Details on the One-Time Waiver and Resolution Mechanism for Claims Generated Beyond 31 Jul 2021
The Central Organisation ECHS has issued an advisory regarding the processing of pending claims due to a delay in submission. A one-time waiver window was extended for bills generated up to 31 May 2020, which were to be actioned by 31 Dec 2021. The MoA’s terms and conditions became applicable after this date, and a 30% deduction was to be applied if the hospital submitted bills beyond the 60-day period. There have been queries to accord a waiver for claims generated beyond 31 Jul 2021, and the advisory recommends a resolution mechanism for the same. The advisory has the approval of the MD ECHS.
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/Advisory
17 Apr 2023
(All Regional Centres)
UTLITSL
ADVISORY ON PROCESSING OF PENDING CLAIMS DUE TO DELAY IN SUBMISSION
- Ref to this HQ letter No B/49778/AG/ECHS/Claim/Policy dt 09 Jul 2021.
- A one-time waiver window was periodically extended for ‘all those remaining bills generated upto 31 May 2020 inclusive of bills generated till 31 Jul 2021 ‘which were to be actioned by 31 Dec 2021. Thereafter no further waiver was proposed to be given. Accordingly, the term and condition of MoA became applicable wherein 30% deduction was to be applied if hospital submits bills beyond the 60-day period.
- Queries have been raised from various stakeholders to accord waiver for Claims generated beyond 31 Jul 2021. The following resolution mechanism is recommended: –
| (a) | Claim submitted within 07 days | To be processed as per policy |
|---|---|---|
| Claim submitted beyond 07 days but up to 60 days :- | ||
| (i) If waiver obtained from RC within 60 days | To be processed based on available documents. | |
| (ii) If waiver not obtained from RC within 60 days | Claim to be pending in NMI till 60 days and then minimum 30% deduction be applied on the basis of available documents. | |
| (c) | Claim documents submitted beyond 60 days | Deduction to be applied at minimum 30% deduction based on available documents |
4. This has the approval of MD ECHS.
(Rajesh Batlish)
Surg Capt
JD (Claim)
for MD ECHS