Bill Processing Agency for ECHS

Under the ECHS scheme, all the beneficiaries, including the veterans and their dependent family members, can avail of several healthcare facilities at ECHS polyclinics, empanelled hospitals, diagnostic centres, etc. All across the country, around 426 Polyclinics are established to provide medical facilities to the beneficiaries. If you are an ECHS beneficiary, here is how you can avail medical facilities: 

1. Basic outdoor services will be provided at the empanelled Polyclinics.
2. If further management is required for treatment, the concerned beneficiary will be referred from ECHS polyclinics to Armed Forces Medical Services Hospitals, Empanelled private hospitals, and Dental or Diagnostic centres as applicable. 
   (The referrals can only be made by authorised staff of the Polyclinics)
3. A valid Memorandum of Agreement (MOA) is required to avail treatment at empanelled hospitals. The expenses incurred at the time of treatment at the empanelled hospital/Dental/Diagnostic centres will be paid directly by the ECHS as per the rates approved by the authorities in the scheme. 

The beneficiaries are entitled to wards (private, semi-private, or general) during the treatment. The type of ward given would depend on the rank of the beneficiary at the time of retirement. 
Here are the details regarding every type of ward:

1. Private Ward - A private ward has the facilities of an attached toilet (lavatory and bath combined) and certain furnishings, including a wardrobe, bedside table, and a resting bed for the attendants. This room accommodates a single patient along with an attendant. Officers of the Army and equivalent in the Navy or Air Force are entitled to this room. 
2. Semi-Private Ward - It is a hospital room accommodating 2-3 patients. A Semi-private room has an attached toilet and includes the necessary furnishings. JCOs (Junior Commissioned Officers) in Army and equivalent in the Navy and Air Force are entitled to this room. 
3. General Ward - It is a hall that accommodates anywhere between 4-10 patients. NCOs (Non-commissioned Officers) below of Army and equivalent in the Navy and Air Force are entitled to this room. 

Note: The beneficiaries cannot avail the benefit of a higher category ward than the one entitled to them. However, if the entitled ward is unavailable during a medical emergency, the beneficiary will be provided with a higher category ward until the entitled ward becomes available. If the hospital doesn’t have any availability in the entitled ward, the beneficiary will be charged according to the rates of the entitled ward, not the higher category ward. 

The package rate included in the ECHS covers the lump-sum cost of the inpatient treatment/ daycare/ diagnostic procedure that an ECHS beneficiary can avail by the permission of the competent authority. The package rates also cover treatment costs during a medical emergency, including (but not limited to) the following:

1. Registration fee
2. Admission fee
3. Accommodation charges that also include the patient’s diet 
4. Injection charges
5. Operation charges 
6. Dressing charges 
7. Doctor/Consultant visit charges 
8. ICU/ICCU charges 
9. Monitoring charges 
10. Transfusion charges 
11. Anaesthesia charges 
12. Operation theatre charges
13. Procedure charges/ Surgeon’ fee
14. Cost of disposables used during the surgery and other items used during the hospital stay
15. Medicine cost 
16. Routines and essential investigations related to the treatment 
17. Physiotherapy sessions 
18. Nursing care charges 
19. Cost of implants/stents/grafts
20. Treatment charges for newborn baby.

The following are the general instructions for claiming medical reimbursement from the ECHS bill processing agency:

1. All the claim documents should be submitted as hard copies, and every page needs to be serially numbered (and the documents must be arranged in chronological order). 
2. In case of items worth more than INR 1000 per unit, the beneficiary needs to provide MRP/Drug certificate for the Drugs/Medicines/Consumables. 
3. After the patient is discharged, the drugs issued by the hospital are only payable for upto seven days. After seven days, the drugs need to be issued from the ECHS dispensary. 
4. The beneficiary should provide a detailed summary of discharge. The details may include the line of treatment, events of sequential surgical interventions, advice on discharge, presenting complaints, etc. The discharge summary must contain the signature and seal of the treating or resident doctor. 
5. In the case of laboratory and radiological reports, the beneficiary must consider the following points while submitting the documents:
   1. All the reports must be in printed form on Hospital/DC letterhead, signed by the concerned specialist. 
   2. In the case of computerised reports, they should be affixed with digital signatures and the concerned specialist's name. 
   3. All the hospital reports must contain the Hospital code/CGHS code. 
6. In the case of a referral letter, the beneficiary must consider the following points while submitting the documents:
   1. All the printed referral letters must be affixed with a seal and signature of MO I/C  (Medical Officers-in-charge) and O I/C (Officers-in-charge).
   2. If the referrals are computerised, they must contain the name and designation of MO I/C and O I/C. 
7. The final bill must contain Bill No. as well as the seal and signature of an authorised person. The bill must include all the details regarding the amount claimed against accommodation, consultation, investigations, medicines and consumables and other Procedures. The patient or the relative should sign it. 
8. In case the beneficiary claims reimbursement for unlisted implants, procedures, investigations, and extended stay, he or she must get prior approval. 
9. Approval of cardiac implants like AICD/Bi Vent Pacemakers/ ICD/ ComboDevices CRT-D etc., needs prior approval of the Service Cardiologist and ECHS competent authorities. The amount for the same will be paid as per the CGHS/ECHS guidelines. 
10. The invoice must contain the Nomenclature, Batch Number/ Lot Number, and the Serial number of the implant with the date of manufacture and expiry. The patient's name must also be mentioned that matches the outer pouch and sticker. The beneficiary must mention the name of the Patient and Challan number in every individual invoice. If the hospital has issued a group invoice, the beneficiary must attach an individual invoice for every implant provided by the hospital. All implants need to be supported by the pouch and stickers. 
11. Total Joint replacement surgeries and other orthopaedic surgeries need to be supported with pre- and post- Op radiological reports and related images.
12. The package rates are considered according to the CGHS guidelines as per No: OM. S. 11011/23/2009 - CGHS D.11/Hospital Cell (Part IV) Government of India. Medical management that is to be covered within the package period of 0-12 days is considered to be a part of the package period. No extra billing on medicines is allowed. 
13. In the case of blood bank expenses, they need to be supported with voucher/compatibility forms with transfusion notes. 
14. The beneficiary must also submit a Feedback Performa for the treatment and the claim documents. The Performa needs to be signed by either the beneficiary or a relative.  
15. Hospitals need to provide ICP (Indoor case papers) when required. 
16. Ambulance charges are not permissible. 
17. Admission case notes/ Clinical assessment notes are required to be submitted for all emergency admissions. The notes must also contain clinical details in brief, proposed investigations, and proposed line of treatment at the time of admission and a hard copy at the time of claim submission. 

Out Patient Bill Submission - Bill Processing Agency ECHS

The following points are to be considered to claim reimbursement for outpatient bills: 

1. The outpatient consultation bill needs to be affixed with the signature of the treating doctor. 

You need to submit the outpatient consultation bill along with the:

1. Copy of ECHS card
2. Referral card
3. OPD consultation slip on hospital letterhead

In Patient Bill Submission - Bill Processing Agency ECHS

In case the patient needs further management, he or she is transferred from ECHS polyclinics to Armed Forces Medical Services Hospitals. 
The procedure for the patient transfer and claiming the reimbursement of the medical bills is as follows:
All claim documents will be uploaded in a pdf format on the UTIITSL website, and hard copies will be submitted at the respective regional centres.

ECHS aims to provide healthcare benefits to the veterans drawing pension and their dependent family members. The beneficiaries can avail the benefits of ECHS at several healthcare facilities including the ECHS polyclinics, government hospitals and empanelled medical hospitals. There is no restriction on the treatment of any type of disease or medicine to be provided, and the beneficiaries can claim reimbursement of the expenditure incurred. You can refer to the instructions given in this article for claiming medical reimbursement from the ECHS bill processing agency.
You can also contact HexaHealth experts to know more about the ECHS bill processing agency. In case of any medical-related queries, we are always here to help and support you in the best way possible.