ECHS: Processing Pending Claims Due to Submission Delays

The Central Organisation ECHS has issued an advisory to all regional centres and UTLITSL regarding the processing of pending claims due to a delay in submission. The advisory refers to a previous letter from the HQ and states that a one-time waiver window had been extended for bills generated up to 31 May 2020, which were to be processed by 31 Dec 2021, and no further waiver was proposed.

However, queries have been raised regarding claims generated beyond 31 Jul 2021. The advisory recommends a resolution mechanism wherein claims submitted within 07 days will be processed as per policy, claims submitted beyond 07 days but up to 60 days may be processed if a waiver is obtained from the RC within 60 days, and if not, the claim will be pending in NMI till 60 days and then a minimum 30% deduction will be applied based on available documents.

For claim documents submitted beyond 60 days, a minimum 30% deduction will be applied based on available documents. The advisory has the approval of the MD ECHS.

Advisory on processing of pending claims due to delay in submission

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

17 Apr 2023

(All Regional Centres)
UTLITSL

ADVISORY ON PROCESSING OF PENDING CLAIMS DUE TO DELAY IN SUBMISSION

1. Ref to this HQ letter No B/49778/AG/ECHS/Claim/Policy dt 09 Jul 2021.
2. A one-time waiver window was periodically extended for ‘all those remaining bills generated upto 31 May 2020 inclusive of bills generated till 31 Jul 2021 ‘which were to be actioned by 31 Dec 2021. Thereafter no further waiver was proposed to be given. Accordingly, the term and condition of MoA became applicable wherein 30% deduction was to be applied if hospital submits bills beyond the 60-day period.
3. Queries have been raised from various stakeholders to accord waiver for Claims generated beyond 31 Jul 2021. The following resolution mechanism is recommended: –

(ii) If waiver not obtained from RC within 60 days Claim to be pending in NMI till 60 days and then minimum 30% deduction be applied on the basis of available documents.
(c) Claim documents submitted beyond 60 days Deduction to be applied at minimum 30% deduction based on available documents
4, This has the approval of MD ECHS.

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