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Wednesday, January 16, 2013

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


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.

Deputy Secretary to the Government of India


In Hindi [click on picture]


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