NHCX Patient Dashboard

Overview

The NHCX patient page is the hub for all of a patient's claim activity. It shows every NHCX workflow for that patient, the current status and amounts, and the next action to take.

Opening the page

From the patient's record, open the NHCX section. The page shows:

• Get Policies / Discover Policies buttons to start an eligibility check.
• Birth Certificate (Proof of Birth) — upload DCB/BCF documents (see NHCX Newborn Claim).
• The workflow timeline — one entry per NHCX workflow for the patient.

The workflow timeline

Each workflow is a group of NHCX steps (eligibility check, pre-auth, claim, payment, communication) for one patient and payer. Each entry shows:

• Status — the current workflow state (e.g., Acknowledged, Approved, Rejected, Failed). Errors and failures are shown in red.
• Amounts — for claim responses, the asked (claimed), approved, and deducted amounts, with the deduction shown both as a rupee figure and as a percentage of the amount asked; for payment notices, the payment status, TDS, and UTR.
• Next action — what to do next (e.g., submit claim, reprocess, respond to a query). A message the payer sends on its own, rather than inside a response, arrives as a Received step showing the payer's reason and text, and its action is Answer payer's request. The Claim submit action only appears when the pre-authorization is approved and the workflow has a linked admission (encounter); linking the encounter from the workflow card reveals it straight away, without reloading the page. It also reappears when a submitted claim errors or fails, so the claim can be re-submitted.

Click a workflow to expand it and see the individual steps. Each workflow header also has a Refresh button that re-reads just that one workflow from the server — use it to pull in a payer's callback response without reloading the whole page. Actions taken on a workflow (validate, get plan, cycle, discharge, get/discover policies) refresh only the affected workflow the same way, so the rest of the list and your scroll position stay put.

Only submitted cases appear in the timeline. A case is also created by the earlier look-ups — Get Plan and Discover in the Get Policies pop-up each start a case of their own — and a case with nothing submitted to the payer yet is not a claim, so it stays out of the list. The single exception is the newest case with no submission, which remains at the top so you can carry on with it. This keeps the timeline to real cases instead of abandoned look-ups.

Above the step table each workflow has a Concise view checkbox, ticked by default. In concise view the coverage-eligibility steps are hidden so only the business steps remain (pre-authorization, enhancement, resubmission, claim, reprocess, payment notice); the label shows how many steps are hidden. Untick it to show the coverage-eligibility steps again. The checkbox belongs to that one workflow — each workflow is toggled independently.

When a payer's response carried documents, that step's FHIR printout lists them at the end under Documents received from the payer — one line per file with the title, the type, and the resource it arrived with; clicking a line downloads the file.

Wallet

The expanded workflow shows a Get wallet button — but only once the workflow carries the payer and policy details (subscriber, beneficiary, and policy number) and an insurance-plan request has been sent for that workflow (see NHCX Eligibility and Coverage). Clicking it runs a validation coverage-eligibility check in the background (the button stays live — coloured, with a spinner and a Waiting for the payer… (Ns) line counting the seconds up — while it polls the payer), which returns the policy's wallet: whether it is in force, the coverage period, and the total available balance.

The plan itself is requested from the workflow's Discovered Policies dialog: each policy row offers Validate first, and once the validation has been submitted for the case the row offers Get Plan instead. Validate is submitted from the dialog itself — the policy fields are already filled from the discovery, so there is no separate form to complete — and it is posted on the case straight away. Validate stays disabled until the payer has answered the discovery, because the dialog needs the payer's own policy code to name in the request. So the dialog order is Validate → Get Plan; Get wallet is an optional step after that.

The wallet is not required. Once the insurance plan has been requested, the accordion reveals the pre-authorization actions and Search whether or not a wallet has been fetched — some payers (unlike PMJAY) never report a balance, and their cases proceed normally. When a wallet is fetched, Get wallet is replaced by a wallet summary card (Active / Inactive, validity period, and balance in INR). The same wallet summary also appears on the workflow's Kanban card.

When the payer publishes the plan's own sum insured (in the plan resource itself), the case card shows it as Plan sum insured beside the wallet figure, both in one card — as published by the payer, never gating anything. It appears whether or not a wallet has been fetched.

If the payer refuses the plan request itself — usually because the hospital is not empanelled for its HFR ID — the case shows Insurance plan request refused by the payer: … with the payer's own code and message. The failed step stays printable. Confirm the empanelment, then request the plan again; each request is a new exchange.

If the payer refuses the validation, Get wallet shows the payer's own error — its code and message, for example HBP016 — No policies available for the selected policy code — instead of the wallet. The reason stays visible when the page is reloaded, and a later successful validation replaces it with the wallet card.

Newborn (Baby of Parent)

For a patient under 6 years old, each expanded workflow shows a Newborn (Baby of Parent) block. Enter the card-holder parent's UHID and click Link parent to resolve and link the parent to that workflow. Once linked, the block shows Linked to {parent name} (UHID …) with an Edit option.

The link is only offered when the patient's date of birth is known and under 6 years. The parent must be over 6 years old and have a valid date of birth — otherwise the system shows an inline error and does not link.

Admission / discharge cycles

For cyclic treatments, the timeline tracks each admission and discharge with timestamps and cycle numbers. The admission and discharge actions open biometric capture for the corresponding process.

Load More

The timeline shows 3 workflows at a time. Click Load More to fetch 3 more. Only submitted cases (plus the one in-progress case described above) are counted, so a patient whose only activity was plan or coverage look-ups shows the single in-progress case and no Load More.

Common Issues

• "No workflows found" — the patient has no NHCX activity yet; start with an eligibility check.
• Failed status — click the red status/error icon to view the error details returned by the payer.

FAQ

Q: Why does the page load workflows in pages? A: The timeline is paginated for performance, so patients with many workflows load quickly. Use Load More to see older workflows.

Q: Where do I start a new claim for this patient? A: From the patient's NHCX page, run an eligibility check first, then follow the workflow's next action to submit the claim.