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CGHS Pune

Disclaimer

This presentations is intended for educational purposes only and do not replace the available Office Memorandums or Office Orders issued from time to time about the topics discussed. Statements of fact and opinions expressed are those of the presenter as is interpreted by him and, unless expressly stated to the contrary, are not the opinion or position of the Ministry of Health & Family Welfare / Directorate of CGHS. The presenter does not endorse or approve, and assumes no responsibility for completeness of the information presented.

Expectations

 For you?  For Your organization ?  For me?  For my organization ?  Scope

Stepping out of the comfort zone

If it scares you – it might be a good thing to try

 Welfare of Employees  Employees who pay contribution for the healthcare

services

 It is their right that the amounts spent be reimbursed

– ASAP

 Are you doing this ?  What is the turn around time for settlement of claims

in your office?

MRC for Central Government Employees

www.cghspune.gov.in

MRC Claims - Employees

 OPD claims

Consultation only Investigations only Consultation and investigations

 IPD / Admission claims

Surgical Management only Medical Management only Surgical management + Medical Management Medical Management + Surgical Management

Link for MRC form: https://cghs.gov.in/showfile.php?lid=3984

MRC Claims - Employees

 OPD claims

Consultation only Investigations only Consultation and investigations Prerequisites:

Referral from CGHS wellness center/ Govt specialist

No separate permission letter required https://cghs.gov.in/showfile.php?lid=4830 https://cghs.gov.in/showfile.php?lid=5079

Validity of referral – for OPD consultation/ investigation/ procedure

• Q1. Referral slip from CGHS has been issued for
• consultation. The employee has done four consultations

at empanelled hospital over next ten days from date of issue of reference. Claimant has submitted all documents and has claimed for OPD consultations. The admissible amount would be:

• A. As admissible for one consultation
• B. As admissible for three consultation
• C. As admissible for four consultation

MRC Claims - Employees

Amount claimed Amount admissible Consultation only XYZ 135 × No. of consultations – Maximum of three for one referral letter Investigation/s XYZ As per the CGHS Rate list/AIIMS rate list Consultation and Investigation/s https://www.cghspune.go v.in/images/stories/cghsi mages/pdfs/file924.pdf XYZ 135 × No. of consultations – Maximum of three for one referral letter + Investigations as per CGHS rate list/ AIIMS rate list https://www.cghspune.gov.in/im ages/stories/cghsimages/pdfs/pr

• pratelist.pdf

OPD Claims - documents

 CGHS / Govt Specialist referral letter  Original Bills & receipt  Original Reports for investigations  All other relevant documents as per check list for MRC

claims

Validity of referral – for OPD consultation/ investigation/ procedure

• Q2. Referral slip from CGHS has been issued on 4th

March 2019 for blood tests. The employee has done the tests in empanelled hospital on 25th of March 2019. Claimant has submitted all documents about the tests and reports.

• A. The claim is not admissible as it is used beyond

two weeks of date of issue.

• B. The claim is admissible
• C. The claim is admissible if permitted ex post facto

by the HOD / HOO.

Validity of referral – for IPD procedure

• Q3. Admission memo - Referral slip from CGHS has been

issued to the beneficiary. The employee has done the procedure after two months of issuing the advice at an empanelled hospital. Claimant has submitted all documents and has claimed XYZ amount. The claim and admission was for surgical management/ package.

A.

The claim is admissible as per CGHS package rates.

B.

Not admissible – the advised procedure should be done within seven days of date of issue.

C.

Needs delay condonation for delay in procedure – from HOD as the procedure has been done immediately or within seven days of issue of memo. The claim is then admissible.

Validity of referral – for OPD consultation/ investigation/ procedure

https://www.cghspune.gov.in/images/stories/cghsimages/pd fs/clarinvestwoperm.pdf https://www.cghspune.gov.in/images/stories/cghsimages/pd fs/simplificationofprocedurefortreatment- guidelinestohco.pdf http://cgda.nic.in/adm/circular/AN-XIV-1905-200218.pdf https://cghs.gov.in/showfile.php?lid=5266

Delegation of power to HOD/ HOO

http://cghsjaipur.nic.in/Pdf/delegation%20of%20powers%20to%20HOD%2030.1 2.2014.pdf

• :Salient points:-

 Permission/ ex-post facto approval for elective treatment/ investigation taken

in a non empanelled hospital/ diagnostic center

 Ex- post facto approval – for elective treatment-in empanelled hospitals –

without referral from Govt specialist / CGHS wellness center.

 Ex post facto approval for elective treatment with recommendation of Govt

specialist / CGHS wellness center but without prior permission from HOD/HOO.

 Ex post facto approval for cancer treatment in non empanelled hospitals.

https://cghs.gov.in/showfile.php?lid=4830 No requirement of a permission letter.

Reference memo for consultation

 MRC claims for investigations / consultations done from a

non empanelled private hospital / laboratory – must be supported by reference letter ( original) in printed format issued for the same from wellness center.

 Exception to this is – Beneficiaries over 80 years can take

follow up treatment from same specialist in a non empanelled hospital from where he/ she was taking treatment earlier. The claim will be restricted to CGHS rates for follow up consultations/ investigations (relevant to illness for which they were admitted in the same private hospital ). Medicines purchased however are not reimbursable.

IPD Claims – Elective Treatment

 CGHS / Govt Specialist referral letter  Discharge Card / Death summary  Date wise break up of bills – room rent, investigations &

medicines.

 Original Bills & receipt  Original Reports for investigations  Private Insurance related documents if any  Implant related documents  Blood and blood products details  All other relevant documents as per check list for MRC

claims

ICU/HDU/Step down ICU/ Positive or negative pressure room/Isolation Room

• Q4. What are the admissible Rates ???

Claim is for admission for suspected swine flu and patient was admitted in isolation room / Negative pressure room with justification from the hospital . The room rent for isolation room is charged at Rs. 4000/- per

• day. The admissible room rent is:

A.

As per entitlement

B.

As per actuals since the case is of swine flu and justification has been provided to isolate the patient

C.

As per entitlement + CCU rates subject to justification

• Q5. What are the admissible Rates ???

Claim is for admission for stay in step down ICU or HDU after head injury, initially the patient was kept in ICU and now has been shifted to step down ICU / HDU before shifting to ward. The stay in ICU was for five days, In step down ICU / HDU for three days and then in ward for seven days. The charges have been at following rates – For ICU stay – Rs 4500/- per day, For step down ICU / HDU at Rs 4000/- per day and for ward at Rs 800/- per

• day. The patient is entitled for private ward. The

admissible room rent is:

A.

3750 ×5 + 3000×3 + 800×7

B.

4500 ×5 + 4000×3 + 800×7

C.

3750 × 5 + 3750×3 + 800×7

Packages and stay duration to be allowed:

Type of Treatment Number of Days admissible Specialized ( Super-specialty treatment) 12 Days Other Major Surgeries 7 Days Laparoscopic surgery & Normal Delivery 3 Days Day Care / Minor OPD surgeries 1 Day

Surgical Management with prolonged stay

• Q6a. Beneficiary admitted for CABG surgery – allowing

twelve days stay as per the package under Super specialty – On 11th day develops complication not related to the

• peration and requires further stay of seven days for recovery.
• A. Claimant would reimbursed as per package rate only
• B. If HOD allows would be reimbursed as per package

rates + all other admissible charges as per medical management from date of complication.

• C. Claimant would be reimbursed as per package rates

and case referred to CGHS for guidance about other charges

Surgical Management with prolonged stay

• Q6b. Beneficiary admitted for CABG surgery – allowing twelve

days stay as per the package under Super specialty – develops infection of the wound or a complication related to the operation

• n 11th day and requires further stay of seven days for recovery.

A.

Claimant would reimbursed as per package rate only

B.

If HOD allows would be reimbursed as per package rates + all other admissible charges as per medical management from date of complication.

C.

Claimant would be reimbursed as per package rates and case referred to CGHS for guidance about other charges

Surgical Management with prolonged stay

Claimant would be reimbursed as per package rates + all

• ther admissible charges as per medical management

from date of complication. ( Room rent, investigations and medicines for the period of complication)

 Allowed if not related to surgical complication  Allowed only if supplemented by justification from the

treating specialist

Surgical Management with prolonged stay

In cases of post operative infections and resultant prolonged stay: Claimant would be reimbursed as per package rates + all

• ther charges levied to the employee to be reimbursed

to the employee by the hospital – the HOD to initiate action in form of a letter to the HCO.

Surgical Management with prolonged stay

 Allowed if not related to surgical complication  Allowed only if supplemented by justification from the

treating specialist indicating clearly that the complication is not related to the surgery performed and needs immediate treatment for recovery of patient.

Blood & Blood Products

Q7 Grouping and cross matching charges with blood/ blood products:

• A. Allowed with basic processing charges
• B. Allowed but processing charges not allowed
• C. Not allowed

Dual Settlement- Insurance + Government

• Q8a. Claim submitted for Rs. 230000/-, the employee has

also claimed from private insurance company which has sanctioned Rs. 140000/-as per their admissibility for the

• procedure. Claim is for a medical management – the

admissible amount for the same at CGHS rates is 1,50,000/- The amount admissible is:

• A. Rs. 150000/-
• B. Rs. 90000/-
• C. NIL – payments for room rent, medicines,

investigations etc cannot be made from two sources.

Dual Settlement- Insurance + Government

• Q8b. Claim submitted for Rs. 4,30,000/-, the employee has

submitted the claim to office , the hospital bills indicate that the claim has been partially paid by the private insurance company – amount sanctioned is Rs. 3,00,000/- Claim is for a surgical procedure – the admissible amount for the same as CGHS rates is 80,000/- The amount admissible is:

• A. Rs. 80,000/-
• B. Rs. 1,30,000/-
• C. Nil – claim for the surgery has been paid for by

insurance company and claimant can’t receive payments from two sources for same procedure.

Dual Settlement- Insurance + Government

 The details about insurance claimed or not has to be

mentioned.

 If claimant is claiming from private insurance – the

claim must first be submitted to the private insurance company and sanction letter showing the amount sanctioned must be enclosed with the MRC. The guidelines about dual settlement of claims to be followed. https://www.cghspune.gov.in/images/stories/cghsimage s/pdfs/twosourcereimb.pdf

Basic points

 Check for all relevant documents & details.  Check the CGHS Card for entitlement – mention the

entitlement in the column.

 Emergency certificate is NOT mandatory.  Tick mark that you have checked all relevant details.  Accept the claim only when all relevant documents are

available

 In case of death of the principal card holder – the claimant

can enclose the nomination details if nomination has been done, if not the affidavit from all legal heirs is mandatory –

Basic points - continued

 The form should be signed and filled for all details.  The amount claimed must be mentioned  The details about insurance claimed or not has to be

mentioned.

 Every admission and discharge is a separate event --

for each admission a separate claim has to be submitted

 The Claim has to be submitted as ORIGINAL and a

COPY thereof

Claims about outsourced investigations / blood & blood products – documents required additionally are--

 Letter from HCO – specifically mentioning

 The facility was not available  Beneficiary has paid for the outsourced investigations /

blood or blood products

 Check that the reports are from an outsourced

laboratory or blood / blood products receipts are from different blood bank.

 Such claims should pertain to the hospitalization

period.

MRC claim processing utility

 CGHS Pune has been utilizing an Excel utility – which

has been tailor made for processing MRCs.

 The same hastens the processing of claims

significantly.

 We will now demonstrate the utility developed – by

processing two sample claims.

 The claims have been submitted and have been

assessed for admissibility with allowed and disallowed items depicted on the claim document.

MRC Claims- Employees

Special Cases

Hearing Aids claims

 Permission letter from HOD / HOO is a must prior to

purchase of hearing aid/aids.

 Permission letter is issued based on following

documents— Prior to sending the patient for obtaining sanction letter check for following documents:--

 Reference letter for ENT consultation from CGHS -WC.  Advise from ENT specialist of CGHS / Government Hospital

specifically mentioning the type of hearing aid advised – Digital BTE / ITC / CIC etc.

 Report of Audiogram – authenticated by the prescribing

specialist.

 Valid CGHS card

https://cghs.gov.in/showfile.php?lid=3986

Hearing Aids claims

 Permission letter is issued by the HOD / HOO.  The hearing aid/ aids claim should be accompanied by all

relevant documents mentioned in the OM.

 Check that all the items mentioned in the check list below are

submitted:

• MRC form duly filled in
• Permission letter
• CGHS Card
• CGHS / Government Hospital referral letter
• Audiogram report – duly authenticated by Specialist
• Advice from CGHS / Government Specialist – specifying the type of

hearing aid Receipt / bill of the hearing aid/s

• RCI number / certificate of the seller
• Warranty card/s – Three year warranty
• Declaration by the claimant – five years
• Original box/es of the hearing aid/s.

• Q9. Claimant has procured hearing aid of ITC type

while permission is for Digital BTE type. Amount claimed as per bill is 40,000/-

 All necessary documents are submitted  Amount admissible:

A.

20,000/- - since the machine is of ITC type

B.

15000/- since the permission is for Digital BTE type

C.

NIL – the permission is for Digital BTE while the claimant has procured ITC machine which is not as per advice of specialist

Hearing Aids claims

 The hearing aid claim is admissible based on the type of hearing

aid sanctioned and purchased.

 If the hearing aid purchased is of Digital BTE type and the

sanction is for Digital CIC/ ITC type – specifically mention that the claim is admissible as per the amount admissible for Digital BTE type – Rs 15,000/- per hearing aid .

 If the hearing aid purchased is of Digital CIC/ ITC type and the

sanction is for Digital BTE type – specifically mention that the claim is admissible as per the amount admissible as per the sanction letter – Rs 15,000/- per hearing aid .

 On the bill submitted specifically mention the admissible

amount taking into account the points mentioned above and a short note .

Claims about NIN ( National Institute of Naturopathy- Pune)

 NIN claims must be accompanied by reference letter –

printed format or specifically mentioning the number

• f days for which the reference is valid in the note

book along with signature and stamp of recommending medical officer, the note book page should depict the ben id and name of the patient.

 Printed reference letter is considered valid for

consultation and follow up treatment for thirty days.

Stickers & Invoices for implants

 MRC claims where implants / stents have been used

must be accompanied by:

 Original stickers / pouches of the stent / implant  Original invoice for the stent / implant  If original invoice is not available – the claim should be

accompanied by letter from HCO showing bulk purchase invoice and a utilization certificate mentioning the implant from the treating specialist on HCO letter head.

IMPLANTS / STENTS

 Coronary stents  Non Coronary stents  Intra ocular lens – check for type ( hydrophilic /

hydrophobic)

 Orthopedic Implants  Voice Box & other ENT implants  Permcath for hemodialysis  Mesh for hernia surgery  Artificial valves  Pacemakers

* Disclaimer: This is an indicative list and not the complete list of implants / devices

Coronary stents

 Number of coronary stents permissible – Maximum of two

Drug eluding stents ( DES) , others if used to be reimbursed at rates for bare metal stents.

 Recommendation from Cardiologist necessary – indicating

the number of stents required and the locations where they would be used.

 Coronary angiography report – compulsory.

https://cghs.gov.in/showfile.php?lid=4124 https://www.cghspune.gov.in/images/stories/cghsimages/pd fs/barestentrate.pdf https://cghs.gov.in/showfile.php?lid=3905

Other cardiac devices

 Cardiac Pacemaker  AICD  Combo Device  Rotablader  Aortic Stent Graft, etc. Permission to be granted on advice of Government Cardiologist by Ministry/ organization/ department For replacement of device – additional document required – copy of details

• f earlier device along with the terms of warranty.

For implantation of device in emergency – Ex-post Facto approval by Additional Director / HOD as per latest circular about powers to HOD.

https://cghs.gov.in/showfile.php?lid=5117 http://cghsjaipur.nic.in/Pdf/Pacemaker%20O.M.%20dated%2022.07.2014.pdf

Orthopedic Implants

 Knee Joint Implants- Revised rates – component wise  Revision Knee Replacement System – component wise  Hip Replacement

https://cghs.gov.in/showfile.php?lid=4805 Other Orthopedic Implants – One lac and above – permission needed from ADDG CGHS , Min of Health & Family welfare, Nirman Bhavan, New Delhi.

Neurological Implants

 https://cghs.gov.in/showfile.php?lid=5075

Artificial Appliances

 Physical medicine & rehabilitation ( PMR) or Orthopedic Surgeon –

not below the rank of consultant of Government Hospital.

 Maintenance cost – not reimbursable  Adults – reissue after five years  Children ( up-to 12 yrs.) – reissue after 2 years ( except motorized wheel

chair and tricycle)

 High end prosthetic devices & appliances – special cases only as per

OM.

 Items not included in Annexure –

i.

less than 50,000/- ( three quotations – permission of HOD/HOO)

ii.

More than 50,000/-- ( three quotations + approval of technical committee – permission by Additional Director – CGHS)

iii.

Procurement subject to certain terms and conditions – as per OM

https://www.cghspune.gov.in/images/stories/cghsimages/pdfs/artificial_ applicances_revisionlist.pdf

Bariatric Surgery procedures & permissions

 NOT allowed in Private non empanelled hospitals.  Prior permission is compulsory  NO Ex-post facto approval  Recommendation of Government specialist/ Surgeon/

• Govt. GI surgeon

 Permission granted by parent ministry/ department /

• ffice.

 Other terms and conditions as per the OM

https://www.cghspune.gov.in/images/stories/cghsimage s/pdfs/bariasurguide.pdf

MRC claims about Organ Transplants

 Kidney Transplant – CGHS Package rates are available.  Liver Transplant – Follow the guidelines – Permission from

standing committee preferably prior to the transplant. In case of emergency, the Committee at Directorate decides about admissibility. The cases of In service beneficiaries to be forwarded by respective HOD/ HOO. https://www.cghspune.gov.in/images/stories/cghsimages/pd fs/livertrans.pdf

 Bone Marrow Transplant – No rates defined – permission

to be sought from Directorate, Ministry of Health & Family welfare – All relevant documents to be enclosed.

MRCs about CPAP/BIPAP/Oxygen Concentrator

 Individual request accompanied by the duly filled in

form and supportive documents—

 Screening Committee – comprising of Additional

Director and Two specialists .

 Permission / Ex-post facto approval  Replacement of the device not allowed for five years.  Machine issued to be returned to Department – if the

patient expires / improves to a great extent. https://www.cghspune.gov.in/images/stories/cghsimage s/pdfs/cpap.pdf

Hemodialysis claims

 All Hemodialysis claims – reference letter from a Govt.

hospital or CGHS WC is compulsory.

 Charges for medicines and other accessories - like dialyzer,

tubing's etc used during hemodialysis are not admissible

 Post dialysis medicines are also not admissible  Investigations carried out during the period of

hemodialysis relevant to the wellbeing of beneficiary to be allowed at CGHS package rates – reports are mandatory.

 Hemodialysis can be undertaken in any hospital –

empanelled or non empanelled.

MRC Claims – Surgical Management – Cancer surgery cases

 MRC claims wherein the surgical procedure is for treatment of

cancer or suspected cancer

 These claims to be processed as per the guidelines for cancer

surgery – OM dated 07-09-2015.

 The details including the Grade / Grades of surgical procedures

admissible, along with anesthesia and OT charges are to be mentioned clearly.

 If two or more grades of surgery are applicable the anesthesia

charges and OT charges are admissible as per the highest grade

• nce.

 All other equipment's/ medicines/room rent / consultations etc

are admissible additionally. Exclude only the items mentioned specifically as non reimbursable as per the MOA. https://cghs.gov.in/showfile.php?lid=3950

Miscellaneous items:-

 Ambulance charges  Charges for oxygen therapy  Voice Box  Unlisted Surgical Procedures:- Surgical procedures not

listed in CGHS / AIIMS rate lists

 Unlisted investigations:- Related but with new

nomenclature / totally new investigations

 IVF therapy --

http://cghsnagpur.gov.in/fckimagefile/circular_3.pdf

 Physiotherapy at home  Glucometer and nebulizer

Recent Important OM – Full Reimbursement

 Shiv Kant Zha vs UOI delivered on – 13th April 2018  OM issued on 6th June 2018 - has certain terms and conditions  NON- HPC Cases:

Decision to be taken at local level whether the claim falls under the clauses of admissibility. IF Yes – forward the claim to Directorate – MOHFW for further decision IF No- Convey to the applicant the reason for non admissibility

 HPC Cases:  To be referred to Directorate – MOHFW for further decision by

technical committee. https://cghs.gov.in/showfile.php?lid=5037

• Q10. Claim received for full reimbursement

The beneficiary underwent Cesarean section in a private non empanelled hospital for delivery of baby who was in fetal distress, the lady was incapacitated and was admitted by other as per the justification letter of hospital. The patient was discharged after seven days stay. The claimant has claimed full reimbursement – stating that the claim falls under clause 2 ( i) as- The patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged period.

 Can be considered for full reimbursement  Cannot be considered for full reimbursement

• Q11. A lady delivered twins – the hospital has charged

the beneficiary twice for normal delivery. The claim has been submitted to office. The claimed amount would be:

 Twice the amount for normal delivery  As per CGHS package for normal delivery  First delivery at normal rate + 50% additional amount

for the second baby.

• : NON HPC Cases:--

Treatment was obtained in a private unrecognized hospital under emergency

i.

The patient was admitted by others when the beneficiary was unconscious

• r severely incapacitated and was hospitalized for a prolonged

period.

ii.

The Patient was admitted for prolonged period for treatment of Head Injury, Coma , Septicemia, Multi-organ failure , etc.

iii.

Admitted for treatment of advanced malignancy

iv.

Treatment was taken under emergency in higher type of accommodation as rooms as per his/her entitlement are not available during that period.

v.

Treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections

vi.

When there is a strike in Govt. hospitals.

vii.

While on official tour to non-CGHS covered area.

 For conditions in (i) (ii) (iii) and (v) – advice of an expert committee necessary  For conditions falling under (iv), (vi) and (vii) – administrative decision.

• -:HPC Cases :--

i.

Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he is not eligible for air travel / treatment facilities are available in city of residence

ii.

Representations from CGHS beneficiaries seeking full reimbursements under special Circumstances.

• iii. Relaxation of Rules

Additional Directors shall submit the files with relevant documents to the AD(HQ) / Addl. DDG(HQ) for placing the representations before High Power Committee. https://cghs.gov.in/showfile.php?lid=4996

MRC Claims – for medical reimbursement only

 Admissible

 Room Rent – as per entitlement ( +/- CCU) ( +/- Ventilator)  Admissible medicines as per the bills – detailed date wise breakup

• f bills necessary

 Investigations during the admission period – at CGHS rates as per

reports – Reports are mandatory.( in some exceptional cases if reports are endorsed on the discharge card / summary the same can be considered if it is difficult to get the reports) The same has to be explicitly mentioned in the notes written

 Investigations which are not in the CGHS/ AIIMS schedule to be

specifically mentioned.

 Consultations –

 Maximum of Two per day for admission in Room / ward  Maximum of Three per day for admission in CCU/ICU/NICU/HDU/

Step down ICU

Standard format of notes to be written

Mention the following in your notes :--

Room Rent Count the number of Days admissible Mention the number of Days admissible CCU Count the number of Days admissible Mention the number of Days admissible Ventilator Count the number of Days admissible Mention the number of Days admissible Investigations Check availability of all reports – allow reports during the period of admission + on the day of admission if done in casualty prior to admission. All investigations at CGHS rates as per reports. In non routine investigations mention the relevant package number as well Consultations For routine stay – two per day and for ICU/CCU/HDU/Step down ICU / NICU – three per day Mention the number of consultations allowed Medicines Check and allow admissible medicines etc Clearly indicate disallowed medicines/ items - No question marks please.

MRC Claims – for medical reimbursement only



On the detailed bill – mention following



Number of days –



Room rent only



Room rent + CCU charges



Room rent + CCU charges+ Ventilator charges 

Number of consultations allowed.



In medicines section – deduct inadmissible items as mentioned in the MOA and other items - where ever the procedure charges are being reimbursed like catheterization.,

• xygen per hour, nebulization, ventilator charges.



Foley's catheter charges



Oxygen mask charges



Nebulizer mask charges



Ventilator tubing's etc.



Monitor charges



Lancets for blood sugar, syringe pumps, burettes, Amika pump , feeding bag.



Identification tags 

While recommending deductions clearly mark against the item as , allow all others with a clear mark as – allowed

MRC Claims – for Surgical reimbursement only

 The package number or numbers admissible to be

mentioned.

 For more than one packages – the claim should be

accompanied by detailed justification along with operation notes for the additional packages from the treating specialist ( surgical specialist)

 If the procedures are done on the same day

 One package ( most important one – at 100 %)  Additional packages if relevant at – 50% of the package rates.

 These details to be mentioned on the main bill.  All other attached bills should bear a remark – not allowed

as part of package.

MRC Claims – for Medical & Surgical reimbursement

 Check the date of procedure.  Surgical Packages are to be counted from the date of procedure

and for number of days as per the procedure – as per existing guidelines.

 Admission days other than the package days for surgery to be

allowed as medical management claims.

 On the main bill clearly mention the Dates for surgical package/s

and dates for medical management.

 In the detailed bill

 Allow the investigations , medicines, room rent and consultations

for the medical management period.

 Disallow the investigations , medicines, room rent and

consultations for the Surgical management period and mention the same in the bills.