ONLINE CLAIM SUBMISSION PROCESS

1 ONLINE CLAIM SUBMISSION PROCESSV idal Health AppEmployee PortalOnline PROCESS via emailONLINE CLAIM SUBMISSION TO BE DONE IN 3 WAY S Self declaration form is mandatory while submitting ONLINE CLAIM formsVIDAL HEALTH APPHEALTH CLAIMSC ustomers to download the Vidal Health App from the play store/Apps store for Android/iOS to login to the application using the registered mobile and email submit an ONLINE CLAIM , policyholders to click on Health Claims as shown in Figure 1: Health ClaimsNote:If the registered users have logged in through the registered mobile number, user can easily access Health Claims section without logging in 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 :30 Customers to login to the application using the registered mobile and email submit an ONLINE CLAIM , policyholders to click on Health Claims as shown in Figure 1: Health ClaimsNote:If the registered users have logged in through the registered mobile number, user can easily access Health Claims section without logging in 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.

2 30If 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 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 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 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.

3 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 Clcik on Add Button (+) as shown in below 8:30 Clcik on Add Button (+) as shown in below 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.

4 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 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. 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.

5 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 HOSPITAL DETAILSB) 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 :30 HOSPITAL DETAILSB) Hospital Details: As the user clicks on the Hospitals details a dropdown opens will following 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.

6 <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 :30B) Hospital Details: As the user clicks on the Hospitals details a dropdown opens will following 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 DETAILS As the user clicks on the Hospitals details a dropdown opens will follow- Hospital Name(Hint Text): As the user has to enter hospital name <Reset>: Clicking on the reset button will refresh the screen and the entered details will get deleted, user has to fill data gain.

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

8 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 HOSPITALIZATION DETAILSC) 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:Physician s Name o Physician s Phone:Physician s number. o Requested Amount: Total CLAIM amount. o Aliment Name: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.

9 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 HOSPITALIZATION DETAILS Policyholders will have to input following fields: 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.

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