CGHS Clarification regarding tests/investigations at private hospitals/diagnostic laboratories/imaging centres

S-11045/40 /2012/CGHS/HEC/CGHS (P)

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

Nirman Bhawan, New Delhi

Dated the 15th January, 2013

OFFICE MEMORANDUM

Subject: Regarding tests/investigations at private
hospitals/diagnostic laboratories/imaging centres empanelled under
CGHS.

The undersigned is directed to refer to the Office Memorandum
of even no. dated 1st January, 2013 on the above subject and to further lay down
the procedure for getting the diagnostic tests investigations carried out at the
CGHS empanelled private hospitals/diagnostic laboratories / imaging centres on a
valid prescription issued by a CCIFIS Medical Officer / Government Specialist,
without a referral / permission letter from the Department concerned or
CMO-in-charge of CGHS Wellness Centre, as the case may be.

2. The CGHS empanelled private hospitals / diagnostic
laboratories / imaging centres shall perform the investigations / diagnostic
tests as prescribed by the CGHS Medical Officer / Government Specialist on
cashless basis to the COFIS pensioner beneficiaries, ex-MPs, freedom fighters
and other eligible categories of CGHS beneficiaries, who are presently eligible
for credit facility, at CGHS approved rates, only in respect of the tests /
investigations for which CGHS rates are available.

3.The Serving beneficiaries will not require any permission
from their Department for getting the diagnostic tests / investigations carried
out in a CGHS empanelled private hospital /diagnostic laboratory / imaging
centre in respect of investigations for which CGHS rates are available. They will get the prescribed tests done on payment basis and claim reimbursement from
their Office.

4. For providing cashless facilities to the eligible CGHS
beneficiaries, the empanelled private hospital / diagnostic laboratory/ imaging
centre shall obtain the prescription either in original or self-attested copy of
the prescription and self attested photocopies of the CGHS card of the patient
and the CGHS card of the main CGHS cardholder beneficiary and enclose the same
with their bills for claiming payment from CGHS or the Department concerned, as
the case may be. The hospital/ diagnostic laboratory] imaging centre shall
however, verify the self attested copies from the original prescription/CGHS
cards, before allowing the credit facility to the eligible CGHS beneficiary.

5. The medical prescription issued by a CGHS Medical Officer /
Government Specialist prescribing diagnostic tests / investigations shall be
treated as valid for a single use within a period of two weeks from the date of
prescription unless specifically provided otherwise by the Government Specialist
in the prescription, about the date or period after which the prescribed tests
are to be conducted for a follow up treatment. The medical prescription would
require revalidation or issue of a fresh prescription from the prescribing CGHS
doctor/ Government Specialist for getting the prescribed tests done after expiry
of the validity period of two weeks, as indicated above.

6. The CGHS empanelled private hospitals / diagnostic
laboratories / imaging centres shall provide cashless facilities to the serving
CGHS beneficiaries entitled for credit facilities in terms of this Ministry’s OM
No Rec.1-2008/ Gr./CGHS/Delhi/CGHS (P) dated 10.06.2008, on submission of a self
attested photocopy of his / her Identity card issued by the Department /
Ministry, alongwith self attested photocopies of the CGHS card of the patient
and the main cardholder. The hospital / diagnostic laboratory / imaging centre
shall enclose the above documents with their bills to the Department concerned
for claiming payment.

Sd/-

[V.P.Singh]

Deputy Secretary to the Government of India