West Bengal Health Scheme
West Bengal Health Scheme

Checklist for claim under the West Bengal Health Scheme 2008

Guidelines for medical treatment & reimbursement under West Bengal Health Scheme 2008: 1. Use recognized hospital under Scheme 2. Show Identity Card & give copy to hospital 3. Give office address & number for indoor treatment 4. Inform office within 3 days of starting treatment 5. Check identification number on hospital bill 6. Check procedures/investigations coded on bill 7. Check surgical procedures charged at package rate 8. Claim within 3 months of discharge for indoor treatment 9. Claim within 3 months for OPD treatment 10. Permission needed for specific procedures/treatment 11. Permission needed for out-of-state specialty hospitals 12. Report over-billing or unnecessary procedures within 15 days 13. Use appropriate Essentiality Certificates forms for gov't employees 14. Sanctioning Authority to issue maximum amount per approved rates.

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:

  1. Checking the details of the employee/pensioner, patient, hospital, disease, treatment dates and costs, and proper documentation.
  2. Checking that the necessary papers and information such as photocopies of identity cards, temporary permits, organ transplant permissions, and claim submission deadlines were provided.
  3. Validating treatment done in non-empanelled private hospitals and checking the bed availability and admissibility rates.
  4. Checking that estimates, surgical package codes, and bills were properly furnished and approved before advances are given.

……

Checklist for Sanctioning Authority regarding settlement of claim under the West Bengal Health Scheme, 2008: –

[Put tick (√) mark]

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

 

 

 

 

…………………………………….

Click here to view & download pdf.
More Orders
Tags
SIWB
SIWB
Articles: 35

Related Posts

Leave a Reply