Simplification of referral systems under ECHS: Online approval of APPX ‘A’

Revision of Guidelines regarding Simplification of referral systems under ECHS: Online approval of APPX ‘A’

Central Organisation, ECHS
Adjutant General’s Branch
Integrated Headquarters
Ministry of Defence (Army)
Thimayya Marg, Near Gopinath Circle
Delhi Cantt-110010 |

B/49774/AG/ECHS/Referral/2021

09 Dec 2021

IHQ of MoD (Navy)/Dir ECHS (N)
DAV, Subroto Park
HQ Southern Command (A/ECHS)
HQ Eastern Command (A/ECHS)
HQ Western Command (A/ECHS)
HQ Central Command (A/ECHS)
HQ Northern Command (A/ECHS)
HQ South Western Command (A/ECHS)
HQ Andaman & Nicobar Command (A/ECHS)
All Regional Centres

REVISION OF GUIDELINES REGARDING SIMPLIFICATION OF REFERRAL SYSTEMS UNDER ECHS: ONLINE APPROVAL OF APPX ‘A’

1. Pl ref the following (copies att):-
(a) CO ECHS letter No B/49778/AG/ECHS/PA/Ruling dated 28 Jun 2011.
(b) CO ECHS letter No B/49774/AG/ECHS/Referral/2020 dt 20 May 2020.

2. It has been observed that for unlisted procedure / investigation, hospitals are sending back the ECHS beneficiaries (Including those of 75 years and above) for getting the approval which is in contravention to Para 26 (g) of SOP on Treatment Management dt 28 sep 2018/ (available on our website echs.gov.in).

3. It is reiterated that for ECHS beneficiaries, if it is an emergency any investigation / procedure whether listed or unlisted has to be carried out by the hospital without any approval. However, in non emergency condition if the investigation / procedure is listed, no implant / approval will be required and it will be carried out by the hospital but if the investigation / procedure / is unlisted the procedure to be followed is given below :-

(a) The empanelled Health Care Organizations (HCOs) will generate Appx A on BPA portal by clicking the icon for Appx A and filling up the card number. The revised format is att as Appx ‘A’. The basic info will be autofilled through the software. Further details and digital signature of the Doctor will be filled by the empanelled hospital. Thereafter submit button will be clicked.

(b) All 136 Nodal ECHS PCs to utilise the existing manpower for getting approval on Appx A from AFMS hospital. The ECHS cells located in BH, AH (R & R) and all Command Hospitals will also be suitably employed for this purpose. Mapping of each nodal PC has been done to the emp hosp and service hosp. The list is attached as Appendix ‘B’.

(c) BPA portal will send ‘Pending Appx ‘A’ popup alert to concerned nodal ECHS PC and the PC will fill up Part-Il and put DSC of OIC PC. Thereafter he will take a print out of Appx ‘A’ and obtain the approval of competent auth i.e. SEMO (upto 2 Lakhs) / Cl or Gd Spl of concerned specialty (between 2 to 4 Lakhs) / Sr Adv or Consultant of Concerned Specialty (More than 4 Lakhs).

(d) ‘The revised Appx ‘A’ will be scanned and uploaded by the PC with digital signatures of OIC PC in the relevant claim ID of the concerned hospital. The ECHS beneficiary is requested to kindly contact the concerned empanelled hospital to confirm uploading of Appx A. A period of up to 48 hours/two working days may be given for the process.

(e) Ongetting a confirmation from OIC PC, the ECHS beneficiary will visit the hosp for getting the required investigation / procedure done. The work flow is att as Appx ‘C’ to this letter.

4. lf the required specialist officer is not available in the dependent AFMS Hosp of nodal PC, OIC PC will forward the Appx ‘A’ to the Nodal ECHS PC of Zonal or Command AFMS Hosp, where the | concerned specialist officer is available by selecting such Nodal ECHS PC from drop down menu. Pop up alert of ‘Pending Appx ‘A’ will also appear on the screen of receiving Nodal PC. All steps enumerated at Para -3(c), 3(d) & 3(e) to be followed by next nodal PC OIC.

5. Responsibilities. The responsibilities of various stake holders is as enumerated below.

(a) Empanelled HCQs.

(i) Provisions mentioned at Para 3 to be followed.
(ii) If some unlisted procedure / investigation / implant is required, the hosp will open the BPA portal and click on the Appx ‘A’.
(iii) After entering the ECHS Card No, other details of ECHS beneficiary will be auto filled.
(iv) Column 6 to 12 will be filled by treating doctor. Signature and stamp of treating doctor, name qualification and appointment will be ensured on Part-| before submission.
(v) Once Part-l is complete, emp hosp will click the submit button.

(b) Concerned Nodal PC.

(i) Once the emp hosp submits Appx ‘A’ to concerned nodal PC, a pop up alert will appear on the BPA portal of nodal PC.
(ii) PC will fill up the Part-II of Appx ‘A’ on the portal, put the digital signature of OIC PC and take a print out.
(iii) OIC PC will ensure that all Appx ‘A’ received on the previous day till O900 hrs next day are printed out after filling Part-ll and are sent to OIC Stats by 0930 hrs to get it approved by 1400 hrs the same day.
(iv) Once Part-lll and IV are filled and duly approved Appx ‘A’ is received back at PC. Thereafter the OIC PC will scan and upload it on the BPA portal by clicking ‘Upload Appx ‘A’ in the concerned Claim ID.
(v) ECHS beneficiary is requested to kindly contact the concerned empanelled hospital after 48 hrs / two working days of raising the Appx ‘A’ by the hospital.

(c) Service Hosp.

(i) On receipt of hard copy of Appx ‘A’ from ECHS PC, the OIC Stats will segregate them as per speciality and send it to the concerned Specialist / Sr Adv / Consultant as per CFA powers.
(ii) The concerned Specialist / Sr Adv / Consultant will fill up column 15 to 18 of Part-III after checking the details of the case, at the first available opportunity and send it back to OIC Stats at the earliest.
(iii) OIC Stats will compile duly filled Part-II] of Appx ‘A’ and send the file to SEMO for Signatures and stamp.
(iv) SEMO will complete Part-IV of Appx’A’, put signatures and stamp, at the first available opportunity and sent it back to OIC Stats.
(v) OIC Stats will hand over the complete set of docu to pers from nodal PC by 1400 hrs on each working day.

(d) UTI-ITSL.

(i) They will modify the software as explained above within 03 days from the issue of this letter.
(ii) The Workflow is attached as Appx ‘C’. } Available on website of BPA/UTI-ITSL
(iii) The User Manual is attached as Appx ‘D’. }

6. The revised procedure will be followed by all empanelled HCOs wef 13 Dec 2021 onwards.

7. All RC Directors are requested to disseminate it to all concerned and give a wide publicity for info of all ECHS beneficiaries (Incl aged 75 years and above).

(Anupam N Adhaulia)
Col
Dir (Med)

Encls: As above for MD ECHS

Source: ECHS