NATIONAL HEALTH INSURANCE FUND

Dedicated to providing Quality Health care to its beneficiaries

Telephone +255 022 2133696, +255 022 2133982, +255 022 2133992
Email: info@nhif.or.tz
(All letters should be addressed to the Director General)
In Reply please quote; P.O.Box 1437
Ref. P8660/PWN/06/2022/2928 Dodoma
ARAFA MWENDAPOLE DISPENSARY Tanzania
BOX 45154 Jul 29, 2022
DSM
CLAIM REIMBURSEMENT FOR
AMOUNT CLAIMED TZS 735,780.00
NUMBER OF CLAIM FORMS: 94
Please refer to your claim submitted in June, 2022

Enclosed herewith is a bank cheque numbered PV19380720222023 for Tshs 709,580.00 being payment for medical
services provided to NHIF beneficiaries as detailed hereunder:-

S/No. Benefit No. Of Patients Amount

1 Registration/Consultation Charges 94 94000

2 Inpatient Charges 0 0
3 Medicine and Consumables 93 287580
4 Surgical Charges 0 0
5 Diagnostic Examinations 84 328000
6 Procedural Charges 0 0
7 Other Charges 0 0
8 Major Surgeries 0 0
9 Specialized Surgeries 0 0
10 Specialized Procedures 0 0
11 Cardiac Services 0 0

Please take note that the amount you were supposed to claim is Tshs 709,580.00(Actual Computation),
which is different from the amount you have claimed of Tshs 735,780.00. This difference is due to
calculation errors made by your facility.

The amount payable may not be the same as the amount claimed because the Fund has adjusted the claim as
per anomalies observed. We advise you take remedial action so that the observed anomalies are not repeated in
future.

Kindly acknowledge receipt of this payment with its distribution.

We thank you for your support.

...........................
for: The Director General
Enclosed:List of Deductions (if any), List of Observed Anomalies, Payment Distribution Before Deductions.

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Observed Anomalies
OR/08732/PWN/MAY-2022
Folio No. Serial No. Authorization No. Description Anomaly Observed Amount Adjusted
12 550226948163 Diclofenac sodium Absent/ Improper Dosages & 2,000.00
Quantities
20 550226965951 Diclofenac sodium Absent/ Improper Dosages & 1,000.00
Quantities

Payment Distribution Before Deductions

S/No. Claim No. Facility Name Actual Computation Amount Payable Adjustments
1 OR/08732/ ARAFA 0 0 3000
PWN/ DISPENSARY
MAY-2022 (Kibaha Town/
Pwani)

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