Faster CGHS Claim Processing Timelines and Grievance Channels Introduced

The Central Government Health Scheme (CGHS) has announced revised timelines and procedures to streamline hospital bill processing for CGHS pensioners. This revision was published by a notice dated April 26, 2024.

Key Revisions Introduced
  • Faster Processing: Stricter timelines aim to expedite claim processing by hospitals and CGHS authorities.
  • Condonation of Delay: Delays in claim submission by hospitals can now be reviewed for potential approval depending on the duration of the delay.
  • Transparency and Visibility: Reasons for claim rejections and deductions will be clearly documented.
  • Grievance Redressal: A dedicated grievance redressal mechanism will be established on the NHA portal for hospitals.
  • Improved Communication: Hospitals can track claims and raise grievances online. NHA will assign dedicated contact persons for each region.

  • Faster reimbursement of medical bills for pensioners.
  • Improved communication and transparency between hospitals, CGHS, and pensioners.
  • Reduced administrative burden on hospitals.

Timeline Highlights
  • Hospitals have 2 days to register a patient and inform CGHS.
  • Pre-processing doctors have 3 hours to review the intimation.
  • Hospitals have 15 days to discharge a patient and initiate a claim.
  • Sanctioning authorities will scrutinize bills based on cost.

One-Time Resubmission

Hospitals can resubmit bills rejected due to late submission (after September 1st, 2023) between May 16th and May 31st, 2024.

Additional Measures
  • Training for CGHS officials on the new system.
  • A checklist of required documents for hospitals to ensure smooth processing.
  • Improved tracking system for hospitals to monitor claim status.