CGHS private hospitals – Investigation without referral letter
Investigations at CGHS empanelled private hospitals without referral letter
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
Dated the 1st January, 2013.
Sub: Regarding investigations at private hospitals / diagnostic laboratories/ Imaging centres empanelled under CGHS.
With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for undergoing investigations at private hospitals / diagnostic laboratories / imaging centres empanelled under CGHS. The matter has been examined and with a view to alleviate the inconvenience to CGHS beneficiaries in obtaining requisite permission for undergoing investigations at CGHS empanelled private hospitals / diagnostic laboratories / imaging centres, it has now been decided that CGHS beneficiaries shall herein after be allowed to undergo investigations at private hospitals /diagnostic laboratories /imaging centres empanelled under CGHS after specific investigations have been advised by a CGHS Medical Officer or a Government Specialist without requirement of any other referral(permission) letter.
2. Private empanelled hospitals/ diagnostic laboratories / imaging centres shall perform the investigations / diagnostic tests on cashless basis in respect of pensioners, ex-MPs, freedom fighters and other eligible categories of CGHS beneficiaries, who are presently eligible for credit facility and shall enclose the prescription issued by a CGHS Medical Officer or a Government Specialist, in original along with the hospital bill submitted to competent authorities.
3. Serving government employees shall enclose the prescription issued by a CGHS Medical Officer or a Government Specialist in original, while submitting the medical claim to the concerned Ministry /department/office for reimbursement.
4. CGHS Medical Officer / Government Specialist shall not refer the beneficiaries to any particular diagnostic laboratory or imaging centre by name but, shall specify the Investigation and mention referred to CGHS empanelled centre.
5. These orders are applicable only in respect of investigations for which CGHS rates are available, It shall come into force with immediate effect.
6. This issue with the concurrence of Integrated Finance Division vide FTS No 31560 /2012.