Empanelled Hospital Claims- Ophthalmic procedures

Central Organisation,ECHS
Adjutant General’s Branch
Integrated Headquarters
Ministry Of Defence(army)
Maude Lines
Delhi Cantt – 110010

B/49773/AG/ECHS/Rates/Policy

18th May 2017

UTI-ITSL
15533/1, Above Farico Show Room
1st Floor, Old Madras Road
Halasuru, Bangalore,
Karnataka – 560008

EMPANELLED HOSPITAL CLAIMS : OPHTHALMIC PROCEDURES

1. It has been noted with concern while scrutinizing claims of an Eye Centre that ECHS had been billed more than the hospital rates. It was also observed that for ocular investigations the hospital was billing ECHS at twice the CGHS rates (stating that the CGHS rates are for one eye). It has been clarified the CGHS rates for Ophthalmology investigations are for both eyes unless specified”.

2. As per provisions of MoA and para 4(b)(x) of Gol MoD letter NO.24(8)/03/US(WE)/D(Res) dated 19 Dec 2003, the hospital cannot bill ECHS more than the hospital rates. It should be ensured by Regional Centre’s that the rate list of the hospital is taken whenever MoA is being renewed. The rate list attached with MoA should not have a rate more than CGHS rate/Hospital rate. wherever the hospital rate is below CGHS rate it should be reflected with an asterisk (*) on the rate list attached with MoA.

3. BPA to check the claims of such hospital (including settled claims) which have not been processed correctly and the excess amount paid post implementation of CGHS 2014 rates if any would be recoered from the pending claims of the hospitals.

4. The RCs are directed to ensure no additional charges/extra charges than CGHS/ECHS or actuals whichever is less to be paid to the hospital. It is also requested RCs to accordingly review the pending claims (i.e not settled claims) of the hospitals not restricted to ophthalmic claims and those with observations be returned to BPA for correct processing.

5. Please ask.

Sd/-
(IVS Gahlot)
Col
Dir (Med)
for MD ECHS

Source: [Document Click here to download]

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