Process flow in Medical Claim processing

Submission of claim at the parent Wellness Centre

Online entry of the claim is made by the dealing official in the DEO module. The dealing official examines it and arrives at an admissible amount. It is then forwarded to CMO In-charge.

CMO In-charge follows laid down guidelines for processing, reexamines it and forwards the claim to Head Office.

Processing by Technical Screening Committee (TSC)

Dealing official ascertains admissibility of Claim from competent authority and processes it based on guidelines from TSC.

The claim is then examined by the TSC.

Financial Approval of Competent authority and payment

The claim gets approval of Additional Director, CGHS Bengaluru(for cases with approved amount > 7 lakhs approval from ministry is necessary).

Post approval, bill is prepared and payment is done by PAO/Draft