Hospitals empanelled under government schemes must bill at notified rates with the right documents. Mistakes cause rejected claims and delayed payments.
Why it is different
CGHS and ECHS beneficiaries are billed at rates notified under the scheme, which differ from your general tariff. Rates and rules are revised from time to time, so keep your rate master current and check the latest circulars.
What your process must handle
| Area | Requirement |
|---|---|
| Beneficiary details | Card or ID, referral where required |
| Rate master | Scheme rates separate from general rates |
| Packages | Package scope clear; items outside scope billed correctly |
| Documents | Prescriptions, investigation reports, discharge summary |
| Claim file | Complete bill with supporting papers within the allowed period |
| Follow-up | Track submitted claims, queries and payments |
Common rejection causes
- Wrong rate or code for a service.
- Missing referral or document.
- Billing outside the approved package or ward entitlement.
- Claim submitted late.
How software helps
NexoraHMS keeps general and CGHS rates side by side with a CGHS rate master of 6,459 services, with sponsor-wise masters and claim tracking, so the right rate applies the moment the sponsor is selected.
A pre-submission checklist
- Beneficiary details and referral verified.
- Services billed at the correct scheme rate.
- Package scope respected; extras billed separately where allowed.
- Prescriptions, reports and the discharge summary attached.
- Claim submitted within the permitted time.
- Submission date recorded for ageing and follow-up.
Hospitals that use a checklist for every claim usually see fewer queries and faster payments.
Note: Scheme rules change. Always confirm with the latest official notifications.
Related guides: Hospital Management Software in India (NexoraHMS)
CGHS Billing Software IndiaHospital Management Software IndiaHospital TPA & Insurance Billing Software IndiaAyushman Bharat PM-JAY for HospitalsHospital Billing Best Practices
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