Patient Process Flow
Mode of OP Capture
A beneficiary suffering from an ailment can approach any of the following ‘first point of contact' for registration under the scheme. The mode of OP capture is directly at the NWH in case of emergencies or through referral.
OP Process flow at the NWH:
The beneficiary arrives at the NWH kiosk either with a referral card or with a complaint for registration.
NAM first mandatorily registers the patient. In case the patient is a child, the patient's identity and complaint are registered. OP is registered and OP ticket issued.
Patient is forwarded to the OP and gets counselled to ascertain the eligibility under scheme. Investigations are prescribed if required.
He thereafter moves to the investigation facilities if required, gets tested and returns to the doctor. If he can be treated as an OP case, prescription is given. The diagnosis and prescription are entered in the system by NAM and case disposed.
Uncovered OP Procedure:
If the patient's treatment warrants use of any of the uncovered OP, the MEDCO enters the details in the system and refers the case to Government Hospital.
If the patient's treatment warrants use of any of the listed therapies, the MEDCO enters the details of procedure and investigations in the system, converts the case to IP, sent to the ward concerned (semi-private) and raises pre-authorization.
Evaluation and Admission:
After the initial evaluation of the patient, the patient is admitted if needed and evaluated further. The patient may be evaluated as an out-patient initially and after ascertaining the diagnosis and finalization treatment mode admitted and converted as "in-patient" in the online workflow.
Final Diagnosis and Categorization:
After the evaluation of the patient,
1.If the patient is found to be suffering from listed therapies, MEDCO shall submit the pre-authorization through the Trust portal within 24 hours.
2.If the patient is found to be suffering from diseases other than those that cannot be managed in the NWH or not covered in the listed therapies, he shall be counselled and referred to nearest suitable hospital for further management.
MEDCO shall upload all the relevant documents and send the case for pre-authorization.
The NWH shall render complete treatment to the patient after obtaining pre-authorization. Any complications arising during the course of hospitalization shall also be attended to.
The patient is discharged after complete recovery. The NWH shall issue discharge summary, 10 days post-discharge medication , counsel the patient for follow-up. A letter of satisfactory services shall be obtained from the beneficiary at the time of discharge.
MEDCO shall upload the documents.
1.Patient shall be provided follow-up services as per the standard medical norms duly counselling and recording the same in the discharge summary.
2.The follow-up packages provided under the scheme shall be utilized for this purpose to provide cashless follow-up services.
The NWH will raise the claim after the 10 days of satisfactory discharge of the patient.
Emergency Registration and Admission:
1.All the beneficiaries shall be admitted by a NWH and treated immediately. MEDCO or treating doctor shall obtain emergency telephonic pre-authorization through dedicated round the clock telephone lines of the Trust, if the patient is suffering from listed therapies.
2. If the patient is suffering from diseases other than listed therapies he must be counselled and facilitated safe transportation to the nearest Government Hospital.
3. If the patient's condition warrants shifting him to a higher centre, safe transport shall be facilitated to other NWH if suffering from listed therapies.