Guidelines for claims under 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.