UNITED REPUBLIC OF TANZANIA

PRIME MINISTER’S OFFICE- REGIONAL ADMINISTRATION AND

LOCAL GOVERNMENT (PMORALG)

GOTHOMIS – NHIF Integration

User Manual

For Healthcare Staff at Health Facilities

May, 2026

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Table of Contents
1. Introduction .................................................................................................................................................................... 3
2. Purpose of the Integration ............................................................................................................................................. 3
3. What Must be Done First ................................................................................................................................................ 3
3.1. Installing the device softwares .............................................................................................................................. 3
3.2. Select all NHIF packages to reflected at the particular facilities ........................................................................... 3
3.3. Configure Prices of all NHIF packages accordingly ............................................................................................... 4
4. Basic System Overview ................................................................................................................................................... 4
5. Key Modules used in this Integration ........................................................................................................................ 4
5.1. User Roles ............................................................................................................................................................. 4
6. Step-by-Step Instructions ............................................................................................................................................... 5
6.1. NHIF Card Verification ........................................................................................................................................... 5
6.2. Service Approval ................................................................................................................................................... 6
6.3. Claims .................................................................................................................................................................... 8
6.3.1. Submitting a Claim ............................................................................................................................................ 8
6.3.2. Previewing a Submitted Claim ........................................................................................................................ 10
7. NHIF Setup/Configuration ............................................................................................................................................. 12
7.1. Item Mapping ...................................................................................................................................................... 12
7.2. User Mapping ...................................................................................................................................................... 13
6.3 NHIF Credentials ........................................................................................................................................................ 14
8. Common Errors and How to Resolve Them .................................................................................................................. 16
9. Frequently Asked Questions (FAQ) .............................................................................................................................. 17
10. Appendix: Quick Reference Card................................................................................................................................... 17

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 1. Introduction
Welcome to the GOTHOMIS - NHIF Integration User Manual. This guide is written for healthcare staff who use the Government
of Tanzania Health Operations Management Information System (GOTHOMIS) at their health facilities. You do not need
advanced computer skills to follow this manual the instructions are written in simple, step-by-step language.
GOTHOMIS is the national health information system used across Tanzania to manage patient records, services, and billing.
The National Health Insurance Fund (NHIF) is Tanzania's main health insurance scheme. When these two systems work
together, your facility can verify patient insurance cards, get approval for services, and submit claims to NHIF all without
leaving GOTHOMIS.

📌 Who Should Use This Manual? This manual is for receptionists at registration point, clinical officers, nurses, and any
other staff who handle NHIF insured at a GOTHOMIS enabled facility.

2. Purpose of the Integration

The GOTHOMIS - NHIF integration was designed to make daily work easier for health facility staff. Before this integration,
staff had to:
• Open NHIF's own portal or system separately.
• Re-type patient and service information by hand.
• Wait longer for claims to be processed.
• Deal with frequent errors caused by duplicate data entry.

With the integration in place, staff can now:

• Verify a patient's NHIF card in real time without leaving GOTHOMIS .
• Request NHIF approval for services directly from the system.
• Submit claims electronically with fewer errors.
• Track claim status within GOTHOMIS .
• Manage NHIF configuration settings (prices, item mapping, users) from one place.

✅ Key Benefit: The integration reduces duplicate data entry, speeds up claim processing, and helps your facility get paid
faster by NHIF with minimal or non claims rejection.

3. What Must be Done First

3.1. Installing the device softwares
🔒 Installing the device softwares: Depending on the model available biometric devices, system adminstrator will be
needed to install the devices software in the computers especially in registration desk and at the exit point when
3.2. Select all NHIF packages to reflected at the particular facilities
Make sure all NHIF insurance packages have been selected in facility cost sharing.
To do this,
Þ Go to Item Setups,
Þ then open System Settings,
Þ Select Item Setup,
Þ And finally, click on "Facility cost sharing” and tick all NHIF packages. These includes;
¨ Standard NHIF Benefit Scheme
💡 ¨ Ngorongoro Benefit Scheme
¨ Serengeti Benefit Scheme
¨ Toto Afya Kadi Benefit Scheme
¨ Student Benefit Scheme
¨ Najali Benefit Scheme
¨ Wekeza Benefit Scheme

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 ¨ Timiza Benefit Scheme
¨ NSSF Benefit Scheme
¨ TRA Benefit Scheme
¨ Tarangire Benefit Scheme
¨ Mikumi Benefit Scheme
¨ Tanzanite Benefit Scheme
¨ Tourist Benefit Scheme (CHAN)
¨ Bunge Health Insurance Scheme
¨ BoT Health Insurance Scheme
¨ Option One
¨ Option Two
¨ Option Three
¨ CRDB Health Insurance Scheme
¨ NMB Health Insurance Scheme
¨ DCB Health Insurance Scheme
¨ WVT Health Insurance Scheme
¨ Essential Benefit Scheme
¨ FARAJA AFYA SCHEME

Þ Complete this configuration before proceeding to any next task.

3.3. Configure Prices of all NHIF packages accordingly

Step 2: Before you begin, you will need to set up your facility's item prices for NHIF sub-category
To do this,
Þ Go to Item Setups,
Þ then open System Settings,
💡 Þ Select Item Setup,
Þ and finally click on Facility Item Prices.
Þ Complete this configuration before proceeding to any other task (use the normal methodolgies of prices
configuration it might be by (dowloading excel or filling via the system);

4. Basic System Overview

GOTHOMIS is a web-based centralized system you access it using a web browser (such as Google Chrome or Mozilla
Firefox) on a computer connected to the internet or your facility's local network.
4.1. Key Modules used in this Integration
Module What It Does

Patient Registration Registers patients and links their NHIF card to their record.

NHIF Card Verification Checks whether a patient's NHIF card is valid and active.

Service Approval Requests NHIF approval before delivering a service.

Claims Management Creates, submits, and previews NHIF claims.

NHIF Setup/Configuration Manages item mapping, user mapping, and NHIF system credentials.

4.2. User Roles

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Different staff members have different levels of access in GOTHOMIS . Your role determines what you can see and do in the
system. Below are the main roles involved in the NHIF integration.
Role Typical Job Title NHIF Tasks Allowed

Configure NHIF credentials, manage user mapping, item

System Administrator IT Office /System Admin
mapping, price packages, and all setup tasks.

Verify NHIF cards, request service approvals, submit and preview

NHIF Coordinator Medical Personel
claims.

Clinical Officer/Nurse Medical Personel View patient NHIF status, confirm services delivered for billing.

Receptionist Front Desk/Reception Staff Register patients, verify NHIF card at point of entry.

In-Charge/Medical Officer in View reports and claim summaries; approve workflow steps
Facility Manager
Charge where configured.

🔒 Access Note: If you cannot see a menu or button described in this manual, your user account may not have the required
permission. Contact your System Administrator to request access.

5. Step-by-Step Instructions
This section walks you through every key task in the GOTHOMIS - NHIF integration. Each task has numbered steps and notes
to help you complete it correctly.
5.1. NHIF Card Verification
When a patient arrives and says they have NHIF insurance, you must verify their card before providing services. This confirms
the card is valid and the patient is currently covered. Membership verification can be done by using card number of using
biometric.
📋 Before You Start: You need the patient to already be registered in GOTHOMIS, and you need their NHIF card number or
membership number. The system must have an active internet connection.

How to Verify an NHIF Card

Step Action What to Do / What You See

Open your web browser and go to the GOTHOMIS login page. Enter your username
1 Log in to GOTHOMIS
and password, then click Login.

Search for the patient by name, patient ID, or phone number. Click on their name to
2 Open the Patient Record
open their record.

Inside the patient record, click on the 'Insurance' or 'NHIF' tab. Then click the 'Verify
3 Go to NHIF Verification
NHIF Card' button.

Type the patient's NHIF membership number exactly as it appears on the card.
4 Enter the Card Number
Double-check for typos.

Click the Verify button. The system will contact NHIF and return a result within a few
5 Click 'Verify'
seconds.

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 A green message means the card is VALID and the patient is covered. A red message
6 Read the Result means the card is INVALID or EXPIRED. Do not proceed with NHIF billing if the card is
not valid.

7 Save the Verification If valid, click 'Confirm' or 'Save' to record the verification result in the patient's file.

⚠ Warning: Never skip card verification. If you bill NHIF for an unverified or expired card, the claim will be rejected and your
facility will not be paid.

5.2. Service Approval

Some services require prior approval from NHIF before they can be delivered and billed. This step ensures NHIF knows about
the service and agrees to pay for it.
How to Request Service Approval
Step Action What to Do / What You See

Open the insurance module and

1 Enter the MRN of the client (verified from the registration point)
the click Service Approval

Choose the service or procedure the clinician has ordered (e.g., full blood
2 Select the Service Picture, Laparatomy, admission). Click on it to select it, and enter the
amount needed

Add attachment If there is any attachment you may attach;

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 3 Click Save A button labelled Save

NHIF typically responds within a short time. The status will change to
6 Wait for Response
'Approved', 'Pending', or 'Rejected'.

If approved, the system will display an Approval Number. This is

7 Record the Approval Number automatically saved and will be used when submitting the claim. Note it for
your records.

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 📌 Note: If NHIF rejects an approval request, do not re-submit immediately. Check the reason displayed, correct any errors
(e.g., wrong ICD code), and try again.

5.3. Claims
A claim is the request your facility sends to NHIF asking to be paid for services you have delivered to an insured patient.
GOTHOMIS allows you to create, submit, and review claims.
5.3.1. Submitting a Claim
Step Action What to Do / What You See

1 Navigate to Claims From the main menu, click ‘Claims'.

Select the time range by following the instruction on the screen and click
Navigate to Not Submitted
Filter Unsubmitted Claims

Search for the patient using their MRN or authorization number. Select the
2 Search for the Patient Visits
visit for which you want to submit a claim.

GOTHOMIS automatically pulls in the services delivered, quantities, and

prices from the patient's visit record. Click in the action at right and select
3 Review the Claim Summary
Review and compile claims this will allow the user to preview the
completeness of data,.

When the claim looks correct, click the 'Submit Claim' button. A
4 Click 'Submit Claim'
confirmation dialog will appear asking you to confirm.

Click 'Yes, Submit'. The system sends the claim to NHIF. A claim will moved
5 Confirm Submission
to submitted claim;.

Follow the following steps

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 ¨ Review &Complile Claims—Use this sub-
menu to preview the completeness of the
form;

¨ Claims---à Use this to preview the form that

will be submitted to NHIF

¨ Cancelà Use this to cancel the process

Review &Complile Claims

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Claims for claim submission

5.3.2. Previewing a Submitted Claim

After submitting a claim, you can view it at any time to check its details or status.
Step Action What to Do / What You See

1 Go to Claims List From the main insurance menu, click ‘NHIF’> ‘Claims' > 'Submitted'

Select the time range by following the instruction on the screen and click
2 Navigate to Submitted
Filter submitted Claims

Search for the patient using their MRN or authorization number. Select the
2 Search for the Claim
visit for which you want to preview

You will see all services billed, amounts, dates, patient details, and the
4 Review Claim Details
current claim status (e.g., Submitted, Under Review, Paid, or Rejected).

If you need a printed copy, click the 'Print' or 'Download PDF' button at
5 Download or Print (Optional)
the top of the claim details page.

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6. NHIF Setup/Configuration
Before the NHIF integration can work at your facility, a System Administrator medical officer incharge must complete or a
one-time setup. This section covers three configuration tasks: Item Mapping, User Mapping, and NHIF Credentials. These
settings must be correct for the integration to function.
🔒 Who Does This? Only System Administrators or staff with configuration permissions/ medical officer incharge should
perform these steps. If you are not an administrator, please hand this section to your IT officer.

6.1. Item Mapping

Item mapping connects the services and medicines in GOTHOMIS to the corresponding codes used by NHIF. Without this
mapping, GOTHOMIS cannot correctly communicate with NHIF about what was provided. For most items mapping has been
done this should be done only for mapping missing items;
How to Map Items
Step Action What to Do / What You See

1 Open NHIF under insurance From the main menu, go to Insurance>NHIF> Item Mapping.

The screen will show a list of services, medicines, or procedures in

2 View Unmapped Items
GOTHOMIS that have not yet been linked to an NHIF code.

Click add Button and the enter few character of item name you want to
3 Select an Item to Map
map (e.g., 'Paracetamol 500mg' or 'Outpatient Consultation').

In the NHIF Code field, type the name or code of the equivalent item in
4 Search for the NHIF Code/name
NHIF's list. A dropdown of matching NHIF codes will appear.

5 Select the Correct NHIF Code Click on the correct NHIF code from the dropdown to select it.

Click the drop down menu in category select the corresponding category
6 Select the category
of an item;

7 Save the Mapping Click 'Save'.

8 Repeat for All Items Repeat steps 3–6 for every items your facility bills to NHIF.

Follow this steps

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 📌 Tip: Map only for the missing or unmapped items

6.2. User Mapping

User mapping links GOTHOMIS system users (staff accounts) to their corresponding NHIF provider numbers which basically
is from respective professional councils. This ensures that claims are submitted under the correct provider identity.
How to Map Users
Step Action What to Do / What You See

Open NHIF User

1 Go to Insurance > ‘NHIF > ‘User Mapping’.
Mapping

A table of GOTHOMIS mapped accounts will be displayed if any. To map a new click Add
View the mapped
2 New and then follow onscreen instructions, Search the user by using username(phone
User List
number) or email then select the user

Select user qualifications, enter the full practioner number starting with its initial letters
3 Enter the Details eg. MCT32344, the select mode of signature respectively (Depending on the context you
be required to upload signature in image format, or sign in signing pad if available)

5 Save the Mapping Click ‘Save’. The user’s GOTHOMIS account is now linked to their NHIF provider identity.

Repeat for All

6 Repeat for each user.
Clinicians

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Follow these steps to map the users;

⚠ Important: Claims submitted by an unmapped user will be rejected by NHIF. Ensure all active clinical staff are mapped
before going live.

6.3 NHIF Credentials

NHIF Credentials are the login details that allow GOTHOMIS to connect securely to NHIF's servers. These include your
facility's NHIF username, password, and NHIF facility code. These are provided by NHIF when your facility is registered for
the integration. But incase the fields are blank;

How to Enter NHIF Credentials

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 Step Action What to Do / What You See

1 Open NHIF Credentials Settings Go to 'Insurance' > 'NHIF > 'NHIF Credentials'.

2 Enter the Facility Code Type your facility's NHIF Facility Code exactly as provided by NHIF.

3 Enter the NHIF Username Type the NHIF username for your facility.

Type the NHIF API password/secret. The characters will appear as “not
4 Enter the Password
understable phrase” for security.

Choose Yes for “ Live Mode” for the live NHIF system. Only use No for
5 Select the Environment
'Test'

6 Save the Credentials Click 'Save'..

🔒 Security Warning: Never share your NHIF credentials with anyone who does not need them. If your password is
compromised, contact NHIF immediately to reset it.

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 8. Common Errors and How to Resolve Them
Below are errors you may encounter when using the GOTHOMIS - NHIF integration, along with the most likely cause and
how to fix them.
Error Message Likely Cause How to Fix

Card number entered Double-check the card number. Ask the

incorrectly, card expired, or patient to show their card. If the number is
NHIF Card Not Found / Invalid Card
patient is not registered with correct, ask the patient to contact NHIF to
NHIF. confirm their registration status.

Check your internet connection. Wait 5 minutes

No internet connection, or
and try again. If the problem continues for
Connection to NHIF Failed / Timeout NHIF's system is temporarily
more than 30 minutes, contact your IT officer
unavailable.
or report to NHIF support.

The service requires prior

Go back to the patient's visit record, request
approval but approval was not
Service Not Approved by NHIF approval for the service, and wait for a
requested, or NHIF rejected
response before proceeding.
the request.

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 9. Frequently Asked Questions (FAQ)
Q: What do I do if the NHIF card verification screen is not showing in GOTHOMIS ?
A: This usually means your user account does not have permission to access the NHIF module. Contact your System
Administrator to check and update your user permissions.

Q: Can I verify an NHIF card without an internet connection?

A: No. NHIF card verification requires a live connection to NHIF's servers. If there is no internet, you will need internet
to verif.

Q: A patient says their card is valid, but GOTHOMIS says it is invalid. What should I do?
A: Ask the patient to confirm their card number again. Check for common mistakes like the letter 'O' vs the number '0'.
If the card number is correct and the card was recently renewed/created, the NHIF system may not yet be updated ask
the patient to contact NHIF's helpdesk.

Q: How do I know which services require prior approval from NHIF?

A: GOTHOMIS will automatically indicate when a service requires approval by showing an 'Approval Required' badge or
prompting you before the service can be added to a claim. You can also ask your facility manager or check NHIF's
official list of pre-authorisation requirements.

Q: Can I edit a claim after it has been submitted?

A: No. Once a claim is submitted, it cannot be edited in GOTHOMIS . If corrections are needed, should be involved in
the process. For future claims, review all items carefully before clicking 'Submit'.

Q: How often should the item mapping be updated?

A: Item mapping should be reviewed whenever NHIF updates its list of billable services or codes, or when your facility
adds new services. Your System Administrator should check for updates at least once per quarter.

Q: Who do I contact if there is a problem with the NHIF integration that I cannot resolve?
A: First, contact your facility's System Administrator or IT officer. If the issue is on NHIF's side (e.g., their system is
down or rejecting valid cards), contact the NHIF national helpdesk. If the issue is with GOTHOMIS software, contact
your GOTHOMIS system support team.

10. Appendix: Quick Reference Card

Use the table below as a daily quick-reference for the most common NHIF tasks.
Task Menu Path in GOTHOMIS

Verify NHIF Card Client Management → Card Verification

Request Service Approval insuarance → Services Aproval

Submit a Claim insuarance →Claims → Not Submitted

Preview a Submitted Claim insuarance →Claims → Submitted

Item Mapping Insuarance → Item Mapping

User Mapping Insuarance → User Mapping

NHIF Credentials Insuarance → NHIF Credentials

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