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Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS
Office of the Director, CGHS

No: Z.15025/79/1/DIR/CGHS

545-A Nirman Bhawan, New Delhi
Dated the 5th October, 2016
OFFICE MEMORANDUM

Subject :- Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

With reference to the above subject the undersigned is directed to state that it has now been decided to define ‘Time Lines’ for processing and settlement of medical claims of pensioner CGHS beneficiaries as per the details given under:

Medical_Claims
 not requiring
Special approvals
i. Issue of Serial No. for
Medical Claim at CGHS WC
same day
ii. Submission of physical bill
to Office of AD
within 7 days
iii. Processing of Claims by
Dealing Asst. and submission to CMO(R&H)
within 10 days
iv. Processing of Medical
claims by CMO(R&H)
within 7 days
v. Sanction of Addl. Director
and return to CMO
within 3 days
vi. Preparation of Bill and
submission to P&AO
 within 7 days
(Total within 45 days)
Medical claims
 requiring
approval of higher authorities
Total time within 60 days in Delhi
Total time within 90 days in other cities
Medical claims
requiring opinion of
specialists
Total time 60 days

Medical Claims
requiring STC
approval for full reimbursement
1st STC meeting may be
conducted within 90 days
Chief Medical Officer in charge shall thoroughly check the papers initially for the completeness of the requisite documents before accepting the claim papers to ensure that the claim papers are not returned subsequently for want of some documents.

(D.C.Joshi)
Director, CGHS

Source: www.cghs.nic.in [Click here to download/view]

COMMENTS

WORDPRESS: 1
  • CGHS payments We are not getting even after submitting the bills even after 6 months.The Govt should consider these problems for early settlement.
    Dr.D.S.Pandey