAILS

D) Account Details:

• User has to enter all the account details to get the reimbursement/claim amount.

o Account Holder Name

o IFSC/RTCG Code

o Bank Name

o Branch MICR

o Account No.

o Branch Address

8:30o Remark



UPLOAD DOCUMENTS

E) Upload Documents:

• User can upload the claim documents through <Upload Documents> option.

o Document Type: Clicking on this option will display a popup with all type documents. Example (Lab reports/ CT scan/ Bills etc.) wants to claim, user has to select from these document list or can search the document type.

o Amount: User has to enter exact amount in numerical value which the user wants to claim.

o Claim Type: Clicking in the claim type will display a popup screen with claim type Example: (Main Claim/Pre Hospitalization/Post Hospitalization) selecting any one will fill the data on the claim type field.

o Upload Document: User can submit claim documents through this button through following ways.

o Claim documents can be uploaded through various format: (PDF 8MB max, JPEG, JPG files)

> Take photo: User can take a photo of their claim documents and upload.

> Upload Photo: User can upload a claim document in JPEG or JPG format if already available in the photo gallery.

> Upload Document: User can select this option to upload JPEG, JPG or PDF format by browsing the folders available in the user mobile. Device.

> Add button: Clicking on the add button a user pre-filled data in a popup get displayed with following fields below.

» Document Type:

» Amount:

» Claim Type:

» Camera Upload:

> Reset Button: Clicking on the <reset> button will refresh the screen and the entered details will get deleted, user has to enter data again.

> Submit Button: Click on the <submit> button which will give confirmation message on the screen.

Reset Button: Clicking on the <reset> button will refresh the screen and the entered details will get deleted, user has to

Submit Button: Click on the <submit> button which will give confirmation message on the screen.

Reset Button: Clicking on the <reset> button will refresh the screen and the entered details will get deleted, user has to

Submit Button: Click on the <submit> button which will give Submit Button: Click on the <submit> button which will give Submit Button: Click on the <submit> button which will give

UPLOAD DOCUMENTS

Note: After uploading softcopies of Insurance holder must send hard copies to the Vidal Health for getting approval of their claims amount.

8:30

8:30

EMPLOYEE PORTAL

CLAIMS

• Employee portal is accessible only for corporate employees.

• Corporate employees will have to login to https://tips.vidalhealthtpa.com/vidalhealth/ with their credentials.

Step 1: Click on Claims --> Reimbursements

Step 2: Select the respective policy displayed on left side as shown in below screen.

Self declaration form is mandatory while submitting the claims Online

CLAIM SUBMISSIONS

Step 3: Navigate on “CLAIM SUBMISSIONS” tab and click on “Submit Claims” button for submitting online claim.

Step 4: Fill in the below mandatory fields and click on “Submit” buttonA. Under “Claim details”, fill in below fields mandatory fields: o Vidal Health Insurance TPA ID / Name o Ailments o Admission date o Discharge Date

B. Under “Hospital information, fill in below mandatory field: o Hospital Name

C. Under “Upload Documents”, Upload required documents

Note: Figure on next page

CLAIM SUBMISSIONSCLAIM SUBMISSIONS

CLAIM SUBMISSIONS

Step 5: The submitted claims will appear under “CLAIM SUBMISSION” tab.

• Users to click on generate icon to download the prepopulated Claim form

• Click on submit icon to upload the self attested claim form along with the self declaration form (Download prepopulated form)

Step 5:

ONLINE PROCESSVIA EMAIL

ONLINE PROCESS VIA EMAIL

• If the claimants/providers are unable to submit the claims through Vidal health app or through employee portal, they can submit the claims through email with attachments.

• Claimants/providers to submit claims with attachments on this below provided email address: [email protected]

Note: Customers will also have to submit self declaration form on mandatory basis