Introduction of Online Reimbursement Claim through WBHS Portal
Government of West Bengal
Finance Department
Medical Cell, Writers’ Building
No. 127-F (MED) WB Dated: 26.11.2021
ORDER
Sub: Introduction of online reimbursement claim processing through WBHS Portal in revised Claim Forms under West Bengal Health Scheme.
At present, beneficiaries under the WBHS submit their claims manually to their respective Head of Offices in the prescribed claim Forms C1, C2, C3 and C4 as per Finance Order No. 78-F (MED) WB, dated- 22/10/2019, attaching necessary annexure (where applicable) and other treatment documents against each of their individual claim for reimbursing the costs incurred in connection with medical treatment under this Scheme.
Online processing of such reimbursement claims through WBHS Portal and making payments thereof under WBIFMS in integrated web mode was under active consideration for some time past. And, in order to make the ONLINE processing of these claim more comprehensively, the existing claim Forms mentioned herein above also required further modification and expansion to meet the need of the purpose.
Now, after careful consideration, the Governor is pleased to implement the online processing of reimbursement claim under West Bengal Health Scheme as per process flows detailed below:
| Sl. No. | Contents of Attachment | Appendix No. |
|---|---|---|
| 1 | Process flow for online reimbursement claim through WBHS Portal. | I |
| 2 | Process flow for preparation of Bill to disburse reimbursement claim from Treasury/PAO through payment integration between WBHS and WBIFMS Portal. | II |
Similarly, the Governor is further pleased to introduce the following Forms and Essentiality Certificates to ensure the online claim processing more comprehensive and purposeful by replacing the existing Claim Forms and Essentiality Certificates circulated earlier vide Order No. 78-F(MED)WB, dated- 22/10/2019:
| Sl. No. | Contents of Attachment | Appendix No. | |
| 1 | Revised Reimbursement Claim Forms: | III | |
| Form No. | Heading of Forms | ||
| Form-C1 | Reimbursement of cost for Out-Patient Department (OPD) treatment in Recognised/ Empanelled/ Enlisted Hospital. | ||
| Form-C2 | Reimbursement of cost for In-Patient Department (IPD) treatment in Non- Empanelled Hospital. | ||
| Form-C3 | Reimbursement of cost for Cashless In-Patient Department (IPD) treatment in Empanelled Private Hospital. | ||
| Form-C4 | Reimbursement of cost for Non-Cashless In- Patient Department (IPD) treatment in Recognised/ Empanelled/ Enlisted Hospital. | ||
| 2 | Essentiality Certificates: | IV | |
| Annexure No. | Heading of Annexure | ||
| Annexure-I | Certification of Treating Consultant/ Specialist of a Recognized/ Empanelled/ Enlisted Hospital for claiming reimbursement of “Out Patient Department” treatment of all notified diseases/ illnesses except Selected Investigations [Vide Clause 10 of Order No. 797-F(MED), dated 31.01.2011] and Prosthesis & Special Devices under WBHS. | ||
| Annexure-II | Certification of Medical Superintendent or Administrative Officer of the Non-Empanelled Hospital to claim reimbursement for “In- Patient Department” treatment only under WBHS. | ||
Online processing of reimbursement claim through the new functionality added to WBHSP is mandatory for all treatments on and from the date of effect of this order.
This has the approval of Principal Secretary, Finance Department, Government of West Bengal.
Enclosures: As stated
ALOKE KUMAR MUKHERJEE, WBA & AS
Joint Secretary, Finance Department
Government of West Bengal