CGHS Orders 2013 : Regarding tests/investigations at private hospitals /
diagnostic laboratories / imaging centres empanelled under CGHS.
S-11045/40 /2012/CGHS/HEC/CGHS (P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi
Dated the 15th January, 2013
OFFICE MEMORANDUM
Subject: Regarding tests/investigations at private
hospitals / diagnostic laboratories / imaging centres empanelled under CGHS.
The undersigned is
directed to refer to the Office Memorandum of even no. dated 1st January, 2013
on the above subject and to further lay down the procedure for getting the
diagnostic tests / investigations carried out at the CGHS empanelled private
hospitals / diagnostic laboratories / imaging centres on a valid prescription
issued by a CGHS Medical Officer / Government Specialist, without a referral /
permission letter from the Department concerned or CMO-in-charge of CGHS
Weliness Centre, as the case may be.
2. The CGHS empanelled
private hospitals / diagnostic laboratories / imaging centres shall perform the
investigations /diagnostic tests as prescribed by the CGHS Medical Officer
/Government Specialist on cashless basis to the CGHS pensioner beneficiaries, ex-MPs,
freedom fighters and other eligible categories of CGHS beneficiaries, who are
presently eligible for credit facility, at CGHS approved rates, only in respect
of the tests / investigations for which CGHS rates are available.
3. The Serving beneficiaries
will not require any permission from their Department for getting the
diagnostic tests / investigations carried out in a CGHS empanelled private
hospital /diagnostic laboratory / imaging centre in respect of investigations
for which CGHS rates are available. They will get the prescribed tests done on
payment basis and claim reimbursement from their Office.
4. For providing
cashless facilities to the eligible CGHS beneficiaries, the empanelled private
hospital / diagnostic laboratory / imaging centre shall obtain the prescription
either in original or self-attested copy of the prescription and self attested
photocopies of the CGHS card of the patient and the CGHS card of the main CGHS
card holder beneficiary and enclose the same with their bills for claiming
payment from CGHS or the Department concerned, as the case may be. The hospital
/ diagnostic laboratory / imaging centre shall
however, verify the
self attested copies from the original prescription / CGHS cards, before
allowing the credit facility to the eligible CGHS beneficiary.
5. The medical
prescription issued by a CGHS Medical Officer / Government Specialist
prescribing diagnostic tests / investigations shall be treated as valid for a
single use within a period of two weeks from the date of prescription unless
specifically provided otherwise by the Government Specialist in the
prescription, about the date or period after which the prescribed tests are to
be conducted for a follow up treatment. The medical prescription would require
revalidation or issue of a fresh prescription from the prescribing CGHS
doctor/Government Specialist for getting the prescribed tests done after expiry
of the validity period of two weeks, as indicated above.
6. The CGHS empanelled
private hospitals / diagnostic laboratories / imaging centres shall provide
cashless facilities to the serving CGHS beneficiaries entitled for credit
facilities in terms of this Ministry’s OM No Rec.1-2008/ Gr./CGHS/Delhi/CGHS
(P) dated 10.06.2008, on submission of a self attested photocopy of his / her
identity card issued by the Department / Ministry, alongwith self attested
photocopies of the CGHS card of the patient and the main cardholder. The
hospital / diagnostic laboratory / imaging centre shall enclose the above
documents with their bills to the Department concerned for claiming
payment.
sd/-
(V.P.Singh)
Deputy Secretary to the Government of India
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