Central Government Health Scheme
User Manual for TMS (Transaction Management System)
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Contents
Acronyms ......................................................................................................................................................... 3
IT-based Claim Processing on Transaction Management System ..................................................................... 4
Section 1.1 User authentication on TMS .......................................................................................................... 6
Section 1.2 Registration.................................................................................................................................... 7
Section 1.3 For OP patient ................................................................................................................................ 9
Section 2. For IP patient ................................................................................................................................ 14
Section 3. In case of IP patient – Emergency Case .......................................................................................... 21
Section 4. Discharge ...................................................................................................................................... 28
Section 5. Case Cancellation .......................................................................................................................... 33
Section 6. In case of medical management/ conservative treatment. ........................................................... 34
Section 7. Enhancement ................................................................................................................................. 39
Section 8. IP Case - Claim Initiation ................................................................................................................ 43
Section 9. Intimation Query Updation ............................................................................................................ 46
Section 10. Claim Query Updation.................................................................................................................. 50
Section 11. ‘Claims Altered/ Rejected’ section: .............................................................................................. 54
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Acronyms
API Application Program Interface
BEN-ID Beneficiary Identity Document
BIS Beneficiary Identification System
CEX Claim Executive
CGHS Central Government Health Scheme
CPD Claim Processing Doctor
DDO Drawing and Disbursing Officer
DGHS Directorate General of Health Services
e-KYC Electronic Know Your Customer
HCO Health Care Organization
ISA Implementing Support Agency
IP Inpatient
IT Information Technology
MEDCO Medical Coordinator
MoHFW Ministry of Health and Family Welfare
NHA National Health Authority
OP Outpatient
OPD Outpatient Department
PAO Payment and Account Officer
PFMS Public Financial Management System
PMAM Pradhan Mantri Ayushman Mitra
PPD Preauthorization Panel Doctor
SA Sanctioning Authority
TMS Transactions Management System
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Introduction
IT-based Claim Processing on Transaction Management System
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 CGHS Referral Module Platform operated at
Wellness Centers through Application Program Interface (APIs) to fetch referral details of the patient and Public
Financial Management System (PFMS) for onward processing of sanctioned claims and release of payment to
hospital bank accounts. The URL for Transactions Management System for CGHS is
https://cghs.nha.gov.in/CGHS/loginnew.htm.
Fig.1: Treatment and Claims Processing Workflow Summary
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Fig.2: CGHS Claims Process Flow
To register users and receiving login credentials, please fill the following Google form:
https://forms.gle/QaAD9kRBFLXNjeJZA . Please ensure to make multiple unique submissions in case of multiple
TMS users.
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Section 1.1 User authentication on TMS
1. For security reasons, user authentication will be done at the time of using the TMS MEDCO account
for the first time. To complete user authentication
1.1 Go to TMS (Transaction Management System) portal (www.cghs.nha.gov.in) and enter Username
and Password received for the MEDCO Account.
1.2 Enter captcha and click on proceed.
1.3 Enter the Aadhaar.
Note: Please ensure that Aadhaar of the MEDCO who would be operating the TMS account is provided for
authentication on the TMS portal.
2. First OTP will be sent to the MEDCO’s mobile number registered for TMS.
3. Second OTP will be sent to the mobile number linked to the MEDCO’s Aadhaar.
4. To register new MEDCO users and receiving login credentials, or updating Aadhaar or Mobile details of
the existing MEDCO users, please fill the following Google form: https://forms.gle/QaAD9kRBFLXNjeJZA .
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Section 1.2 Registration
1. After the beneficiary verification, the CGHS beneficiary will go to the Medical Coordinator (MEDCO).
2. CGHS plastic card/Index card/print out of e-CGHS card copy will be submitted for uploading on TMS.
3. The MEDCO will retrieve details of the beneficiary by entering the Ben-ID number or the BIS verified
mobile number.
4. As a next step, please update communication address, mobile number of contact (self/family/other)
and register the beneficiary on TMS.
5. Please select “Action Type” as “Register” from the drop and check the box on consent statement.
6. Click “Register”. The following pop-up would appear.
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7. Select “Okay”.
8. As per the above screenshot, registration details of the patient would be auto filled. 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.
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Section 1.3 For OP patient
1. First, select “Primary Diagnosis” under “Diagnosis” tab.
2. In case, a particular diagnosis isn’t listed in the dropdown list, please select “Other” and fill in the
“Diagnosis Description” criterion. The same is as depicted below.
3. Next, please fill the referral section. Please note that a referral is mandatory when: -
When planned OPD and IPD services for beneficiaries less than 75 years.
Unlisted investigations/unlisted procedures for all beneficiaries including those aged 75 years and
above.
4. However, a referral is not mandatory when: -
Emergency cases
Listed OP/IP for beneficiaries aged 75 yrs. and above
5. For beneficiaries referred by CGHS Wellness Centers:
Click on e-referral,
Enter referral number.
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Click on ‘Get Referral Details’.
Referral details will be retrieved automatically.
6. For beneficiaries referred by Government Hospitals or when unable to retrieve details
through e-referral:
Click on Manual referral:
Enter referral number.
Enter Wellness Centre/Government Hospital name.
Enter Date of Referral as mentioned in the referral letter or slip and referral type.
Enter name of Doctor/Specialist from Wellness Centre/Government Hospital who has issued the
referral letter.
After filling referral section – please fill “Treatment Protocol” section with all mandatory details.
In case a doctor is not enlisted in the “Doctor/ Radiotherapist” dropdown – please click on
“Others” to add doctor name and other details.
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Next, click on “Add Procedure”. A pop up confirming that the procedure has been added will
appear.
Once a procedure is added, a table with auto-populated details will appear in the section:
Next, fill all mandatory details in the “Visit Details” section.
7. Next, click on “Add/View Attachments” to upload beneficiary CGHS card and referral slip.
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8. Once the requisite documents are uploaded, then, according to your requirement, click on
corresponding “Action Type”.
9. The progress can be saved by using “Save” as the “Action Type” or can be sent for submission by
clicking on “Submit” from the “Action Type” dropdown.
10. On clicking “Submit” – please click “Okay” on the subsequent pop-up message.
11. Further click on “OK” when the following pop-up appears.
12. On clicking “Ok” – the page will be re-directed to the “Claims” tab under “Claim Initiation”.
13. Scroll down to “Add/ View Attachments” option.
14. After making the necessary uploads, please select “Initiate Claim” as “Action Type”.
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15. Click “Submit” to initiate the claim.
16. Click “Ok” on the pop-up message to initiate.
17. A claim summary will be auto-downloaded on the system & under “Claim Initiation” option – the case
status will be visible.
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Section 2. For IP patient
1. Similar to the registration process followed for OP patients, register the patient for IP procedure by
clicking on “IP”.
2. CGHS plastic card/Index card/print out of e-CGHS card copy will be submitted for uploading on TMS.
3. The MEDCO will retrieve details of the beneficiary by entering the Ben-ID number or the BIS verified
mobile number.
4. As a next step, please update communication address, mobile number of contact (self/family/other)
and register the beneficiary on TMS.
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5. Please select “Action Type” as “Register” from the drop and check the box on consent statement.
6. Click “Register”. The following pop-up would appear.
7. Select “Okay”.
8. Select “IP” option and click “Submit”.
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9. The following prompt would appear – select “Ok”.
10. First, click on “General Findings” tab.
11. Fill in mandatory and/or other observations/ readings.
12. Enter the requisite information and click “Save” and then, “Close”.
13. Similarly, click on “Past and Family History” tab.
14. Click on the check box – as applicable, click “Save” and then “Close”.
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15. Similarly, fill requisite information in “Personal History”, “Past and Family History”, “Symptoms” and
“General Findings”.
18. For beneficiaries referred by CGHS Wellness Centers:
Click on e-referral,
Enter referral number.
Click on ‘Get Referral Details’.
Referral details will be retrieved automatically.
19. For beneficiaries referred by Government Hospitals or when unable to retrieve details
through e-referral:
Click on Manual referral:
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Enter referral number.
Enter Wellness Centre/Government Hospital name.
Enter Date of Referral as mentioned in the referral letter or slip and referral type.
Enter name of Doctor/Specialist from Wellness Centre/Government Hospital who has issued the
referral letter.
After filling referral section – please fill “Treatment Protocol” section with all mandatory details.
In case a doctor is not enlisted in the “Doctor/ Radiotherapist” dropdown – please click on
“Others” to add doctor name and other details.
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Next, click on “Add Procedure”. A pop up confirming that the procedure has been added will
appear.
Once a procedure is added, a table with auto-populated details will appear in the section:
16. Once a procedure is added, it would appear in an auto-populated table (as per picture below).
17. Next, fill the requisite criteria in “Admission Details” section.
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18. Once “Admission Details” are filled in, scroll down and click on “Add/View Attachments”.
19. Upload mandatory and/ or other categorical requirements and click “Close”.
20. Click on “Action Type” – select “Raise Intimation” and then, click “Submit”.
21. A message asking to confirm intimation will pop-up. Click “Ok”.
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22. The following screen would then confirm the intimation.
Section 3. In case of IP patient – Emergency Case
1. Register the patient for IP procedure by clicking on “IP”.
2. CGHS plastic card/Index card/print out of e-CGHS card copy will be submitted for uploading on TMS.
3. The MEDCO will retrieve details of the beneficiary by entering the Ben-ID number or the BIS verified
mobile number.
4. As a next step, please update communication address, mobile number of contact (self/family/other)
and register the beneficiary on TMS.
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5. Please select “Action Type” as “Register” from the drop and check the box on consent statement.
6. Click “Register”. The following pop-up would appear.
7. Select “Okay”.
8. Select “IP” option and click “Submit”.
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9. The following prompt would appear – select “Ok”.
10. First, click on “General Findings” tab.
11. Fill in mandatory and/or other observations/ readings.
12. Enter the requisite information and click “Save” and then, “Close”.
13. Similarly, click on “Past and Family History” tab.
14. Click on the check box – as applicable, click “Save” and then “Close”.
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15. Similarly, fill requisite information in “Personal History”, “Past and Family History”, “Symptoms” and
“General Findings”.
16. Please note that for emergency cases, referral is not a mandatory requirement.
17. Please fill “Treatment Protocol” section with all mandatory details.
18. In case a doctor is not enlisted in the “Doctor/ Radiotherapist” dropdown – please click on “Others” to
add doctor name and other details.
19. Next, click on “Add Procedure”. A pop up confirming that the procedure has been added will appear.
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20. Once a procedure is added, a table with auto-populated details will appear in the section:
21. Next, fill the requisite criteria in “Admission Details” section.
22. Next, fill the requisite criteria in “Admission Details” section. Select “Emergency” as “Admission Type”.
23. Fill necessary/ mandatory fields as per the information available.
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24. As shown in above screenshot, click on “here” to download Emergency Certificate.
25. An “Emergency Certificate” (as shown in screenshot below) will be downloaded in the user’s
computer. Please fill in this certificate with the applicable details.
26. Once “Admission Details” are filled in, scroll down and click on “Add/View Attachments”.
27. As shown in screenshot below, upload the CGHS card and Emergency Certificate mandatorily.
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28. Click on “Action Type” – select “Raise Intimation” and then, click “Submit”.
29. A message asking to confirm intimation will pop-up. Click “Ok”.
30. The following screen would then confirm the intimation.
31. Once intimated, an emergency case would be re-directed to “Cases for Enhancement/ Discharge”
(‘Intimation’ > ‘Cases for Enhancement/ Discharge’). From this tab, the case can be discharged (as
explained in ‘Section 4’ of this document) or enhanced (as explained in Section 7 of this document) –
as applicable.
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Section 4. Discharge
1. After completion of treatment, go to 'Cases for Enhancement/Discharge' tab.
2. Click on the case to be discharged.
3. The page would be re-directed to the “Discharge” tab as shown in the screenshot below.
4. Enter requisite information in the 6 tabs.
5. Click on “Discharge” option in “Discharge Summary” section.
6. On clicking “Discharge” – a specific “Discharge” tab would pop up below the “Discharge Summary”
section.
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7. Fill the requisite details and click on “Add/ View Attachments”. Upload “Discharge Summary” among
other applicable documents.
8. Close the dialog box after uploading documents – and click on “Submit”.
9. Click “Ok” on the dialog box confirming submission.
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10. On clicking “Ok” the following dialogue box would pop up.
11. Click “Yes”.
12. The page would be re-directed to “Claims” tab. “Treatment Protocol” and “Claim Details” tabs would
appear.
13. Fill in ‘Remarks’, ‘Post Discharge Medicine Amount’ and ‘Bill Date’ as applicable.
14. Scroll below to “Action Type” and click on “Initiate Claim”.
15. Click on “Add/ View Attachments” – and upload mandatory and other applicable documents.
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16. After uploading requisite documents – click “Close”.
17. Scroll below to Action Type and select “Initiate Claim” from the dropdown and click “Submit”.
18. The following pop-up would ask for confirmation. Click “Ok”.
19. An “Annexure” of the case would be auto downloaded, and the following pop-up would appear.
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20. Click “Ok”.
21. The claim would appear tabulated in the claims section with the discharge date updated status.
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Section 5. Case Cancellation
1. If a claim has been initiated but the information entered was incorrect – then, that particular case can
be cancelled by the HCO.
2. However, this is only feasible until CEX (claims executive) does not take any action on the claim.
Once CEX processes the claim, the MEDCO would not be able to cancel the claim.
3. Under “Intimation” tab: Go to 'Cases for Cancellation'
4. Select the case for which the claim needs to be cancelled and enter remarks. The remarks could also
mention the previous case ID (which is to be corrected).
5. As shown in screenshot with point 3 above - click on “Cancel Preauth”.
6. A pop-up would appear to confirm cancellation. Click “Ok”.
7. The following pop-up would then appear. Click “Ok”.
8. Register the patient again and raise corrected intimation.
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9. Please note that Case IDs under 'Cases for Cancellation' are not cancelled cases. All cases are visible
in this tab by default. You can cancel cases as per the above-mentioned process.
Section 6. In case of medical management/ conservative treatment.
1. Register the patient for IP procedure by clicking on “IP”.
2. The MEDCO will retrieve details of the beneficiary by entering the Ben-ID number or the BIS verified
mobile number.
3. As a next step, please update communication address, mobile number of contact (self/family/other)
and register the beneficiary on TMS.
4. Please select “Action Type” as “Register” from the drop and check the box on consent statement.
5. Click “Register”. The following pop-up would appear.
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6. Select “Okay”.
7. Select “IP” option and click “Submit”.
8. The following prompt would appear – select “Ok”.
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9. First, click on “General Findings” tab.
10. Fill in mandatory and/or other observations/ readings.
11. Enter the requisite information and click “Save” and then, “Close”.
12. Similarly, click on “Past and Family History” tab.
13. Click on the check box – as applicable, click “Save” and then “Close”.
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14. Similarly, fill requisite information in “Personal History”, “Past and Family History”, “Symptoms” and
“General Findings”.
15. Accordingly fill “Diagnosis” and “Referral Details” tab.
16. Under “Treatment Protocol” tab:
(a) Book Room Rent (Ward as per entitlement/ICU/NICU) on admission date (allowed up to 7 days at
a given time), using the respective 'Medical Per Day' package under treatment protocol section.
(b) CP018A for Ward as per entitlement.
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(c) CP018B for NICU
(d) CP018C for ICU
(e) CP019 series for covid special wards as per the treatment plan.
(f) TMHxxxxxx for graded surgeries for Cancer treatment Onco specialty).
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17. Book tentative consultations/investigations/procedures as per planned line of management and enter
treatment start date as applicable.
18. Raise intimation as per process described in Section 2 of this document.
Section 7. Enhancement
1. If the treatment plan by doctor requires extension of hospital stay and/or addition of new services and
procedures after acknowledgement of intimation, then go to 'Cases for Enhancement/Discharge' tab
to raise enhancement request.
2. Open the case and click on 'Intimation/Enhancement' button.
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3. Go to the bottom of the page, enter required remarks, and click on 'Enhancement' button.
4. Click “Ok” to the subsequent pop-up.
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5. The case will move to the 'Raise Intimation' tab.
6. Add additional 'Medical Per Day' package/ consultations/ investigations and procedures etc. along
with treatment start dates as applicable.
7. If a procedure is not mentioned in the dropdown, then, please select “Unspecified” package as per the
concerned specialty.
8. Next, please fill out the mandatory details (Quantity/ No. of Days, Procedure and Amount).
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9. Click on “View/Add Attachments” and upload justification note by doctor for enhancement period
mentioning exact date range and other mandatory documents.
10. Next, scroll to the bottom of the page, select “Raise Intimation” as “Action Type” and Click “Submit”.
11. Click “Ok”.
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12. The case will be re-directed to “Discharge” tab.
13. Follow steps as described in section 4 of this document.
14. Repeat the above steps for Enhancement multiple times during medical management period, as
necessary.
15. Please note: All cases for enhancement will go to Preauth Processing Doctor for approval.
Section 8. IP Case - Claim Initiation
1. Go to 'Claim Initiation' and open the case to initiate claim within 7 days of discharging the patient
from TMS.
2. In case of unused services/length of stay, reduce quantity of booked
consultations/investigations/procedures as per actuals by altering respective units. Claim amount will
get adjusted accordingly.
3. Please note that quantity can only be reduced here. To increase quantity for any procedure booked,
an enhancement would have to be raised (as explained in Section 7 of this document).
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4. Add amount for drugs and consumables and post discharge medicines (as per CGHS guidelines) along
with bills in attachment. Claim amount will get adjusted accordingly.
5. Click on “Add/ View Attachments”.
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6. Upload applicable and mandatory attachments and click “Close”.
7. Click on “Initiate Claim” as “Action Type”. Click “Submit”.
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8. Click “Ok” to the subsequent pop-up message.
9. Case Annexure will be auto downloaded. Click “Ok” to the pop-up message confirming claim
initiation.
10. Claim will be forwarded to CEX (claims executive) for claim scrutiny.
Section 9. Intimation Query Updation
1. Whenever the MEDCO raises an enhancement – the case is sent to PPD for acknowledgment.
2. PPD may raise a query and ask the MEDCO to clarify/ provide required documentation.
3. These queries are directed to “Intimation Query Updation” tab on MEDCO login. Click “Intimation” >
“Intimation Query Updation”.
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4. Click on concerned case number.
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5. Scroll below to enter ‘Remarks’ below ‘Admission Details’ tab.
6. Scroll further below to “Preauth Query/ Rejection Reasons” section to find PPD query.
7. As per required documentation – click on “Select File” under “Attachments” column and upload
required document.
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8. Once required file is uploaded – please fill “Medco Remarks”. Select “Update” from “Action Type”
dropdown and click “Submit”.
9. Click “Ok” to the subsequent pop-up question.
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10. Click “Ok”.
11. The intimation query is responded.
Section 10. Claim Query Updation
1. For already submitted claims – CPD may raise query on a particular claim.
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2. To respond to the query – click on “Claims” > “Claim Query Updation”.
3. Click on the concerned case number.
4. Scroll down to “Claim Query/ Rejection Reasons”.
5. Enter “Medco Remarks”.
6. Click on “Select File” and upload required document.
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7. Next, click on “Add/ View Attachments”.
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8. Upload attachments as applicable.
9. Select “Update” from “Action Type” dropdown and click “Submit”.
10. Click “Ok”.
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11. Click “Ok”.
12. The CPD query is updated.
Section 11. ‘Claims Altered/ Rejected’ section:
1. When either CPD or SA applies a deduction to a claim or rejects the claim – the case is directed to
‘Claim Altered/ Rejected Cases’ section (pathway: “Claims” > “Claims Altered/ Rejected Cases”).
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2. Click on the concerned case number.
3. Enter ‘Remarks’ under ‘Claim Details’.
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4. Scroll down to ‘Claim Query/ Rejection Reasons’ tab.
5. As per the query – fill in ‘Medco Remarks’ and upload the required documentation by clicking on
‘Select File’ option under ‘Attachments’ column.
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6. Next, click on ‘Add/ View Attachments’ and upload all applicable documentation.
7. Once files are uploaded – click “Close”.
8. Next, select ‘Update’ from ‘Action Type’.
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9. Next, click “Submit”.
10. Click ‘Ok’ to the pop-up “Do you want to update?”
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11. Click ‘Ok’.
12. The query is responded to.
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