Scrutiny of OPD/ IPD Claims at RC Level – ECHS

Scrutiny of out patient department and in person department claims in ECHS hospitals clarification regarding.

Central Organisation ECHS
Adjutant General’s Branch
Integrated HQ of MoD (Army)
Maude Lines
Delhi Cantt- 110 010

B/ 49779-Outsourcing/ AG/ ECHS/ Policy

12 Jul 2018

All Regional Centres

SCRUTINY OF OPD/IPD CLAIMS AT RC LEVEL

1. Further to our letter No B/ 49779-Outsourcing/ AG/ ECHS/ Policy dated 10 Nov 2017, pursuant to the instructions received from DoESW vide letter No. 18(80) / 2017/WE/ D(Res-1) dated 12 Jul 2018 and proposal to formalize second tier check vide case file No B/ 49779- Outsourcing/ AG/ ECHS initiated on 06 Jul 2018.

2. It is directed that the process for online bill processing at RC level to be carried out as under:-

(a)Bills/Amounting to Less than Rs 30,000/ –. For bills amounting to less than Rs. 30,000/ -, 2% bills per day shall be checked by the JD (HS). The bills selected will be those having highest financial value. Additional bills can be checked as per discretion.

(b) Bills in the Range of Rs 30,000/ -to Rs 59,999/ –. For bills in the range of Rs 30,000/ – to 59,999/ -, 3% bills per day shall be checked by the JD (HS). The bills selected will be those having highest financial value. Additional bills can be checked as per discretion.

(c) Bills in the Range of Rs 60,000/ -to Rs 99,999/ –. For bills in the range of Rs. 60,000/ – to 99,999/ -, 5% bills per day shall be checked by the JD (HS). The bills selected will be those having highest financial value. Additional bills can be checked as per discretion.

(d) Bills More than Rs.1 Lakh. 100% Bills for amount more than Rs. 1 Lakh to be checked by JD(HS) at RC.

3. The process to be put in effect immediately and respective functionaries in the Online Bill Processing chain to ensure that the above is compiled.

4. The modification incorporated in the system of the online bill processing application will be such that a basket of 100 claims is presented to the JD(HS), those 100 claims will be picked up in FIFO manner out of the claims processed by BPA. There will be separate baskets for OPD, IPD and individual reimbursement claims. The 100 claims in each basket will be strictly presented in FIFO manner. The presentation of these baskets to JD(HS) and its subsequent manner of processing for all baskets (OPD, IPD and individual reimbursement) is described below:-

(a)Claims less than Rs. 30,000/ –. These will be listed on top of the page and JD(HS) would have to compulsorily check 2% of such claims (number to be rounded off to the next round figure). These claims would be the one’s with the highest recommended amount. The multi select option for the balance claim in this category would be available orally after atleast 2% claims have been checked. JD(HS) can check additional claims also as per his discretion.

(b) Claims between Rs. 30.000/ – to Rs. 59,999/-. A counter for the claims falling in this region would be created by BPA to reflect 3% of such claims,(number to be rounded off to the next round figure) which would have to be compulsorily checked by the JD(HS). These claims would be the ones with the highest recommended amount. The JD(HS) would have the option to check any additional claim also should he choose to do so. The multi select option for the balance claim in this category would be available only after atleast 3% claims have been checked.

(c) Claims between Rs. 60,000/ – to Rs. 99,999 / –. A counter for the claims falling in this region would be created by BPA to reflect 5% of such claims (number to be rounded off to the next round figure) which would have to be compulsorily checked by the JD(HS). These claims would be the one’s with the highest recommended amount. The JD(HS) would have the option to check any additional claim also should he choose to do so. The multi select option for the balance claim in this category would be available only after atleast 5% claims have been checked.

(d) Claims above Rs. 1 Lakh/-. All claims above Rs. 1 Lakh will have to be compulsorily checked by JD(HS). No multi select option will be enable? in this window.

5. Next set of 100 claims in the concerned basket will be presented to the JD(HS) only after the claims in the respective basket has been completely cleared.

6.In addition, it is highlighted that in accordance with Para 2(d) of MoD letter No. 22(A)(10/ 10/ US(WE)(Res) dated 23 Feb 2012, “CFA will examine the bill and BPA’s worksheet prior to according sanction,,.” Hence, all CFAs must ensure that no violation to the above guidelines take place and ‘the provisions brought out above are not compromised in any manner.

7. Please ensure speedy clearance of bills so that large pendencies can be reduced. Financial integrity of checks, will not be compromised.

8. These instructions are issued with approval of MD ECHS.

(DM Anand)
Col
Dir (Stats & Automation)
for MD ECHS

Read/Download ECHS Memo B/ 49779-Outsourcing/ AG/ ECHS/ Policy dated 12th July 2018.

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