Referral procedure to empanelled hospitals for ECHS beneficiaries: Clarification on reimbursement of individual claims
Central Organisation ECHS
Adjutant General’s Branch
Integrated Headquarters of
Near Gopinath Circle,
Delhi Cantt- 110 010
27 Jul 2021
(All Regional Centres)
REFERRAL PROCEDURE TO EMPANELLED HOSPITALS FOR ECHS BENEFICIARIES
1 Please refer to CO, ECHS letter No 8/49711-NSC/AG/ECHS dated 15 Jul 2021.
2. As per Para-14 of letter under reference, in case of out station referrals the OIC out station polyclinic and the concerned Dir Regional Centre will be responsible for processing the IPD/OPD Hospital claim from empanelled Hospitals through UTI-TSL. Further, all approvals/sanctions related to extension of stay and unlisted procedures will be processed through outstation Polyclinic and Regional Centre.
3 It is also clarified that all claims for individual reimbursement (including Emergency Admission Claims) by the ECHS beneficiaries where the treatment has taken on cash payment from Govt Hospitals and Private Hospitals including hospitals of National repute like CMC Vellore, Shanker Netralaya, Chennai, Tata Memorial Hospital Mumbai etc will continue to be processed as hithertofore by respective parent polyclinics.
(Anupam N Adhaulia)
for MD ECHS