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