- i. The beneficiary will submit the MRC in the prescribed format with all relevant supporting vouchers/documents in original, to the CMO-I/C of the relevant CGHS Wellness Centre. The CGHS Wellness Centre shall verify and ensure, before accepting the claim papers, that all relevant documents are enclosed as per the prescribed checklist and issue a dated acknowledgement to the claimant in token of receipt of the MRC by CGHS.
- ii. The CGHS Wellness Centre shall forward the MRC papers online to the Office of Zonal AD/JD, CGHS for further processing for reimbursement of claims. The physical papers shall be sent to the office of the AD/JD within one / two days of receipt of claim papers.
- iii. If there are still any deficiencies / gaps found in MRC documents/papers, the Office of AD/JD, shall retain the papers and communicate the list of deficiencies / observations, preferably online, to the CMO-I/C for removing the shortcomings. The MRC may also be returned in original to the CMO- I/C, if it is absolutely necessary for doing the needful to remove the deficiencies inconsultation wïth the beneficiary.
- iv. The CMO-I/C shall contact the beneficiary concerned and inform him about the shortcomings in the MRC papers and request him to submit the requisite information / documents. The CMO I/C shall not return the MRC in original unless it is rejected in total.
- v. The MRCs should be scrutinized and processed by the Office of AD/JD as far as possible through computerized software as per the extant policy and instructions issued from time to time about the CGHS rates and admissibility of claims under CGHS.
- vi. The amount found admissible as per the CGHS guidelines may be passed for payment and forwarded online / manually to the PAO for making payment. The original documents should also be forwarded simultaneously to the PAO for making payment of the admissible amount to the claimant.
- vii. When a bill is sent to the PAO, the details pertaining to the claimant will be entered through computer and the claimant shall be informed of the same along with bill number, amount admissible and details of disallowances clearly indicating the specific reasons / grounds for deductions.
- viii. The Office of AD/ID of the zone / city shall submit a weekly report in Form —‘MRC-I’ and Monthly Return in Form — ‘MRC — II’ indicating the details of disposal of MRC cases, to the Office of AD(HQ), CGHS for Delhi & NCR and to the Office of Additional DDG (HQ), CGHS for other than Delhi and NCR CGHS cities.
- ix. A separate analytical statement shall be attached with the Monthly Return in Form-’MRC- II’ giving therein, the details of the MRCs pending for 2 months and above, clearly indicating the reasons there for and steps taken to dispose of such cases.
- x. The Office of AD (HQ), CGHS, New Delhi and Office of Addi. DDG (HQ), CGHS shall compile the Monthly returns received from the respective zones andc ities and submit a consolidated Monthly Return on MRC cases (Zone-wise/City wise) to the Director, CGHS for monitoring of MRC cases on a monthly basis. A copy of this Monthly Return shall also be endorsed by AD (HQ), CGHS and Addi. DDG (HQ), CGHS to Additional Secretary and Director General, CGHS for his information.
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Sir,
No, doubt a bold step has been taken by the concerned authorities for the benefit of ex-vetarns. But, of my own experience, it is seen that the orders whatever circulated by the authorites are not been complied with in J&K. I write these lines because I had an head enjury as was slipped from stirrs in the month of Feb 2011 and my faimly members took me to two private hospitals (MH being some 25 kms away from my residence) in Jammu but both did not accept me on ECHS Card where as they are empelled, and it was told first get forwarded from ECHS then it will be seen.
Anyway now for the betterment of ex-service mans a good step has been taken. Thanks.