Online Processing of Advance Claim through WBHS Portal

Government of West Bengal
Finance Department
Medical Cell, Writers Building

No. 48-F (MED)WB Dated: 29.03.2022

ORDER

Sub: Introduction of online processing of Advance claim through WBHS Portal under West Bengal Health Scheme.

Online processing of medical reimbursement claim through WBHS Portal has been introduced vide Finance Department Notification No. 127-F(MED)WB dated 26.11.2021. But, processing of advance drawal against cost of ongoing OPD/ IPD treatment is still being processed manually on the basis of the estimate from the recognised hospitals under the WBHS.

As such, online processing of such advance claim through WBHS Portal and making payments thereof through WBIFMS Portal in integrated mode was under active consideration for some time past.

Now, after careful consideration, the Governor is pleased to introduce the online processing of medical advance claim through WBHS Portal with the following guidelines, new set of Forms and Pro-forma Estimate from the Hospital for processing and settlement of the claim:-

1. Guidelines of process flow for online advance claim through WBHS Portal mentioned in Appendix-I.
2. Form-C5 of advance claim for Out-Patient Department (OPD) treatment in State Aided/ Private Empanelled/ Outside State Enlisted Hospital.
3. Form-C6 of advance claim for In-Patient Department (IPD) treatment in State Aided/ Private Empanelled/ Outside State Enlisted Hospital.
4. Pro-forma of Cost Estimate (Annexure-III) for Out Patient Department (OPD) treatment.
5. Pro-forma of Cost Estimate (Annexure-IV) for In Patient Department (IPD) treatment.

Online processing of advance claim through WBHS Portal is optional for all treatments till 30.06.2022 and it is mandatory thereafter.

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

No. 48-F dated 29.03.2022, Source

Appendix- I
(As per Order No. 48-F(MED)WB dated 29.03.2022)
(Process flow for online advance claim through WBHS Portal)

1. Only enrolled employee (pensioner is not eligible) under WBHS may draw advance for meeting up the expenditure for ongoing/ future treatment in recognized hospitals within State or enlisted hospitals outside State.
2. An employee will have to collect duly signed and stamped Estimate of Expenditure from treating the hospital for taking advance.
3. Treating hospital will issue Cost Estimate for a maximum period of 60 (sixty) days for OPD and 15 (fifteen) days for IPD treatment in a specified format to the employee.
4. Empanelled private hospital of the State shall issue system generated Cost Estimate from WBHS Portal using their credential. On the other hand State aided hospitals and enlisted hospital outside State will issue in manual mode.
5. On request empanelled hospital authority will issue system generated Cost Estimate using their credential in WBHS Portal. When hospital generates it in portal, a 12 (twelve) digit unique ID will be generated and enfaced in the top right of Cost Estimate. Hospital authority will hand over duly signed and stamped Cost Estimate to the employee or his/her relatives. In case of any wrong information mentioned in Cost Estimate, hospital can reject previous one for issuing a fresh one.
6. When employee collect portal generated Cost Estimate from private empanelled hospital of State, the information of advance claim will be filled automatically and to be shown as a claim in “Claim Pending for Submission” under ‘My Claim’ menu in the login of employee in WBHS Portal. On the other hand, when employee gets Cost Estimate from State aided hospitals or enlisted hospital outside State, s/he has to incorporate the information of advance in WBHS Portal using his/her personal login in the Advance menu under ‘My Claim’. Employee will submit the claim electronically.
7. Claim will reach automatically to the Operator (Reimbursement) with whom the employee is mapped for reimbursement claim processing.
8. After online submission, employee shall have to take a print out of system generated form of claim submitted. Then s/he signs in the appropriate space provided in the form. S/he will have to attach all necessary enclosures chronologically mentioned in last part of the claim form. Finally signed copy of such claim form must be submitted physically to the office of the Head of Office at the earliest.
9. After receiving the advance claim at office of the Head of Office, the sanction order will be generated as per guidelines as laid down under Clause No. 13 to 23 of Appendix-I of Finance Department Notification No. 127-F(MED)WB dated 26.11.2021.
10. Appendix-II of Notification No. 127-F(MED)WB dated 26.11.2021 shall be applicable for PAO/ Treasury Bill preparation in TR Form-68C and subsequent disbursement.

SRI ALOKE KUMAR MUKHERJEE, WBA & AS
Joint Secretary, Finance Department
Government of West Bengal