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1.3) Claim Submission

Claim can be submitted online to NHIF by creating a Jason payload. This payload can contain one or more folios (At least one folio) and associated details. So it will always be a collection of folio objects even if only one folio is to be submitted. The sample JSON data to be submitted can be provided by the Fund upon request and the information in the JSON payload is as follows:

(i) Folio

FieldName Description Data Type Example
FolioID Primary Key for a folio of visit GUID 817d6e75-3bef-4d25-a2e1-a3bc009530ab
FacilityCode Unique identification number issued by NHIF to a particular health facility as part of the registration process Text 01099
ClaimYear Claim’s calendar year int 2020 ClaimMonth Month of claim Int 12 FolioNo A unique sequential number Int 1
SerialNo A Serial number as provided in NHIF 2A&B form Text 01099\ 2\2020\00001
CardNo Number of NHIF Beneficiary’s Cards Text 109900035308
FirstName Card holder’s First Name Text Amour
LastName Card holder’s Last Name Text Rashid
Gender Card Holder’s Gender Text Male
DateOfBirth Card Holder’s Date Of Birth Date 18/03/2020
TelephoneNo Text 0686155255
PatientFileNo Patient’s File number as recorded by the Hospital or other health facility Text MNH/03/99999
PatientFile A PDF of the patient treatment details serialized as Base 64 string Text
AuthorizationNo Authorization number issued during member verification Text 187870908768
AttendanceDate The date that the patient attended for service Date 07/03/2020
PatientTypeCode IN PATIENT or OUTPATIENT Text OUT or IN
DateAdmitted If patient was admitted then the admission date otherwise null Date 07/03/2020
DateDischarged If patient was admitted then the discharge date otherwise null Date 08/03/2020
PractitionerNo The Registration number of the medical practioner attending the patient as registered by the Medical council of Tanganyika Text 2999999
CreatedBy User who Created the Entry in the HMIS Text ghaule
DateCreated The Date the entry was created Date 07/03/2020

(ii) FolioDisease

FieldName Description Data Type Example
FolioDiseaseID Primary Key for a folio of visit GUID e9429e1c-f892-40ae-8c0a-a3bc0095681f
FolioID The ID of the folio associated to this diese GUIN 817d6e75-3bef-4d25-a2e1-a3bc009530ab
DiseaseCode Disease code as identified by WHO(Currently ICD 9) Text 084
CreatedBy User who Created the Entry in the HMIS Text
DateCreated The Date the entry was created Date 07/03/

(iii) FolioItem

FieldName Description Data Type Example
FolioItemID Primary Key for a service or item issued to the patient. This could be a medicine,procedure,s urgery,or consumables GUID e9429e1c-f892-40ae-8c0a-a3bc0095681f
FolioID The ID of the folio associated to this Item or Service Issued GUID 817d6e75-3bef-4d25-a2e1-a3bc009530abItemCode
ItemCode used to identify each Item or Service in NHIF Database Text 5036
ItemQuantity Number of Items Claimed Int 10
UnitPrice Price for each Item Decimal 1500.
AmountClaimed Sub Total (ItemQuantity*UnitPrice)\ Decimal 15000.
ApprovalRefNo If the service requires Appeoval then supply the Aproval reference number issued to the patient to get this ervice. Text NHIF/REF/ 1000024
CreatedBy User who Created the Entry in the HMIS Text ghaule
DateCreated The Date the entry was created Date 07/03/2017

The method that accepts json array that will contain one or more folios and uses POST method which can be access via the following url:

https://verification.nhif.or.tz/claimsserver/api/v1/Claims/SubmitFolios

The authentication used is a Token Authentication (Bearer Token). An Example is given in Java on how to call a method from the API. You will be give username and password for each facility that will be integrated with NHIF. This will help NHIF Systems to identify and authorize any API call before giving it access.

SAMPLE CODE FOR CALLING AN API USING JAVA

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@Action
public void OnTest()
{
    String userName = "integrationuser";
    String password = "nhif@2018";

    try {
        String url ="https://verification.nhif.or.tz/claimsserver/api/v1/claims/SubmitFolios"; 
        String tokenEndPoint ="https://verification.nhif.or.tz/claimsserver/Token";

        EntityBuilder eb = new EntityBuilder();
        String jsonText = eb.getEntityString();
        CloseableHttpClient tokenClient = HttpClientBuilder.create().build();


        HttpPost request = new HttpPost(tokenEndPoint);
        request.addHeader("content-type", "application/x-www-formurlencoded");

        String entityBody="username= integrationuser &password=nhif@2018&grant_type=password";    
        StringEntity entity = new StringEntity(entityBody);
        request.setEntity(entity);

        HttpResponse result = tokenClient.execute(request);
        String stringToParse = EntityUtils.toString(result.getEntity(), "UTF-8");

        JSONParser parser = new JSONParser();
        JSONObject json = (JSONObject)
        parser.parse(stringToParse);

        String tokenString = json.get("access_token").toString();
        String bearer = String.format("Bearer %1s",tokenString );

        CloseableHttpClient httpClient = HttpClientBuilder.create().build();
        HttpPost claimRequest = new HttpPost(url);
        claimRequest.addHeader("content-type", "application/json");
        claimRequest.addHeader("Authorization", bearer);

        StringEntity claimEntity = new StringEntity(jsonText);
        claimRequest.setEntity(claimEntity);

        HttpResponse claimResult = httpClient.execute(claimRequest);
        String claim = EntityUtils.toString(claimResult.getEntity(), "UTF-8");

        this.jTextField1.setText(claim);
    }
    catch(IOException e)
    {
        System.out.println(e.getMessage());
    }
    catch (Exception e){
        System.out.println(e.getMessage());
    }
}

Using EntityBuilder

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package hmacjava;

/**
 *
 * @author arashid 
 */
public class EntityBuilder {
    public String getEntityString()
    {
        StringBuffer sb =  new StringBuffer(); 

        sb.append("{");
        sb.append("\"entities\":[");
        sb.append("{");
        sb.append("\"FacilityCode\":\"01099 \",");
        sb.append("\"ClaimYear\":6,");
        sb.append("\"ClaimMonth\":7,");
        sb.append("\"FolioNo\":1,");
        sb.append("\"SerialNo\":\"SN00099\",");
        sb.append("\"CardNo\":\"308900035308\",");
        sb.append("\"FirstName\":\"Flora\",");
        sb.append("\"LastName\":\"Mataba\",");
        sb.append("\"Gender\":\"Female\",");
        sb.append("\"DateOfBirth\":\"19 74 - 01 - 23 \",");
        sb.append("\"Age\":30.0,");
        sb.append("\"TelephoneNo\":\"0686155255\",");
        sb.append("\"PatientFileNo\":null,");
        sb.append("\"PatientFile\":\"GQ8XQAYFAiEMfN0qD0COTgMX......\",");
        sb.append("\"AuthorizationNo\":null,");
        sb.append("\"AttendanceDate\":\"2014- 09 - 01 \",");
        sb.append("\"PatientTypeCode\":\"OUT\",");
        sb.append("\"DateAdmitted\":null,");
        sb.append("\"DateDischarged\":null,");
        sb.append("\"PractitionerNo\":\"12345\",");
        sb.append("\"PractitionerName\":\"Dr.William Herbert\",");
        sb.append("\"PractitionerName\":1,");
        sb.append("\"FolioDiseases\":[");
        sb.append("{");
        sb.append("\"DiseaseCode\":\"084\",");
        sb.append("\"Remarks\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 - 23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 - 23 \"");
        sb.append("}");
        sb.append("],");
        sb.append("\"FolioItems\":[");
        sb.append("{");
        sb.append("\"ItemCode\":\"11\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":1,");
        sb.append("\"UnitPrice\":2000.00,");
        sb.append("\"AmountClaimed\":.00,");
        sb.append("\"ApprovalRefNo\":\"NHIF/REF/201000024\",");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015-01-23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015-01-23 \"");
        sb.append("},");
        sb.append("{");
        sb.append("\"ItemCode\":\"11533\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":1,");
        sb.append("\"UnitPrice\":1950.00,");
        sb.append("\"AmountClaimed\":.00,");
        sb.append("\"ApprovalRefNo\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015-01 - 23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015-01 - 23 \"");
        sb.append("},");
        sb.append("{");

        sb.append("\"ItemCode\":\"11004\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":3,");
        sb.append("\"UnitPrice\":100.00,");
        sb.append("\"AmountClaimed\":300.00,");
        sb.append("\"ApprovalRefNo\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 -23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 -23 \"");
        sb.append("},");
        sb.append("{");
        sb.append("\"ItemCode\":\"5039\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":2,");
        sb.append("\"UnitPrice\":3000.00,");
        sb.append("\"AmountClaimed\":6000.00,");
        sb.append("\"ApprovalRefNo\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 -23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 - 23 \"");
        sb.append("},");
        sb.append("{");
        sb.append("\"ItemCode\":\"7402\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":1,");
        sb.append("\"UnitPrice\":20000.00,");
        sb.append("\"AmountClaimed\":20000.00,");
        sb.append("\"ApprovalRefNo\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015-01-23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 - 23 \"");
        sb.append("}");
        sb.append("],");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015-01-23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015-01 - 26 \"");
        sb.append("},");
        sb.append("{");
        sb.append("\"FacilityCode\":\"01099\",");
        sb.append("\"ClaimYear\":2016,");
        sb.append("\"ClaimMonth\":7,");
        sb.append("\"FolioNo\":2,");
        sb.append("\"SerialNo\":\"13/109998777\",");
        sb.append("\"CardNo\":\"109900035308\",");
        sb.append("\"FirstName\":\"Amour\",");
        sb.append("\"LastName\":\"Rashid\",");
        sb.append("\"Gender\":\"Male\",");
        sb.append("\"DateOfBirth\":\"1974- 01 - 23 \",");
        sb.append("\"Age\":40.0,");


        sb.append("\"TelephoneNo\":\"0686155255\",");
        sb.append("\"PatientFileNo\":null,");
        sb.append("\"PatientFile\":\"GQ8XQAYFAiEMfN0qD0COTgMX......\",");
        sb.append("\"AuthorizationNo\":null,");
        sb.append("\"AttendanceDate\":\"2014- 09 - 01 \",");
        sb.append("\"PatientTypeCode\":\"OUT\",");
        sb.append("\"DateAdmitted\":null,");
        sb.append("\"DateDischarged\":null,");
        sb.append("\"PractitionerNo\":null,");
        sb.append("\"PractitionerName\":\"Dr.WilliamHerbert\",");
        sb.append("\"PractitionerName\":1,");
        sb.append("\"FolioDiseases\":[");
        sb.append("{");
        sb.append("\"DiseaseCode\":\"084\",");
        sb.append("\"Remarks\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 - 23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 - 23 \"");
        sb.append("}"); 
        sb.append("],");
        sb.append("\"FolioItems\":[");
        sb.append("{");
        sb.append("\"ItemCode\":\"5036\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":1,");
        sb.append("\"UnitPrice\":3200.00,");
        sb.append("\"AmountClaimed\":3200.00,");
        sb.append("\"ApprovalRefNo\":null,");

        sb.append("\"CreatedBy\":\"Administrator\",")
        sb.append("\"DateCreated\":\"2015- 01 -23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 -23 \"");

        sb.append("}");
        sb.append("],");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 -23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\","); 
        sb.append("\"LastModified\":\"2015-01 - 28 \""); 
        sb.append("},"); 
        sb.append("{");
        sb.append("\"FacilityCode\":\"01099\",");
        sb.append("\"ClaimYear\":2016,");
        sb.append("\"ClaimMonth\":7,");
        sb.append("\"FolioNo\":3,");
        sb.append("\"SerialNo\":null,");
        sb.append("\"CardNo\":\"01-NHIF241\",");
        sb.append("\"FirstName\":\"Amour\",");
        sb.append("\"LastName\":\"Hamad\",");
        sb.append("\"Gender\":\"Male\",");
        sb.append("\"DateOfBirth\":\"1974- 01 -23 \","); 
        sb.append("\"Age\":40.0,");
        sb.append("\"TelephoneNo\":\"0686155255\",");
        sb.append("\"PatientFileNo\":null,");
        sb.append("\"PatientFile\":\"GQ8XQAYFAiEMfN0qD0COTgMX......\",");
        sb.append("\"AuthorizationNo\":null,");
        sb.append("\"AttendanceDate\":\"2014- 09 - 01 \",");
        sb.append("\"PatientTypeCode\":\"OUT\",");
        sb.append("\"DateAdmitted\":null,");
        sb.append("\"DateDischarged\":null,");
        sb.append("\"PractitionerNo\":null,");
        sb.append("\"PractitionerName\":\"Dr.WilliamHerbert\",");
        sb.append("\"PractitionerName\":1,");
        sb.append("\"FolioDiseases\":[");
        sb.append("{");
        sb.append("\"DiseaseCode\":\"084\",");

        sb.append("\"Remarks\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 - 23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 - 23 \"");
        sb.append("}"); sb.append("],");
        sb.append("\"FolioItems\":[");
        sb.append("{");
        sb.append("\"ItemCode\":\"5059\",");
        sb.append("\"OtherDetails\":null,");
        sb.append("\"ItemQuantity\":1,");
        sb.append("\"UnitPrice\":3800.00,");
        sb.append("\"AmountClaimed\":3800.00,");
        sb.append("\"ApprovalRefNo\":null,");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 -23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 -23 \"");
        sb.append("}");
        sb.append("],");
        sb.append("\"CreatedBy\":\"Administrator\",");
        sb.append("\"DateCreated\":\"2015- 01 -23 \",");
        sb.append("\"LastModifiedBy\":\"Administrator\",");
        sb.append("\"LastModified\":\"2015- 01 -26 \""); 
        sb.append("}"); sb.append("]");
        sb.append("}");

        return sb.toString();
    }
}

For a particular programming Language such as PHP, JavaScript, C# etc, Please send use a request to it@nhif.or.tz and we will send you the sample code.

SUBMITTING DOCUMENTS:

The field in the Folio Object in the JSON Schema with a name "PatientFile" is supposed to contain the PDF Document that contain all details about the patient treatment for that particular folio. The document need to be submitted as Base 64 String. At the end, all the contents of the JSON document should be submitted as a single Complex object as given in sample document below.

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{
  "entities": [
    {
      "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
      "ClaimYear": 2016,
      "ClaimMonth": 7,
      "FolioNo": 1,
      "SerialNo": "SN00 099",
      "CardNo": "308900035308",
      "FirstName": "Flora",
      "LastName": "Mataba",
      "Gender": "Female",
      "DateOfBirth": "1974- 01 -23T16:56:20.287",
      "Age": 30.0,
      "TelephoneNo": "0686155255",
      "PatientFileNo": null,
      "PatientFile": "GQ8XQAYFAiEMfN0qD0COTgMX......",
      "AuthorizationNo": null,
      "AttendanceDate": "2014- 09 -01T00:00:00",
      "PatientTypeCode": "OUT",
      "DateAdmitted": null,
      "DateDischarged": null,
      "PractitionerNo": "12345",
      "CreatedBy": "Administrator",
      "DateCreated": "2015- 01 -23T16:56:20.223",
      "LastModifiedBy": "Administrator",
      "LastModified": "2015-01 - 2 6T12:31:25.097",
      "FolioDiseases": [
        {
          "FolioDiseaseID": "e9429e1c-f892-40ae-8c0a-a3bc0095681f",
          "DiseaseCode": "084",
          "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
          "Remarks": null,
          "CreatedBy": "Administrator",
          "DateCreated": "2015 - 01 -23T16:56:20.287",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.287"
        }
      ],
      "FolioItems": [
        {
          "FolioItemID": "e0d30408- 1863 - 4eb4-8cce-a3bc00957501",
          "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
          "ItemCode": "11",
          "OtherDetails": null,
          "ItemQuantity": 1,
          "UnitPrice": 2000.0,
          "AmountClaimed": 2000.0,
          "ApprovalRefNo": "NHIF/REF/201000024",
          "CreatedBy": "Administrator",
          "DateCreated": "2015- 01 -23T16:56:20.35",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.35"
        },
        {
          "FolioItemID": "84ae41a0-514c-489d-8e6f-a3bc00958289",
          "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
          "ItemCode": "11533",
          "OtherDetails": null,
          "ItemQuantity": 1,
          "UnitPrice": 1950.0,
          "AmountClaimed": 1950.0,
          "ApprovalRefNo": "null",
          "CreatedBy": "Administrator",
          "DateCreated": "2015- 01 -23T16:56:20.37",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.37"
        },
        {
          "FolioItemID": "3c5b814c-7fbf-454b-9c9e-a3bc00985ba5",
          "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
          "ItemCode": "11004",
          "OtherDetails": null,
          "ItemQuantity": 3,
          "UnitPrice": 100.0,
          "AmountClaimed": 300.0,
          "ApprovalRefNo": "null",
          "CreatedBy": "Administrator",
          "DateCreated": "2015- 01 -23T16:56:20.39",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.39"
        },
        {
          "FolioItemID": "338ce17c- 1655 - 417f-80e3-a3ca01019326",
          "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
          "ItemCode": "5039",
          "OtherDetails": null,
          "ItemQuantity": 2,
          "UnitPrice": 3000.0,
          "AmountClaimed": 6000.0,
          "ApprovalRefNo": "null",
          "CreatedBy": "Administrator",
          "DateCreated": "2015- 01 -23T16:56:20.41",
          "LastModifiedBy": "Administrator",
          "LastModified": "2 015 -01 - 23T16:56:20.41"
        },
        {
          "FolioItemID": "ae3e912a-137b-48e7- 9853 -a3ca01058118",
          "FolioID": "817d6e75-3bef-4d25-a2e1-a3bc009530ab",
          "ItemCode": "7402",
          "OtherDetails": null,
          "ItemQuantity": 1,
          "UnitPrice": 20000.0,
          "AmountClaimed": 20000.0,
          "ApprovalRefNo": "null",
          "CreatedBy": "Administrator",
          "DateCreated": "2015- 01 -23T16:56:20.47",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.47"
        }
      ]
    },
    {
      "FolioID": "d3d7656b-7c3b- 4392 - b75f-a3ca01048e2b",
      "ClaimYear": 2016,
      "ClaimMonth": 7,
      "FolioNo": 2,
      "SerialNo": "13/109998777",
      "CardNo": "109900035308",
      "FirstName": "Amour",
      "LastName": "Rashid",
      "Gender": "Male",
      "DateOfBirth": "1974- 01 -23T16:56:20.287",
      "Age": 40.0,
      "TelephoneNo": "0686155255",
      "PatientFileNo": null,
      "AuthorizationNo": null,
      "AttendanceDate": "2014- 09 -01T00:00:00",
      "PatientTypeCode": "OUT",
      "DateAdmitted": null,
      "DateDischarged": null,
      "PractitionerNo": null,
      "CreatedBy": "Administrator",
      "DateCreated": "2015- 01 -23T16:56:20.247",
      "LastModifiedBy": "Administrator",
      "LastModified": "2015-01 - 28T13:31:09.297",
      "FolioDiseases": [
        {
          "FolioDiseaseID": "c4f56a4c- 6217 - 475d-b3de-a3ca0104c9dc",
          "DiseaseCode": "084",
          "FolioID": "d3d7656b-7c3b- 4392 - b75f-a3ca01048e2b",
          "Remarks": null,
          "CreatedBy": "Administrator",
          "DateCreated": "2015 - 01 -23T16:56:20.307",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.307"
        }
      ],
      "FolioItems": [
        {
          "FolioItemID": "248fa65b-dab8-4ca2- 9905 -a3ca0104cfc7",
          "FolioID": "d3d7656b-7c3b- 4392 - b75f-a3ca01048e2b",
          "ItemCode": "5036",
          "OtherDetails": null,
          "ItemQuantity": 1,
          "UnitPrice": 3200.0,
          "AmountClaimed": 3200.0,
          "ApprovalRefNo": "null",
          "CreatedBy": "Administrator",
          "DateCreated": "2015- 01 -23T16:56:20.43",
          "LastModifiedBy": "Administrator",
          "LastModified": "2015-01 - 23T16:56:20.43"
        }
      ]
    }
  ]
}

The screenshot below shows the layout of the sample JSON document that can be posted on an NHIF API.

CLAIMS RECONCILIATION

You can call the API below to retrieve list of claims that have been successful received by NHIF for reconciliation purpose

1
2
https://verification.nhif.or.tz/claimsServer/api/v1/claims/
getSubmittedClaims?FacilityCode=06852&ClaimYear=2019&ClaimMonth=9