Revised Procedure for processing of waivers and sanctions – Online Claims: ECHS Order dated 14.12.2021
Central Organisation ECHS
Adjutant General’s Branch
Integrated HQ of MoD(Army)
Near Gopinath Circle
New Delhi- 110 010
14 Dec 2021
(All Regional Centres)
REVISED PROCEDURE FOR PROCESSING OF WAIVERS AND SANCTIONS: ONLINE CLAIMS
1. Refer Cent Org ECHS letter No B/49778/AG/ECHS/Claim/Policy dt 30 Aug 2017.
2. The present procedure being followed in case of claims with discrepancy in overlapping of admission and discharge date is that the cases are examined in detail by RC and fwd to Cent Org ECHS with due justification and recommendations of Dir RC. Cent Org ECHS further gives the sanction / concurrence for processing of such claims. In more than 99% of such cases, the fault is of the first hospital by wrongly mentioning the discharge date / time due to which the second hospital is unable to upload the claim.
3. To resolve the delay in payments in cases of overlapping claims, the following amendments are suggested:-
(a) The RC will examine the case in detail consulting both the affected HCOs with due diligence. The HCOs will be given a period of 30 working days / 03 Reminders (At the end of 1st, 2nd & 3rd weeks) to respond to the queries raised by the RC.
(b) Depending upon the merit of the case, Dir RC with his recommendations will instruct the BPA to make necessary amendments in discharge time of the erring HCO and ensure necessary deduction as applicable as per the actual time of discharge.
(c) In case the first HCO (for which the claim is already settled) does not respond to the queries raised by the RC within the stipulated time period given at Para 3 (a) above, Director RC will instruct the BPA to deduct the amount equivalent to the overlap period of the settled claim of the first HCO from their subsequent claims.
(d) As per the recommendations of Dir RC, the BPA will further enable the claim processing of the second concerned hospital for which the uploading of claim is still awaited.
4. This has the approval of MD ECHS.
5. This is for your info and necessary action please. :
(K B Rana)
Joint Dir (Med)
for MD ECHS