Referral Procedure to Empanelled Hospitals for ECHS Beneficiaries: Order dtd 15.07.2021 |
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REFERRAL PROCEDURE TO EMPANELLED HOSPITALS FOR ECHS BENEFICIARIES
General
1. All ECHS beneficiaries are provided medical cover through a network of Regional Centres and Polyclinics spread across the country and also Polyclinics located at Nepal. To provide Specialized Medical Cover ECHS beneficiaries are referred to Civil Health Care Organisation which have been empanelled by Regional Centres in their respective Area of Responsibility. The specialized Medical Cover is also provided by Military Hospitals and also by Research and Referral (R&R) Hospital located at Delhi to ECHS beneficiaries on being referred by ECHS Polyclinics.
2. There are ECHS Polyclinics which are located with a Military Hospital and have been nominated as Military Polyclinics. A list of 128 Military Polyclinic is given at Appx ‘A’ attached. The Military Polyclinics to manage Specialized Medical condition of its beneficiaries are first required to refer them to these affiliated Military Hospitals in case of availability of Specialized Medical Facilities in the Military Hospital. In such cases the beneficiary will either be treated at the Military Hospital or will be recommended/referred to empanelled Hospital for further management of the beneficiary.
3. A detail referral procedure is given in succeeding Paragraphs.
Referral To Empanelied Hospital Within The Area Of Responsibility Of The Regional Centre Of The Parent Polyclinic
4. Action by the ESM at Parent Polyclinic.
(a) The ECHS beneficiary on reaching the Parent Polyclinic will register and select a Doctor to be consulted through Kiosk/ICAT and a token will be generated which will have a queue number.
(b) The ECHS beneficiary will report to the Doctor as per token/queue serial. Based on the medical condition, the ECHS beneficiary will either be provided medical treatment at the Polyclinic or will be referred for further treatment to empaneiled Hospital or Military Hospital.
5 Action by the Medical Officer at Parent Polyclinic.
(a) In case the Parent Polyclinic is a Military Polyclinic, the ECHS beneficiary will be referred either to the affiliated Military Hospital or Empanelled Hospital based on following considerations:-
(i) if specialist for the required medical condition is posted and present in the Military Hospital as also adequate capacity to accommodate the ECHS beneficiary is available, the ECHS beneficiary will be referred to Military Hospital.
(ii) if any of the a/m conditions are not met, the ECHS beneficiary will bereferred to Empaneiled Hospital.
(iii) The OIC Military policlinic will endeavour to keep an updated data of the affiliated Military Hospital on the availability of specialist and also the beds.
(b) A sample referral to Military Hospital is attached as Appx B.
(c) In case the Parent Polyclinic is not a Military Polyclinic then based on the Medical condition the beneficiary will either be provided medical treatment at the Polyclinic or will be referred for further treatment to Empanelled Hospital located within the Area of Responsibility of concerned Regional Centre (no Hospital will be specified). He/she will be issued with a referral form which will have a referral number and basic details of the beneficiary. A sample referral form is attached as Appx C.
6. Action by the OIC Parent Polyclinic. The referral form will be digitally signed by the QIC Parent Polyclinic and will hand over a print out to the ECHS beneficiary. No signature and or official seal is required to be put on the referral print out.
7. Action at the Empanelled Hospital. The ECHS beneficiary on reaching the Empanelled Hospital of his/her choice, within the Area of Responsibility of the Regional Centre will provide the referral form and valid ECHS Card to the Hospital. The Empanelled Hospital will access the UTI-ITSL site and feed the referral number. A claim ID will be generated from the UTITSL site and the referral number and claim ID will get locked. The referral number now cannot be used at any other empanelled Hospital.
Referral From Parent Polyclinic For Hospital Out Side The Area Of Responsibility Of The Regional Centre Of The Parent Polyclinic
8. The procedure to be adopted by the Parent Polyclinic to give referral to ECHS beneficiary to utilize the facility of Empanelled Hospital or Military Hospital outside the Area of Responsibility of the Regional Centre of the Parent Polyclinic is given in succeeding Paragraphs.
9. Action by the ECHS Beneficiary at the Parent Polyclinic.
(a) The beneficiary will take action to report to the Doctor at Parent Polyclinic as given at Para 4(a) & (b) above.
(b) The ECHS beneficiary will ask for referral from the Doctor for the Specialized Medical condition either for Empanelled Hospital or Military Hospital.
10. Action by the Doctor at Parent Polyclinic.
(a) In case the referral has to be given to the Military Hospital outside the Area of Responsibility then the beneficiary will identify the Military Polyclinic affiliated to desired Military Hospital. The Doctor will generate the referral.
(b) In case the referral has to be given to an Empanelled Hospital then the Beneficiary will identify Polyclinic closest to the Empanelled facilities where treatment is desired. The Doctor will generate online referral after entering necessary details.
11. Action by the OIC Parent Polyclinic. The OIC Parent Polyclinic will approve the referral using digital signature online and then referral will be visible to the OIC of out station Polyclinic for approval.
12. Action by the OIC, Out Station Polyclinic. The Out Station Polyclinic in case is a Military Polyclinic then the OIC will have two options either to refer to Military Hospital or to Empanelled Hospital as per the status of availability of specific treatment at the affiliated Military Hospital. {if the Out Station Polyclinic is a non Military Polyclinic, the OIC of the Out Station Polyclinic will approve referral to an empanelled hospital. Once the approval after exercising the option is given by the OIC of Out Station Polyclinic the referral will he visible to the OIC Parent Polyclinic to give print out to the ECHS Beneficiary.
13. Action by the ECHS Beneficiary. The beneficiary after collecting the referral will directly go to the referred Military Hospital or Out Station Empanelled Hospital w/o reporting to the concerned Out Station Polyclinic.
14. Action by the Dir Regional Centre In case of Out Station referral. The OIC Out Station Polyclinic and the Dir Regional Centre will be responsible for such ECHS beneficiary for that particular referral and also for processing the IPD/OPD claim through UTI-ITSL.
Use Of Card Reader At All Polyclinic
15. A Card reader will be provided with the Doctor at each Polyclinic to read the details in the ECHS Card and also to save the Medical details immediately on occurrence. Hence, the referral will only function when the ECHS Cards/Valid instrument is available with the ECHS beneficiary.
16 All Regional Centres are requested to disseminate this information to Empanelled Hospitals and Polyclinics under their respective jurisdiction.
17. This supersedes CO, ECHS letter No. B/49711-NSC/AG/ECHS dated 27 Feb 2019.
Sd/-
(Bakesti Kakar)
Col (Retd.)
Jt Dir (Statistics & Automation)
for MD ECHS
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