PROCESSING OF PENDING CLAIMS DELAY IN INTIMATION, SUBMISSION, NMI QUERY REPLY AND DELAY DUE TO OBTAINING DIGITAL SIGNATURE

Central Organisation, ECHS
Adjutant General’s Branch
Integrated HQ of MoD(Army)
Near Gopinath Circle
Thamiyya Marg
New Delhi- 110 010

B/49778/ AG/ ECHS/ Claims / Policy

15 Jun 2020
___________________
(All Regional Centres ECHS)

PROCESSING OF PENDING CLAIMS DELAY IN INTIMATION, SUBMISSION, NMI QUERY REPLY AND DELAY DUE TO OBTAINING DIGITAL SIGNATURE

1. Reference the following :-

(a) This HQ letter No B/49779-Outsourcing/AG/ECHS dated 20 Jun 2017.
(b) This HQ letter No B/49778/AG/ECHS/Claim dated 08 Feb 2018.
(c) This HQ letter No B/49778/AG/ECHS/Policy dated 18 Dec 2018.

2. Refer this HQ letter B/49778/AG/ECHS/Claim/Policy dated 30 Aug 2017, as per which all hospital bills are to be processed in a time bound manner without burdening the online system with delayed NMI clarification.

3. Despite giving a waiver window period earlier vide ibid letter mentioned at Para 4 ((a) to (c)), many empanelled medical facilities are not adhering to the timelines as per letter mentioned at Para 2 and various stakeholders/ empanelled medical facilities are frequently requesting for granting special waiver/sanction. A number of representations have been received from empanelled hospitals that bills pertaining to the waiver given vide letters as mentioned at Para 1 (a) to (c) are still pending for uploading. Hospitals have approached MoD also for non clearance of such bills, is affecting their anti COVID-19 preparations.

4. In view of above, it has been decided after due deliberation that waiver may be accorded by the respective Dir RC ECHS for the claims for following reasons only:-

(a) Delay in intimation, submission of online & physical bills for already uploaded/submitted claims & query reply under Need More Info (NMI) claims till 30 Sep 17 unless a hospital has given a certificate that no claim is pending. –

(b) Delay in submission/uploading of claims for more than 60 days from 01 Oct 2017 to 31 May 2020.

(c) Delay in | Submission/uploading of claims due to non availability of digital Signatures pertaining to bills between 04 Apr 2018 to 30 Sep 2018.

(d) Delay in intimation to BPA wef 01 Oct 2017 to 31 May 2020.

(e) Delay in query reply under NMI Claims after 01 Oct 2017 to 31 May 2020.

5 The waiver is only for condoning delay / non submission due to technical reasons/ recommended for rejection due to technical reasons, hence permits uploading. Once uploaded the bills have to be scrutinized by all validators and CFAs with due diligence as per existing orders.

6 In view of above, respective RCs may accord suitable waiver after detailed examination of genuine and legitimate bills with highest probity and integrity by providing emp facilities PAN india, a six months duration to do so in keeping with the back log these emp hospitals would have to face because of stagnation of their billing due to unprecedented lock down in view of COVID-19. The waiver is valid for bills generated upto 31 May 2020. All actions pertaining to waiver/sanction including response by hospital must be completed by 31 Dec 2020. All hospitals should render a certificate stating that:-

“It is certified that there is no outstanding claims/bills for delay in intimation, submission (online & physical bills), query reply under Need More Info (NMI) till 31 May 20 and they will not prefer any such claim for consideration of processing thereafter’.

7. All the claims stuck/recommended for rejection for conditions as mentioned in Para 4 are to be processed and reverted in NMI basket for further processing.  Already rejected and settled claims will not be re-processed.

8. Please disseminate the information to all stakeholders for information and necessary action.

9. This has the approval of MD ECHS.

(SBK Singh)
Brig
Dy MD
for MD ECHS

Source: https://echs.gov.in/img/Instructions%20for%20Processing%20of%20Pending%20Claims.pdf

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