Tele: 011-25683476 Ml 36833
Email: jdmed.navy@echs.cov.in

BY REGD POST / SDS
Central Organisation ECHS
Adjutant General’s Branch
Integrated HQ of MoD(Army)
Thimayya Marg,
Near Gopinath Circle
Delhi Cantt – 110 010

B/49778/AG/ECHS/Claim/Advisory 04 Oct 2022

IHQ of MoD (Navy)/Dir ECHS (N)

Air HQ (SP), Dte of AV, Subroto Park HQ Coast Guard

HQ Southern Command (A/ECHS) HQ
Easthern Command (A/ECHS)
HQ Western Command (A/ECHS)
HQ Northern Command (A/ECHS)
HQ Central Command (A/ECHS)
HQ South Western Command (A/ECHS)
HQ Andaman & Nicobar Command (A/ECHS)
HQs Training Command AF, Bangalore
All Regional Centres ECHS

ADVISORY ON PAYABLE / NON-PAYABLE ITEMS FOR SETTLEMENT OF CLAIMS

Refer to Para 17 (e) & 44 (j) of SOP on Treatment Management.
There have been many complaints in the past from the environment regarding the cashless claim settlement process as per ECHS policy. Both the ESM clientele and empaneled HCOs repeatedly approach various echelons of the ECHS organization requesting for full reimbursement of their claims.
The package rates for procedures/investigations and cost of implants are published as per compendium of CGHS rates amended from time to time. These city wise rates are taken into consideration while processing CGHS/ECHS claims. Similarly, the policy for items which are payable/not payable for CGHS beneficiaries is also applicable equally for ECHS beneficiaries.
There is no standard list published by CGHS for payable/non payable consumable items and the CGHS earlier considered these as per the merits of the case. Post convergence of Central Government schemes like ESI, CAPF and CGHS on NHA IT platform, there is a standard list promulgated by NHA for processing all hospital and indls reimbursement claims. This list as obtained from NHA is being promulgated through this letter to bring parity and objectivity in processing of claims at all echelons; BPA, RCs and Central Org.
The payable / non-payable template has items summarized under the following heads: –
Administration or non-medical charges (23 Items) Appx ‘A’
External durable devices (25 Items) Appx ‘B’

Item specifically excluded in the policies (14 Items)Elements of Room charge (12 Items)Items payable if supported by a prescription (17 Items)Items which from part of hospital services where separate Consumables are not payable (21 Items)

Appx ‘C’ Appx Appx `E’
Appx ‘F’

Toiletries I cosmetics / personal comfort or convenience – Appx `G’
Items (58 Items).
Others (24 Items) – Appx ‘H’
(j) Part of Hospital own costs and not payable (03 Items) – Appx
Cardiology related consumbles. Queries have also been received from some
RCs regarding admissibility of Cardiology related consumables like catheters, guidewires sheaths and microcatheters. Modern recanalization systems / devices like IVL and suture mediated closure systems like Proglide etc will require approval from Sr Adv Cardiology / CI specialist with rational justification for use. Other consumables like Guide wires, sheaths, simple wires or catheters are to be construed as part of the package and are not to be billed separately.
Investigations billed/claimed separately. As per SOP, all investigations are
part of the package rate, therefore even if they are done prior to admission separately, they will not be paid. Billing it separately is tantamount to splitting of bills, hence will not be permitted.
Antibiotics. All NABH accredited hospitals have a written antibiotic policy. RCs
may ask for the same and accordingly process the bill if indiscriminate injudicious use of antibodies is suspected. CO, ECHS has formulated a standard antibiotic policy in consultation with o/o DGMS. The same may be referred to review antibiotic use.
Reimbursement of expenses incurred by beneficiaries as IPD case during Hospital admission. It is also clarified that expenses incurred on medicines, consumables sundry equipment and accessories which are purchased from outside based on specific authorization of treating doctor / staff of concerned hospital will be reimbursable only if they are falling under the list of payable items. In case, the empanelled hospital has asked an ECHS beneficiary for purchase of such payable items over and above the package rates reimbursement will be made to the beneficiary and the amount shall be recovered from the pending bill of the hospital. (Ref Para 2 of OM Govt of India MoHFW F.No 2-1/2012/CGHSNC/CGHS(P) dated 01 Aug 2013). For such reimbursement cases, the date of purchase of such items should match with the in-patient stay at the hospital.

SEMOs are requested to advise Sr Adv / spls to diligently scrutinize the justification
on Appx A for unlisted procedures / implants / investigation raised by empanelled hospitals.
All RCs are requested to ensure that the contents of attached enclosures be
disseminated to all Empaneled hospitals in their AoR for strict compliance.

3. The list of payable & non-payable is not exhaustive in nature and will be revised from time to time as per extant policies of CGHS / GOI directives in future.

Jt Dir Claim for MD ECHS

Encls: – As above Internal: –

Ops & Coord

Med P&FC

C&L Emp S&A please upload on ECHS portal.

Copy to:-

M/s UTI ITSL UTI Bhawan Plot No 3, Sector 11 CBD Belapur, Navi Mumbai Maharashtra – 400614

for info and necessary action regarding ECHS related bills.

Appx ‘A’

(Ref to this HQ letter No B/49778/AG/ECHS/Claim/Advisory dt &Q Oct 2022.

ADMINSTRATIVE OR NON-MEDICAL CHARGES

S NO	ITEMS	STATUS
I.	MORTUARY CHARGES	Payable up to 24 hrs, shifting charges not payable
	ADMISSION KIT	Not Payable
	BIRTH CERTIFICATE	Not Payable
	BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES	Not Payable
	CERTIFICATE CHARGES	Not Payable
	CONVEYANCE CHARGES	Not Payable
	COURIER CHARGES	Not Payable
	DAILY CHART CHARGES	Not Payable
	DIABETIC CHART CHARGES	Not Payable
	DISCHARGE PROCEDURE CHARGES	Not Payable
	DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES	Not Payable
	ENTRANCE PASS / VISITORS PASS CHARGES	Not Payable
	FILE OPENING CHARGES	Not Payable
	INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)	Not Payable
	MAINTENANCE CHARGES	Not Payable
	MEDICAL CERTIFICATE	Not Payable
	MEDICAL RECORDS	Not Payable
	MEDICINE BOX	Not Payable
	MEDICO LEGAL CASE CHARGES (MLC CHARGES)	Not Payable
	PATIENT IDENTIFICATION BAND / NAME TAG	Not Payable
21:	PHOTOCOPIES CHARGES	Not Payable
	PREPARATION CHARGES	Not Payable
	WASHING CHARGES	Not Payable

Appx ‘8’

(Ref to this HO letter No B/49778/AG/ECHS/Claim/Advisory dt o Oct 2022

EXTERNAL DURABLE DEVICES

S NO	ITEMS	STATUS
I.	LUMBOSACRAL BELT	ry ___ Payable for surgery of lumbar spine.
2.	NIMBUS BED OR WATER OR AIR BED CHARGES	Not payable included in RR
r4	ABDOMINAL BINDER	Essential and should be paid at least in Post Surgery patients of major Abdominal Surgery Including TAH, LSCS, Incisional Hernia Repair, Exploratory Laparotomy for Intestinal Obstruction. Liver Transplant Etc.
	AMBULANCE COLLAR	Not Payable
	AMBULANCE EQUIPMENT	Not Payable
	ARMSLING	Not Payable
	BIPAP MACHINE	Not Payable .
	CERVICAL COLLAR .`	Not Payable ..
	BEDPAN	Not Payable
	CPAP/ CAPD EQUIPMENTS	Device not payable
II.	DIABETIC FOOT WEAR	Not Payable
	INFUSION PUMP — COST	Device not payable
	KNEE BRACES (LONG/ SHORT/ HINGED)	Not Payable
	KNEE IMMOBILIZER/SHOULDER IMMOBILIZER	Not Payable
	MICROSHEILD	Not Payable
	NEBULIZER KIT	Not Payable
	OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL)	Not Payable
	PULSEOXYMETER CHARGES	Device not payable
	SPO2 PROBE	Not Payable
	SPACER	Not Payable
	SPIROMETRE	Device not payable
	SPLINT	Not Payable
	STEAM INHALER	Not Payable
	THERMOMETER	Not Payable
	WALKING AIDS CHARGES	Not Payable

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