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:
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Medical_Claims
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not requiring Special approvals |
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| 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 | ||
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(Total within 45 days)
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Medical claims
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requiring approval of higher authorities |
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| Total time within | 60 days in Delhi | ||||
| Total time within | 90 days in other cities | ||||
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Medical claims
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requiring opinion of specialists |
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| Total time | 60 days | ||||
Medical Claims |
requiring STC approval for full reimbursement |
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| 1st STC meeting may be conducted within 90 days |
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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
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