Advisory on claims settlement

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/Policy

02 Feb 2023

(All Regional Centres)

ADVISORY ON CLAIMS SETTLEMENT RELATED TO ONCOLOGY RELATED TREATMENT

1. There has been a noticeable increase in Oncology related treatment at Empanelled Hospitals. The proportion of expenditure on Investigation and Treatment will definitely have an impact on bill settlement for other morbidities considering fiscal limitations Some RCs esp at metros have reported an increased preference amongst HCO’s for prescribing costly investigations within powers of SEMO which necessitate approval by Senior Advisor Oncology to justify its indication and prevent misuse.
2. The following measures are advised to check unnecessary investigations and Chemotherapy on the online BPA billing portal:-

(a) Chemotherapy Most oncology drugs are single use and therefore uploading of the vial wrapper is essential and uploaded as one image, preferably as a printed sticker with following details:-

• (i) Claim ID.
• (ii) Name of Patient.
• (iii) UHID if empanelled Hosp / IPD.
• (iv) MRP of the drug with batch/lot no same as in invoice.

(b) Use of Aprepitant Inj. Admissible, if patient on multi drug chemotherapy view high emetogenic potential. The vial must have details as reqd for Para (a) above.

(c) Investigations Cancer specific investigation above 2 Lakh must be accompanied by approval on Appx ‘A’ recommended by Sr Adv (Oncology) if it is unlisted and not only SEMO.

3. It is requested that this advisory be forwarded to all HCO’s under your jurisdiction for implementation w.r.t Oncology related bills processing.

4. This has the approval of MD ECHS.

(Rajesh Batlish)
Surg capt
OIC Claim
for MD ECHS

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