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  • Beneficiary Registration

    Content

    Benefi­ciaries for any scheme need to be ­first informed about the scheme details, its benefi­ts and the process of receiving the benefi­ts.

    Beneficiary registration is the first step in the processing of Direct Benefit Transfer (DBT) schemes in Ni-kshay. Patients after diagnosed and notified as “Pending Treatment” or “On Treatment” who haven’t updated the Beneficiary status has to enter their bank details to register.

    Ni-kshay maintains a Bank Master and only banks available in Public Financial Management System (PFMS) can be used to make payments. Users need to enter their IFSC Code and Ni-kshay auto-populates the details of the bank. Then the user is expected to enter their account number and click “Save”.

    If a bene­ficiary does not have a bank account/ is a paediatric patient, they may be linked to an account of one of their family members with written consent/ authorisation from the beneficiary. But the bank account needs to be unique to be registered in Ni-kshay.

    Then the request is sent to PFMS to validate the active bank account details. Once validated by PFMS, the beneficiary status will change to “Validated” and will be sent to DBT Checker (at District Tuberculosis Officer (DTO) Office) for approval.

    The DBT checker will approve the bank account details and the beneficiary status will be reflected in Ni-kshay as entered.

    On successful validation of the Bank details of the benefi­ciary, the benefi­ts of the bene­ficiary can be processed.

     

    Process of beneficiary registration in Ni-kshay

    Figure: Process of beneficiary registration in Ni-kshay

     

    Valid documents (passbook/ bank statement/ cancelled cheque) from the benefi­ciary should be collected and maintained at the Peripheral Health Institution (PHI) and produced at the time of veri­fication.

     

    Resource 

     

     

    Assessment

    Question 

    Answer 1 

    Answer 2 

    Answer3 

    Answer 4 

    Correct Answer 

    Correct explanation 

    Only patients with a bank account can be registered as a beneficiary in Ni-kshay.

    True 

    False 

     

     

    2 

    If a beneficiary does not have a bank account/ is a paediatric patient, they may be linked to an account of one of their family members with written consent/ authorisation.

     

     

     

  • Benefits Processing in Nikshay

    Content

    Ni-kshay automatically generates benefi­ts as per the scheme guidelines. All bene­fits are linked to the patient's episode irrespective of the benefi­ciary. These bene­fits need to undergo two levels of approvals in Ni-kshay before being sent to Public Financial Management System (PFMS) for payment to the benefi­ciary. Action can be taken only for bene­fits for which the corresponding benefi­ciary has been registered (validated) with PFMS.

    Direct Benefit Transfer (DBT) maker and DBT checker are responsible for the 2-level benefit approval in Ni-kshay. First Tuberculosis Unit (TU) user (DBT maker) has to approve the benefits, which then will be displayed under the ‘Pending’ section of the DBT module from the District Tuberculosis Officer's (DTO’s) login (DBT checker).

    The benefi­t transaction remains in the ‘Processing’ tab of the maker till it is under process with DTO (for approval) or PFMS (for payment). Only the status of the transaction changes. The status of the transaction will either be “waiting for has not yet approved it when it is under the DBT Checker or will be “Sent to PFMS for Payment" when DBT Checker has approved and the benefi­t is pending PFMS for payment.

     

    Benefit processing in Ni-kshay

    Figure: Benefit processing in Ni-kshay

     

    The approved benefi­ts by the DBT checker in Ni-kshay are sent to PFMS regularly (every night). Once the benefit is processed and money is credited, PFMS will inform Ni-kshay and the status of such benefi­ts is updated/ displayed in Ni-kshay as “Paid”.

     

     

    Resource

     

    Assessment

    Question 

    Answer 1 

    Answer 2 

    Answer3 

    Answer 4 

    Correct Answer 

    Correct explanation 

    A benefit undergoes 2-level of approval in Ni-kshay first by____ and then by___

    Creator at Public Health CarePHC level and

    Checker at the district level

    Maker at DTO level and

    Checker at State TB Officer's (STO) level

    Maker at TU level and Checker at DTO level

     None of the above

    3

    A benefit undergoes 2-level of approval in Ni-kshay first by maker at TU level and then by checker at DTO level.

     

  • Action by DBT Maker/Checker in Nikshay interface

    Content

    Direct Benefit Transfer (DBT) Maker and Checker are responsible for the 2-level benefit approval in Ni-kshay, which must be repeated for every benefit.

    The Ni-kshay “Pending” tab lists all benefits to be paid. The DBT maker and checker review benefit and beneficiary details, and only beneficiaries with bank details are validated are approved.

    Actions taken by Maker and Checker at various stages of benefits processing are given in the table below.

    Table: Actions taken by Maker and Checker

     

    After the action, benefi­t would be visible in the benefi­t processing tab of Ni-kshay named:

    Action

    Action by

    Message

    For Maker

    For Checker

    Do nothing

    Maker/ Checker

    It is a default option for any benefi­t and implies no change in the bene­fit status.

    Pending

    Pending

    (Only if the benefi­t

    has been processed

    by Maker and sent to

    Checker)

    Send to checker

    DBT Maker

    DBT Maker can send a benefi­t to DBT Checker by approving the benefi­t as DBT Maker sends the benefi­t.

    Processing

    Pending

    Approve

    DBT

    Checker

    DBT Checker can approve the benefi­ts. Once the benefi­t is approved by the DBT checker, benefi­ts are clubbed into batches in PFMS. These batches are either accepted or rejected by the PFMS approver. If the batch is accepted, PPA is generated, signed, and sent to the bank for processing. If rejected, the benefi­ts are sent back to Maker Pending.

    Processing

    Processing

    Rejected

    DBT

    Checker

    This option is to be selected to resend the benefi­t to DBT Maker for his review and necessary action.

    Pending

     

    Paid external

    DBT Maker/ Checker

    If a benefi­t was paid directly via PFMS, for reconciliation purposes, it is important to update Ni-kshay. For such benefi­ts (which have been paid externally) can be marked as “Paid External”. It is now advisable (since September 11, 2019) to make all payments from within Ni-kshay. The reconciliation process is explained in the annexure to this document.

    Paid

    Paid

    Paid in kind

    DBT Maker/ Checker

    It is at the discretion of the State to disburse bene­fits either in cash or in kind for schemes in National TB Elimination Programme (NTEP). Some states, such as Chhattisgarh, are adopting such practices of giving benefi­ts in kind through food baskets, etc.

    Paid

    Paid

    Removed

    DBT Maker/

    Checker

    Users may decide that the benefi­t is not to be paid to the bene­ficiary and have removed the benefi­ts. For example, if a patient refuses to take the bene­fits or is unwilling to share the bank details, the Tuberculosis Unit (TU)/District Tuberculosis Officer (DTO) User can remove it. If a transaction has been removed by mistake, it can be ‘unremoved’ and processed further.

    Removed

    Removed

    Deferred

    DBT Maker/ Checker

    Users may decide to defer the bene­fits in case they decide to pay them later. However, the ­first benefi­ts cannot be deferred. If a Benefit is “deferred”, Ni-kshay will add the amount to the next benefi­t when it is due. Once a transaction is deferred, it can only be processed along with the next bene­fit as it becomes due.

    Deferred

    Deferred

     

     

    Resource

    • Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme; CTD, MoHFW, Govt of India, 2020.

  • Benefit Processing in PFMS

    Content

    After the assigned Checker/ Approver Ni-kshay user clears benefits, Nikshay sends groups/ batches of benefits to PFMS as a "Payment Request" (DBTPayReq). PFMS processes these Payment Requests it receives from Ni-kshay before executing the request. Processing involves checking for any inconsistencies/ errors in the payment request at the batch level and at the benefit level. On processing:

    • If there are no errors the Payment Request, payment can be initiated/executed. Payment initiation depends on availability of the Digital Signature of the assigned "Approver". If the Digital Signature is not present, the Payment Request is submitted to the Approver User (DA ID) in PFMS for physical signature through Print Payment Advice (PPA).
    • If there are errors at either the batch level or at benefit level, the entire batch/ Payment Request would be rejected and sent back to Ni-kshay. Depending upon the type of error Nikshay either automatically corrects the errors/ re-batches them removing the erroneous benefits, or presents it back to the "Maker" user in Ni-kshay to address the error.

    On execution of the Payment Advice from PFMS, PFMS communicates with the corresponding source bank to make the bank transfer. If the bank transfer is successful the benefit amount gets credited to the bank account of the bene­ficiary and the bank informs PFMS, which in turn informs Ni-kshay and the status of such Benefi­ts is updated/displayed in Ni-kshay as “Paid”.

    Resources

     

    Assessment

    Question  Answer 1  Answer 2  Answer3  Answer 4  Correct Answer  Correct explanation 
    PFMS return the entire batch of benefit if one error is found in a request. True False     1 If there are any errors in the batch, PFMS rejects the entire batch. Irrespective of the number of errors and the number of faulty benefits, PFMS may reject the entire batch.

     

  • Transport Support for TB Patients in Notified Tribal Areas

    Content

    Special provisions have been made in the tribal, hilly and difficult to reach areas of the country under the National TB Elimination Programme (NTEP) to expand diagnosis and treatment centres, improve access for TB patients and coverage of TB services.

    To provide access to diagnosis and treatment centres for people in the tribal areas, NTEP has initiated transport support for TB patients in notified tribal areas from the year 2019.
     

    Transport support is available for patients receiving treatment from both the private and public sectors.

    This is a one-time benefit of Rs. 750, provided to a TB patient notified from a health facility registered under a TB Unit (TU) that is flagged as “Tribal TU” on Nikshay to be eligible for this transport support.

    To receive the benefit, the patient should be identified as unique by the Nikshay system or approved by the District TB Officer (DTO).

     

    Resources

    Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme, CTD, 2020.

    Guidelines for Programmatic Management of Drug-resistant TB in India, 2021.

     

    Assessment

    Question​  Answer 1​  Answer 2​  Answer 3​  Answer 4​  Correct answer​  Correct explanation​ 
    TB patients in tribal areas are eligible for transport support for every visit to the nearest health facility.  True False     2 Transport support for TB patients is a one-time benefit for a notified TB patient registered under Tribal TU.

     

     

  • Treatment Supporter Honorarium Eligibility

    Content

    Treatment supporters are eligible for Honorarium at the end of TB patients treatment, only if the patient's treatment outcome has been declared either as "Cured “or "Treatment Complete".

     

    The eligible amount of honorarium is

    • Rs. 1,000 for DSTB Patients and for
    • Rs. 5,000 for DRTB patients. 

     

    These benefit amount are processed through Nikshay and below are the prerequisite conditions that needs to be met in Nikshay, for generating incentive

    • Treatment supporter should be registered and enabled for receiving honorarium from Nikshay.
    • Bank details of Treatment supporter should be submitted to the nearest NTEP health facility staff.
    • In Nikshay, this is the only scheme where benefits are generated manually by TU users - STS
    • Nikshay will allow NTEP TU users to generate benefits, only if
      • ​Treatment Outcome has been declared as "Cured “or "Treatment Complete"
      • Patient duplication status should be Unique i.e. Nikshay marks the patient duplicate based on Gender and Mobile Number
    • For DSTB patient, one benefit of maximum amount of Rs. 1,000 can be created if outcome is updated as “Cured” or “Treatment Completed
    • For DR TB patients two benefits can be generated in Nikshay:
      • First benefit of maximum amount Rs. 2,000 can be created at end IP - Intensive Phase (i.e. Initiation Date + 6 months)
      • Second benefit of maximum amount Rs. 3,000 can be created if Outcome is updated as “Cured” or “Treatment Completed”

  • Incentives for Private Providers and Informants

    Content

    Private health providers are an inevitable part of the TB treatment and support in the country. These private providers include:

    • Practitioner / Clinic etc. (Single)
    • Hospital/ Clinic/ Nursing Home etc. (Multi)
    • Laboratories
    • Chemists

     

    To improve complete reporting and ensure support care for patients in the private sector, the facilities will receive an incentive of:

    • Rs 500 as Informant or Notification Incentive
    • Rs. 500 for Outcome declaration

    For patients seeking healthcare from a facility in a different district, Nikshay enables the feature of linking a health facility (HF) in addition to the current HF. This enables the private facilities to enter treatment outcomes and become eligible for the incentive.

    Private health providers are also eligible for treatment supporter incentives of Rs. 1000 for DS-TB patients and Rs 5000 for each DR-TB patient for ensuring support for the entire course of treatment.

    Resources

    Guidelines for Programmatic Management of Drug-resistant TB in India, 2021.

     

    Assessment

    Question​  Answer 1​  Answer 2​  Answer 3​  Answer 4​  Correct answer​  Correct explanation​ 
    What incentive does a private sector facility receive for every TB patient notified?  Rs. 1000 Rs. 700  Rs.500  Rs. 250 3 A private facility will receive an incentive of Rs. 500 for every TB patient notified.

     

     

  • Roles and responsibilities of Beneficiaries and NTEP Staff to process DBT

    Content

    In the National TB Elimination Programme (NTEP), the beneficiaries and different staff members have different roles and responsibilities for Direct Benefit Transfer (DBT) processing.

     

    Beneficiaries

    • Provide their bank details of an active savings account to health staff for registration on Ni-kshay. This includes the account holder's name, Bank account number and IFSC code. 
      • If the beneficiary does not have a bank account, open one via Jan Dhan Yojana or India Post Payments Bank.
    • Provide a copy of the passbook or cancelled cheque or any other supporting documents for the bank account.
    • Provide a written declaration to forego the benefits or to credit the payments to a relative’s bank account.
    • Check the payment transfers as and when made and troubleshoot if not receiving the payment.

     

    Health Staff

    This includes Multipurpose Workers (MPWs), Female Health Workers (FHWs), Senior Treatment Supervisor (STS), Senior TB Lab Supervisors (STLS), TB Health Volunteers (TB-HV), Data Entry Operator (DEO), Medical Officer TB Centre (MO-TC).

    • Enrol patients on Ni-kshay with correct and complete details.
    • Update treatment information.
    • Facilitate opening a bank account, if required.
    • Collect and maintain bank details of beneficiaries and give assurance that these details will be used for authentication and benefit payment.
    • Spread awareness on scheme benefits and prerequisites to avail them.
    • Update contact and treatment details of a transferred patient to ensure continued treatment.
    • If the health staff is also the DBT Maker, then they need to ensure timely processing benefits. 
    • Ensure that the beneficiary has received the DBT once it is processed by the Public Financial Management System (PFMS). 

     

    District TB Offi­cer (DTO)

    • Ensure that healthcare staff collects required details from beneficiaries and updates Ni-kshay.
    • Review the data entered into Ni-kshay.
    • Duplicate the notifications and approve the benefits payments.
    • Monitor delays in payment and address the issues.
    • Ensure DBT Maker and Checker are assigned for patient management in Ni-kshay.
    • Plan, review and ensure budget/ funds for fi­nancial support to TB patients, treatment supporters and private providers.
    • Coordinate with banks, district authorities et al to ensure that the required processes and interventions are smoothly implemented.
    • Procure Digital Signature Certificates (DSCs) to deploy payments faster by reducing the time required for Print Payment Advice (PPA) printing, signing and delivery to the bank.

     

    State TB Offi­cer (STO)/ State Programme Officer (SPO)/ Offi­cer-in-Charge

    • Guide the district and health staff on DBT.
    • Coordinate with departments to get support in the opening of bank accounts for beneficiaries.
    • Plan, review and ensure budget/ funds for fi­nancial support to TB patients, treatment supporters and private providers.
    • Monitor progress of transaction of ­financial incentives/ honorarium through DBT.
    • Verify transactions using supervision, evaluations, comparing trends, identifying outliers, etc.
    • Ensure that relevant nodal persons at district levels are provided with the Checker ID.
    • Uptake the usage of DSCs for processing payments by supporting the procurement of DSCs for designated signatories.

     

    Resources

     

    Assessment

     

    Question 

    Answer 1 

    Answer 2 

    Answer3 

    Answer 4 

    Correct Answer 

    Correct explanation 

    Who is responsible for updating the details of the patient on Ni-kshay?

    Patient

    District TB Officer

    State TB Officer

    Health staff

    4

    The health staff is responsible for updating the information of the patient on Ni-kshay.

     

  • DBT reports and registers in Ni-kshay

    Content

    The Ni-kshay reports and registers contain beneficiary level information and only authorised users can download these reports from Ni-kshay. Confidential credentials are provided to access these reports.

    The following summary reports can be obtained from Ni-kshay:

     

    1. DBT Summary: This report provides the summary status of the eligibility and paid details of bene­fits and amount. The DBT summary will provide details based on date of notification
    2. DBT Benefi­ciary Status: This report provides a summary status of the eligibility and paid status of benefi­ciaries. The period used to fi­lter this report is based on the diagnosis date.
    3. DBT Benefit Status: This report provides a summary status of the eligibility and paid benefits. The period used to filter this report is based on the diagnosis date.
    4. Notifi­ed Outcome with Empty Bank Details: This report provides information on the patients to whom the outcomes have been assigned. However, the bank details are empty for the action of the concerned users. The period used to fi­lter this report is based on the diagnosis date.
    5. DBT Ni-kshay Poshan Yojana (NPY): This report provides a complete overview of the DBT NPY Scheme. The period used to ­filter this report is based on the diagnosis date.
    6. DBT Transaction Summary: This report provides benefit payout details to align with expenditure summaries. The period used to filter this report is based on the date of the transaction.

    Patient Registers Available in Ni-kshay

     

    1. DBT Benefit Register: This register provides a line list of all benefits with their status as per the current health facilities.
    2. DBT Benefi­ciary Register: This register provides a line list of all bene­ficiaries with their status as per the current health facilities. The period used to ­filter this report is based on the diagnosis date.

    Resources

     

    Assessment

    Question Answer 1 Answer 2 Answer 3 Answer 4 Correct Answer Correct Explanation

    Which reports in Ni-kshay provide a line list of all benefits with their status as per the current health facilities?

    		 DBT Beneficiary Status DBT Benefit Status DBT Summary DBT Benefit Register 4 DBT Benefit Register provides a line list of all benefits with their status as per the current health facilities.

     

  • Troubleshooting for DBT at Maker level

    Content

    DBT Maker needs to identify the common errors that can occur at multiple levels of Direct Benefit Transfer (DBT) processing and take action to resolve that.

     

    During Beneficiary Rejection

    Rejection Code

    Rejection Reason

    Remark
    CBE0056 Bene­ficiary bank account not allowed in this bank The user needs to raise an NSD ticket to highlight the problem

     

    During Benefit/ Payment Rejection

    Rejection Code

    Narration

    Action
    9 Miscellaneous - Others Retrigger benefi­ts
    11 Invalid IFSC/ MICR Code Renter bank account details once more
    R05 R05 Retrigger

     

    Bene­ficiary Approval where Bank Accounts are duplicate

    The principle of ‘One Benefi­ciary One Bank account’ has been recently implemented in Ni-kshay. All existing patients/bene­ficiaries where the bank account is duplicated will need to be updated.

    DBT Checker will be able to approve only one benefi­ciary with the said Bank account. All other bene­ficiary records where the same Bank account was seeded will be converted to “Empty” status and will need to be seeded with a new and unique bank account.

     

    Deduplication at the time of enrollment

    An alert message will be provided by the system for potential duplicate records. Once reviewed by the user and decided that it is a unique case, they can click on “Proceed Anyway” to enrol the patient.

     

    Resources

     

    Assessment

     

    Question 

    Answer 1 

    Answer 2 

    Answer3 

    Answer 4 

    Correct Answer 

    Correct explanation 

    No duplicates in patient records are accepted by Ni-kshay.

    True

    False

    		    

    2

    Potential duplicates identified by the system should be reviewed by the user and decided that it is a unique case, they can click on “Proceed Anyway” to enrol the patient.

     

  • Registration of Private Providers and Processing Benefits

    Content

    Incentives of INR 500 for notification and outcome declaration will be provided to private providers (Health Facilities).

    Presently, Ni-kshay enables users to pay ‘Private Health Facilities’ for Notification of TB patients, referring cases (informing) to public sector laboratories for diagnosis and outcome reporting.

    Payment for other individual informants and TB patents for self-notification will be added later within the same scheme.

    Outcome incentives will be generated when a patient’s treatment outcome is declared from a private practitioner/ clinic (single) and hospital/ clinic/ nursing home (multi).

    The following steps need to be followed for Direct Benefit Transfer (DBT) payment processing in Ni-kshay for the private providers (Figure 1):

     

    Steps for DBT payment processing in Ni-kshay for the private providers

    Figure 1: Steps for DBT Payment Processing in Ni-kshay for the Private Providers

     

    Private providers should register on Ni-kshay and have a valid Health Facility ID to notify patients on Ni-kshay (Figure 2).

    Private providers can either self-register themselves in Ni-kshay or register by calling Ni-kshay Sampark. A District TB Officer (DTO)/ TB Unit (TU) user can also register the providers using the Admin User Management module.

     

    Following details needs to be entered in Ni-kshay during registration

    • Facility Name
    • Government Registration Number
    • Contact person details (Name, Designation and Address)
    • Mobile Number
    • Email ID

    The mobile number needs to be unique and is used to send One-time Password (OTP) during registration.

     

     

    Registration window of private providers in Ni-kshay

    Figure 2: Registration Window of Private Providers in Ni-kshay

     

    After this, the bank details of the provider need to be added (Figure 3).

     

     

    Bank details update window for private providers in Ni-kshay

    Figure 3: Bank details update window for private providers in Ni-kshay

     

    The next step is to get the updated details approved by DBT Checker. It is available on the ‘Private sector’ page in the ‘Beneficiary Approval’.

    Benefits are auto-generated in Ni-kshay.

    The pre-requisites for auto-generation of benefits for a private facility in Ni-kshay are:

    • Active status
    • Not opting for foregoing incentive
    • “Validated” bank account status 
    • ‘System identified unique’ or ‘unique marked by users’ episodes to generate benefits

    Once benefits are auto-generated, DBT Maker and Checker will need to approve before being processed by PFMS.

     

     

    Resources

     

    Assessment

    Question 

    Answer 1 

    Answer 2 

    Answer3 

    Answer 4 

    Correct Answer 

    Correct explanation 

    What details need to be entered on Ni-kshay while registering as a private provider?   
    • Facility Name
    • Government Registration Number
    • Contact person details (Name, Designation and Address)
    • Mobile Number
    • Email ID
    • Facility Name
    • Contact person details (Name, Designation and Address)
    • Mobile Number
    • Email ID
    • Facility Name
    • Contact person details (Name, Designation and Address)
    • Government Registration Number
    • Facility Name
    • Mobile Number
    • Email ID

    1

    The following details need to be entered by private providers:

    • Facility Name
    • Government Registration Number
    • Contact person details (Name, Designation and Address)
    • Mobile Number
    • Email ID