Preparation of Claims by the Private Hospitals for IPD Treatment


Government of West Bengal
Finance Department
Medical Cell, Writers’ Building

No. 184-F(MED)WB Dated- 21/10/2022


Sub:- Discontinuation of Form-H and introduction of comprehensive Form-D4 & preparation of claims in progressive manner by the private hospitals under WBHS

Private empanelled hospitals submit their claim for extending the benefit of cashless facility up to 1.5 lacs under West Bengal Health Scheme in Form-H (not applicable for TMC, Rajarhat) and Form-D4 attaching all other treatment related instruments to Medical Cell, Finance Department. In Form-H, general information of the enrolled employee/ pensioner and beneficiary who availed medical treatment is generally mentioned. On the other hand, Form-D4 contains component wise cost of treatment as are provided by the hospital. At the time of discharging patient, hospital generates both these forms after incorporating all mandatory information. Signatures of three different signatories are also required in both Form-H and D4. As this paper works are to complete just before the discharge of patient, the beneficiary who availed the treatment under the Scheme is sometime forced to wait for a long time before final departure from hospital.

In order to minimize the paper works and to avoid idle time at hospital premises, restructuring of cashless claim Forms and introduction of claim preparation in progressive manner by the hospitals was under active consideration.

Now, after careful observation of all aspects, the Governor is pleased to reintroduce the following guidelines in this regard:

  1. The earlier Form-H is discontinued permanently for all purposes of treatment under WBHS.
  2. A comprehensive Form-D4 is introduced. In this revised Form-D4, there will be two signatories and they are employee/ pensioner/ beneficiary/ legitimate authority from the part of beneficiary and Medical Superintendent/ Administrative Officer/ Facility Director from the part of the treating hospital.
  3. Progressive (date wise) claim preparation by the hospital against each patient under WBHS is introduced mandatorily.

This order will be applicable for all admission of IPD treatment in private empanelled hospital on and from 01.11.2022.

This has the approval of Additional Chief Secretary, Finance Department.

Enclosure: – Revised Form-D4

Sri Aloke Kumar Mukherjee, WBA & AS
Joint Secretary, Finance Department
Government of West Bengal

No. 184-F dated 21.10.2022, Source