CHECKLIST
Checklist for Sanctioning Authority regarding settlement of claim under the
West Bengal Health Scheme, 2008:-
[Put tick (√) mark]
1.
Whether the following information has been furnished
in the Sanctioning G.O.?
(i)
Name of the employee/ pensioner with Identification No.: Yes/ No
(ii)
Name of the patient with Identification No. : Yes/ No
(iii)
Name of the Hospital/ Nursing Home with Code No. : Yes/ No
(iv)
Disease name : Yes/ No
(v)
Period of treatment : Yes/ No
(vi)
If treatment done on Package, Procedure name with
Code No. : Yes/ No
(vii)
Treatment done under O.P.D. or Indoor or both : Yes/ No
(viii)
Head of Account has been mentioned properly : Yes/ No
(ix)
Adjustment of advance taken with details : Yes/ No
2.
Whether the following papers/ information has been
checked?
(i)
Photo Copy of the Health Scheme Identity Card : Yes/ No
(ii)
Photo Copy of the Temporary Family Permit if
Identity Card not issued : Yes/ No
(iii)
Temporary Family Permit was valid at the time of
treatment : Yes/ No
(iv)
Information furnished to the office within three days of
admission for Indoor treatment : Yes/ No
(v)
Permission of the West Bengal Health Scheme Authority
obtained for Human Organ Transplantation/ implantation
of Dual-Chamber Pacemaker/ more than one Drug
Eluting Stent/ more than two Stents or AICD, CRT, Deep
Brain Stimulator, Intrathecal Pump/ Digital Hearing Aid,
etc. : Yes/ No
(vi)
Permission of the West Bengal Health Scheme Authority
taken for treatment in Speciality Hospital outside the
State : Yes/ No
(vii)
Disease for O.P.D. treatment claim is a listed
One under Clause-7 of the Health Scheme
(viii)
Indoor related O.P.D. treatment and not covered under
Clause-7(2) of the Scheme whether the O.P.D. treatment
was done within 30 days prior to admission or 30 days of
discharge : Yes/ No
(ix)
Claim has been preferred within three months vide
Memo No. 2618-F (MED), dt. 05-04-2011 : Yes/ No
(x)
If not preferred within the stipulated period whether
delay has been condoned by the Finance Department : Yes/ No
(xi)
All procedures/ investigations/ implants have been
checked against the Code Nos. and approved rates : Yes/ No
3.
Medical treatment done in non-empanelled Private
Hospital/ Nursing Home [vide Para-23 of the Memo No.
797-F (MED), dt. 31-03-2011]
Whether-
(i)
Name of the Pvt. Hospital/ Nursing Home with address
and Clinical Establishment Licence No. has been
furnished? : Yes/ No
(ii)
No. of beds available in the Hospital/ Nursing Home
as per CE Licence has been furnished? : Yes/ No
(iii)
Admissibility has been checked as per approved
Rate List? : Yes/ No
4.
Sanction of advance- whether
(i)
Estimate has been taken from recognised hospital? : Yes/ No
(ii)
Code No. of the Surgical Package has been mentioned? : Yes/ No
(iii)
Estimate has been furnished as per approved rates? : Yes/ No
(iv)
Code Nos. of major investigations in case of non-package
treatment have been mentioned? : Yes/ No
(v)
Detailed bill for services already given by hospital has
been furnished for sanction of further advance? : Yes/ No