Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

Government of India

Ministry of Health and Family Welfare

Department of Health & Family Welfare

Directorate General of CGHS

Office of the Director, CGHS

No: Z.15025/79/1/DIR/CGHS

545-A Nirman Bhawan, New Delhi

Dated the 5th October, 2016

OFFICE MEMORANDUM

Subject :- Prescription of Timelines under CGHS for settlement of Medical claims of Pensioner CGHS beneficiaries

With reference to the above subject the undersigned is directed to state that it has now been decided to define ‘Time Lines' for processing and settlement of medical claims of pensioner CGHS beneficiaries as per the details given under:

Medical_Claims		not requiring Special approvals
	i.	Issue of Serial No. for Medical Claim at CGHS WC		-	same day
	ii.	Submission of physical bill to Office of AD		-	within 7 days
	iii.	Processing of Claims by Dealing Asst. and submission to CMO(R&H)		-	within 10 days
	iv.	Processing of Medical claims by CMO(R&H)		-	within 7 days
	v.	Sanction of Addl. Director and return to CMO		-	within 3 days
	vi.	Preparation of Bill and submission to P&AO		-	within 7 days
		(Total within 45 days)
Medical claims		requiring approval of higher authorities
		Total time within	60 days in Delhi
		Total time within	90 days in other cities
Medical claims		requiring opinion of specialists
		Total time	60 days
Medical Claims		requiring STC approval for full reimbursement
	1st STC meeting may be conducted within 90 days

Chief Medical Officer in charge shall thoroughly check the papers initially for the completeness of the requisite documents before accepting the claim papers to ensure that the claim papers are not returned subsequently for want of some documents.

(D.C.Joshi)

Director, CGHS

Source: www.cghs.nic.in