West Bengal Health Scheme, 2008 : Checklist for claim :
This is a checklist for a Sanctioning Authority to settle claims under the West Bengal Health Scheme, 2008. The list has 4 sections with sub-points to be marked with a tick (√) or cross (X) to indicate if certain information or papers have been furnished and checked. The sections include:
- Checking the details of the employee/pensioner, patient, hospital, disease, treatment dates and costs, and proper documentation.
- Checking that the necessary papers and information such as photocopies of identity cards, temporary permits, organ transplant permissions, and claim submission deadlines were provided.
- Validating treatment done in non-empanelled private hospitals and checking the bed availability and admissibility rates.
- Checking that estimates, surgical package codes, and bills were properly furnished and approved before advances are given.
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Checklist for Sanctioning Authority regarding settlement of claim under the West Bengal Health Scheme, 2008: –
[Put tick (√) mark]
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Whether the following information has been furnished in the Sanctioning G.O.?
(i) Name of the employee/ pensioner with Identification No.: Yes/ No
(ii) Name of the patient with Identification No.: Yes/ No
(iii) Name of the Hospital/ Nursing Home with Code No.: Yes/ No
(iv) Disease name: Yes/ No
(v) Period of treatment: Yes/ No
(vi) If treatment done on Package, Procedure name with Code No.: Yes/ No
(vii) Treatment done under O.P.D. or Indoor or both: Yes/ No
(viii) Head of Account has been mentioned properly: Yes/ No
(ix) Adjustment of advance taken with details: Yes/ No
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Whether the following papers/ information has been checked?
(i) Photocopy of the Health Scheme Identity Card: Yes/ No
(ii) Photocopy of the Temporary Family Permit if Identity Card not issued: Yes/ No
(iii) Temporary Family Permit was valid at the time of treatment: Yes/ No
(iv) Information furnished to the office within three days of admission for Indoor treatment : Yes/ No
(v) Permission of the West Bengal Health Scheme Authority obtained for Human Organ Transplantation / implantation of Dual-Chamber Pacemaker/ more than one Drug Eluting Stent / more than two Stents or AICD, CRT, Deep Brain Stimulator, Intrathecal Pump/ Digital Hearing Aid, etc.: Yes/ No
(vi) Permission of the West Bengal Health Scheme Authority taken for treatment in Speciality Hospital outside the State: Yes/ No
(vii) Disease for O.P.D. treatment claim is a listed One under Clause-7 of the Health Scheme
(viii) Indoor related O.P.D. treatment and not covered under Clause-7(2) of the Scheme whether the O.P.D. treatment was done within 30 days prior to admission or 30 days of discharge: Yes/ No
(ix) Claim has been preferred within three months vide Memo No. 2618-F (MED), dt. 05-04-2011: Yes/ No
(x) If not preferred within the stipulated period whether delay has been condoned by the Finance Department: Yes/ No
(xi) All procedures/ investigations/ implants have been checked against the Code Nos. and approved rates: Yes/ No
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Medical treatment done in non-empanelled Private Hospital/ Nursing Home [vide Para-23 of the Memo No. 797-F (MED), dt. 31-03-2011] Whether-
(i) Name of the Pvt. Hospital/ Nursing Home with address and Clinical Establishment Licence No. has been furnished? : Yes/ No
(ii) No. of beds available in the Hospital/ Nursing Home as per CE Licence has been furnished? : Yes/ No
(iii) Admissibility has been checked as per approved Rate List? : Yes/ No
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Sanction of advance- whether
(i) Estimate has been taken from recognised hospital? : Yes/ No
(ii) Code No. of the Surgical Package has been mentioned? : Yes/ No
(iii) Estimate has been furnished as per approved rates? : Yes/ No
(iv) Code Nos. of major investigations in case of non-package treatment have been mentioned? : Yes/ No
(v) Detailed bill for services already given by hospital has been furnished for sanction of further advance? : Yes/ No
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