Advisory on Forwarding Cases for HPC: ECHS

Advisory on Forwarding Cases for HPC: ECHS

BY REGDSDS / POST
Central Organisation ECHS
Adjutant General’s Branch
Integrated HQ of MoD(Army)
Thimayya Marg,
Near Gopinath Circle
New Delhi- 110 010

B/49778/AG/ECHS/Claims/Advisory

08 Feb 2023

(Ail Regional Centres)

ADVISORY ON FORWARDING CASES FOR HPC

1. Refer to policy on cases being forwarded for consideration under HPC issued vide this HQ letter No B/49770/AG/ECHS/Policy/2019 dt 08 Apr 2019 (copy att).

2. Of late, many cases are being routinely forwarded to this HQ for consideration by HPC. The cases which can be considered for reimbursement at 100% rates are very well defined in Para 3 of the policy letter quoted ibid. Most of the cases forwarded to MoD are returned unactioned as they are not considered suitable for consideration under HPC as the reasons are neither compelling enough nor felt justified.

3. The following must be ensured prior to forwarding such cases for settlement through HPC at 100% reimbursement: –

(a) The case should not be forwarded for claiming deductions at CGHS / ECHS rates. They fall into the category of supplementary claims and are to be processed accordingly.

(b) The case should be clearly defined and justified as per the correct Encl No mentioned in Para 3 (a) of the HQ letter quoted at Para 1.

(c) The excess expenditure incurred in respect of each item covered under the balance amount (over what is authorized by BPA) shall be justified properly and in consonance with the above stated policy.

(d) The emergency under which the patient is admitted in a non-empanelled hospital must be justified in detail and not merely a sketchy ex post facto recommendation.

(e) A worksheet with item wise assessment criteria and justification by JD (HS) at RC needs to be prepared for considering full payment (at 100% reimbursement instead of CGHS rate or rates authorized by BPA) on the same lines as being done for supplementary claims.

(f) Photocopy of ECHS Card of ESM to be attached.

(g) All Medical bills and medical bill summary of patient to be attached and submitted, with claim IN DUPLICATE.

(h) Admission and discharge sheet to be attached with claim.

4. A sample worksheet with item wise assessment criteria and justification by JD (HS) at RC is placed at enclosure for each case being forwarded for HPC at Appx.

5. This is for your info and necessary action please.

(Rajesh Batlish)
Surg Capt
JD (Claim)
for MD ECHS

Encls: As above