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Process Flow to Reimburse Dialysis Charges for CKD (Stage-V) Patient

December 16, 2022

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

No. 197-F(MED)WB Dated- 23/11/2022

Sub:- Process flow to reimburse Dialysis charges for CKD (stage-V) patient through WBHS Portal.

Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. This procedure is done frequently as a life saving measures for the patient suffering from renal failure (CKD-V stage).

Dialysis is done either IPD or Day Care (OPD) mode in all hospitals. Owing to frequent occurrence (2 or 3 times in a week), patient generally chooses nearby hospital for undergoing such procedure.

In case of online claim processing through WBHS Portal, enrolled beneficiary as well as government offices are at present, facing some problem while processing claim of such dialysis charges. Beneficiary suffering from renal failure (CKD-V stage) avails dialysis in the following two types of hospitals:-

A. In recognized/ empanelled/ enlisted hospital where dialysis is provided as IPD or Day Care (OPD) treatment by issuing Discharge Summary and/or Dialysis Chart.

B. In non-empanelled hospital where dialysis is provided as IPD treatment by issuing Discharge Summary and/or Dialysis Chart.

Process flows of claiming and disposing reimbursement claim in the WBHS Portal for both the above two cases are given below:

A. When treating hospital is recognized/ empanelled/ enlisted one and dialysis is provided as IPD or Day Care (OPD) treatment by issuing Discharge Summary and/or Dialysis Chart.

  1. Enrolled employee/ pension will claim reimbursement of dialysis procedure on calendar month basis e.g. January, February
  2. Claim is to be done under “Indoor and Indoor related OPD Treatment” category with Package Type in Form-C4.
  3. Cost of all dialysis procedures done in a month are to be shown at Package Treatment section individually one by one with procedure code ‘01024064’.
  4. Cost of admissible regular medication of domestic use in connection with Renal Failure (CKD-V stage) shall have to be claimed separately in form-C1 as per Clause 7(1) of WBHS.
  5. Duration of dialysis mentioned in Dialysis Chart is not a consideration for determining admissibility.
  6. Papers of all dialysis and others treatment related documents are to be enclosed sequentially with the claim in Form-C4.

B. When treating hospital is non-empanelled one and dialysis is provided as IPD treatment by issuing Discharge Summary and Dialysis Chart.

  1. Enrolled employee/ pension will claim reimbursement of dialysis procedure on calendar month basis e g. January, February
  2. Claim is to be done under ‘Indoor’ category with Package Type in Form-C2.
  3. All dialysis procedures done in a month are to be shown at Package Treatment section individually one by one with procedure code ‘01024064’.
  4. Cost of regular medication for domestic use in connection with Renal Failure (CKD-V stage) is not reimbursable additionally.
  5. Papers of all dialysis and others treatment related documents are to be enclosed sequentially with the claim in Form-C2.

This process flow shall not be applicable for any other category of treatment and claim thereof under WBHS.

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

No. 197-F dated 23.11.2022, Source

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