The Central Government Health Scheme (CGHS) has announced revised timelines and procedures to streamline hospital bill processing for CGHS pensioners. This revision was published by a notice dated April 26, 2024.
Key Revisions Introduced
- Faster Processing: Stricter timelines aim to expedite claim processing by hospitals and CGHS authorities.
- Condonation of Delay: Delays in claim submission by hospitals can now be reviewed for potential approval depending on the duration of the delay.
- Transparency and Visibility: Reasons for claim rejections and deductions will be clearly documented.
- Grievance Redressal: A dedicated grievance redressal mechanism will be established on the NHA portal for hospitals.
- Improved Communication: Hospitals can track claims and raise grievances online. NHA will assign dedicated contact persons for each region.
Benefits
- Faster reimbursement of medical bills for pensioners.
- Improved communication and transparency between hospitals, CGHS, and pensioners.
- Reduced administrative burden on hospitals.
Timeline Highlights
- Hospitals have 2 days to register a patient and inform CGHS.
- Pre-processing doctors have 3 hours to review the intimation.
- Hospitals have 15 days to discharge a patient and initiate a claim.
- Sanctioning authorities will scrutinize bills based on cost.
One-Time Resubmission
Hospitals can resubmit bills rejected due to late submission (after September 1st, 2023) between May 16th and May 31st, 2024.
Additional Measures
- Training for CGHS officials on the new system.
- A checklist of required documents for hospitals to ensure smooth processing.
- Improved tracking system for hospitals to monitor claim status.
