How to get ECHS approval for unlisted 7-day ELR test?

Dear Narayan singh ji,

Yes, there is a process under ECHS for investigations that are not included in the CGHS/ECHS rate list. If your cardiologist has advised a 7-day Event Loop Recorder (ELR) because it is medically necessary, you should not assume that you have to pay for it yourself simply because the test is not listed.

ECHS specifically provides a prior-approval mechanism for unlisted diagnostic tests and procedures.

What You Should Do

1. Get a detailed prescription from the cardiologist

Ask your treating cardiologist to clearly mention

• 7-day Event Loop Recorder (ELR) is required.
• The medical reason for prescribing it.
• Your cardiac symptoms/diagnosis.
• Why prolonged rhythm monitoring is required.
• Why a shorter monitoring test, such as a 24-hour Holter, may not be sufficient, if applicable.
• The expected duration and estimated cost of the ELR.

A clear clinical justification can help the ECHS authorities assess the request.

2. Approach the ECHS empanelled hospital

Give the prescription to the ECHS desk/Ayushman Mitra-type ECHS help desk at the empanelled hospital.

For an unlisted investigation, the current ECHS guidance says the empanelled facility should use the online approval process for obtaining the necessary approval rather than making the beneficiary obtain the approval personally.

This is an important point: you should first ask the hospital's ECHS desk to initiate the approval process.

3. Prior approval for an unlisted investigation

ECHS policy provides for prior approval when a diagnostic test is not included in the CGHS rate list. The older ECHS compendium describes approval through the ECHS Polyclinic and specifies different approving authorities based on the cost of the test/procedure.

There is also a later ECHS clarification stating that an unlisted investigation/procedure requires permission/referral from the competent authority except in an emergency, while tests costing below ₹5,000 can be done without permission under the stated rule.

Therefore, the exact approval route for your 7-day ELR should be confirmed by the hospital's ECHS desk based on its current cost and the applicable ECHS instructions.

Important: If a Service Specialist Has Recommended It

There is an important exception in the current ECHS clarification.

If the ELR has been advised by a Service Specialist or a specialist at a Government Hospital, the clarification states that listed or unlisted tests/procedures do not require the same ECHS-U approval route; the empanelled hospital/diagnostic centre is expected to carry out the investigation through the applicable ECHS process.

So, if your prescription is from a Service Cardiologist/Government Hospital specialist, specifically tell the empanelled hospital's ECHS desk about this.

Should You Pay for the ELR Yourself?

For a planned investigation, it is better not to pay privately first and then assume that ECHS will reimburse you.

Ask the empanelled hospital to obtain the required ECHS approval/authorization before the test, unless your case falls under an applicable emergency or another specific ECHS provision.

Keep copies of

• ECHS card
• Cardiologist's prescription
• Previous ECG/Echo/Holter reports
• Other cardiac investigation reports
• Current medication list
• Hospital referral/recommendation
• Approval/authorization, if issued

What If the Hospital Says “ELR Is Not in the ECHS List”?

Do not stop at that response. Tell the ECHS desk

“The cardiologist has medically advised a 7-day Event Loop Recorder. Please process this as an unlisted investigation through the applicable ECHS approval procedure.

If the hospital still refuses to process the request, approach your parent ECHS Polyclinic/OIC with the cardiologist's prescription and ask them to guide the hospital regarding the unlisted-investigation approval route.

HexaHealth Can Help

We can help you connect with experienced cardiologists at our partner hospitals and assist with appointment coordination and understanding the ECHS treatment process.

For your specific case, share your city, the name of the ECHS-empanelled hospital where the ELR was prescribed, and whether the prescription was given by a private empanelled cardiologist, Service Specialist, or Government Hospital specialist. We can then guide you on the appropriate next step.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth