ECHS: Change in system of referral – No referral to be in the name of any private empanelled medical facility
Central Organisation ECHS
Adjutant General’s Branch
Ministry of Defence (Army)
Tele: 25683476 Mil 36833
Dated: 3 Aug 2018
UTI Bhawan, Plot No.3, Sector 11
CBD Belapur, Navi Mumbai
Maharashtra – 400 614
CHANGE IN SYSTEM OF REFERRAL : NO REFERRAL TO BE IN THE NAME OF ANY PRIVATE EMPANELLED MEDICAL FACILITY
1. Refer GOI, DoESW letter No. 18(54)l/2018/WE/D(Res-1) dated 02 Aug 2018 (copy enclosed).
2. As per above referred letter the name of Empanelled Medical Facility is not to be mentioned in the referrals issued from E¢HS Polyclinics. The directions of DoESW is to be implemented forthwith and necessary changes to be carried out in the referral issue software. UTl-ITSL to carryout changes in the claim ID system with immediate effect to implement these guidelines. A continuation of the implementation is to be provided to all ROS and CO ECHS with detailed instructions by UTI-ITSL & SDCPL.
3. All ECHS Regional Centres to ensure that this letter is circulated to all ECHS Polyclinics for immediate implementation. No repeat No referral to be generated from SITL software since modification required to be implemented cannot be carried out in that Software. All referrals to be generated from UTl-ITSL software / the new bridge under development with U’l‘l-ITSL and M [is Source Dot Com Pvt Ltd. Further, content of Para 5 of the Govt letter is also to be simulated to all Empanelled Medical Facilities for strict compliance.
Jt Dir (Stats & Automation)
for MD ECHS
All ECHS Regional Centres
Government of India
Department of Ex Servicemen Welfare
Dated 02 August. 2018
Health Scheme Wide Line,
Subject: Change in System of Referral-No referral to be in the Name of any Private Empanelled Medical Facility.
The undersigned is direct to state that as per the Ministry of Health & •amily Welfare OM No. Z15025/105/2017/DIR/CGHS/EHS dated 09.11.2017 the CGHS doctor / Government Specialist shall not refer the beneficiary to any particular empanelled hospital by name but shall specify the treatment procedure and mention “referred to any CGHS empanelled centre”
ECHS has to follow the CGHS Norms. However, it is seen that doctors at CHS Polyclinics are issuing referrals by name to specific Pvt. Empanelled Medical
In view of the above, it has been decided by the competent authority that henceforth no ECHS doctor will issue referrals by name to any Pvt. Empanelled, medical Facility. The ECHS doctors shall mention on the prescription the treatment, procedure/tests required by the ECHS beneficiary and then write as follows:
“Referred to any ECHS Empanelled Medical Facility located within the Area of Responsibility of Regional Centre, (Name of City).”
4 CO, ECHS and RC, ECHS will ensure that the list of Pvt. Empanelled Medical Facilities along with the medical treatment procedures/tests for which they have been empanelled is prominently displayed on the website of ECHS, Regional Centre wise. OIC, of every Polyclinic, will be responsible for ensuring that hard copies of this list downloaded from ECHS website is kept in the Polyclinic in sufficient numbers and given to the ECHS beneficiary whenever demanded. If any change lakes place in this list, it shall be the responsibility of Director RC, ECHS concerned .o ensure display of the corrected/amended list on the website of ECHS without any delay.
5 Whenever an ECHS beneficiary approaches a Pvt. Empanelled Medical Facility with such a referral from ECHS Polyclinic and the Pvt. Empanelled Medical Facility is not empanelled by Ministry of Defence (MoD) for the required treatment procedure / tests, it shall be the responsibility of the Pvt. Empanelled Medical Facility to inform the beneficiary that it is not empanelled for the required treatment procedure / tests. If any Pvt. Empanelled Medical Facility is found providing treatment procedure / conducting tests to such an ECHS beneficiary for which it is not empanelled, then apart from not reimbursing the expenses incurred by the Medical Facility on such treatment, action will be taken against the said ECHS Empanelled Pvt Medical Facility under the rules / as per the provisions of Memorandum of Agreement (MoA).
No ECHS Polyclinic Officer/Official/Doctor should indulge in any action force canvassing for/against any ECHS empanelled Pvt. Medical Facility.
7. The above orders shall come into force with immediate effect.
Under Secretary to the Government of India
Tele fax: 23014946