NOTICE FOR INVITING EXPRESSION OF INTEREST (EOI)

No. : Med./NGP/Tie-up (EOI)/955 Date : 24.09.2018

Medical Department of S. E. C. Railway in Nagpur Division caters to need of 57152

numbers of Railway beneficiaries through Railway hospitals and a chain of health units. The

patients of Nagpur Division are required to be treated and investigated at Private CGHS

empanelled hospitals & investigation centres in view of limited availability of facilities in

Railway set up. The patients in need of secondary & tertiary care and specialised

investigations for which the facilities are not available in Railway set up will be referred to

private tie-up hospitals and investigation centres on bill payment system. In addition, CTSE

Card holders of entire Indian Railways will also be referred to tie-up centres in case of

emergency only but in this case the bills will be paid through BPA.

Such tie-up with Private Hospitals are already in force at Nagpur & Gondia but the

patients of other important places of Nagpur Division like Rajnandgaon, Chhindwara &

Nagbhir are facing difficulties in case of medical emergency due to lack of adequate Railway

medical facilities locally and also due to their distant location from Nagpur.

So, Chief Medical Superintendent, S. E. C. Railway/Nagpur invites “ Expression of

Interest (EOI)” from all the willing Private Hospitals located at Rajnandgaon, Chhindwara

and in & around Nagbhir in Nagpur Division of SECR for entering into tie-up for railway

patients of S. E. C. Railway/Nagpur Division and CTSE Card holders of entire Indian

Railways through MOU (Memorandum of Undertaking) in nominated identified specialities

and specialised investigations. The details are available through website

www.secr.indianrailways.gov.in (Pathway : South East Central Railway About us

Division Nagpur Medical Topics Specific to Department).

FOR “ EOI “ DOCUMENT

EOI document and format should also be downloaded from our above mentioned

website.

The responses on the prescribed format (as enclosed in Annexure : A, B & C should

be submitted to the office of Chief Medical Superintendent, S. E. C. Railway, Kamptee Road,

PO- Bezonbagh, Nagpur – 440014 on or before 29.10.2018 . For any further clarification

Office of Chief Medical Superintendent, S. E. C. Railway/Nagpur may be contacted.

***

द��ण पुव� म�य रेलवे

SOUTH EAST CENTRAL RAILWAY

नागपुर मंडल / NAGPUR DIVISION

काया�लय %

मु�य �च�क�सा अधी�क/नागपुर

Office of the :

Chief Medical Supdt, NAGPUR.

EOI (EXPRESSION OF INTEREST) Sub. : EOI(Expression of Interest) towards entering into tie-up with Private

Hospitals at Rajnandgaon, Chhindwara and in & around Nagbhir in Nagpur Division of SECR for treatment to Railway patients of S. E. C. Railway, Nagpur Division and CTSE card holders of Indian Railways

*** Medical Department of S. E. C. Railway in Nagpur Division caters to need of 58994 numbers

of Railway beneficiaries through Railway hospitals and a chain of health units. The patients

of Nagpur Division are required to be treated and investigated at Private Hospitals in view of

limited availability of facilities in Railway set up. The patients in need of secondary &

territory care and specialised investigations for which the facilities are not available in

Railway set up will be referred to private tie-up Hospitals on bill payment system. In

addition, CTSE Card holders of entire Indian Railways will also be referred to tie-up centres

in case of emergency only but in this case the bills will be paid through BPA.

Such tie-up with Private Hospitals are already in force at Nagpur & Gondia but the

patients of other important places of Nagpur Division like Rajnandgaon, Chhindwara &

Nagbhir are facing difficulties in case of medical emergency due to lack of adequate Railway

medical facilities locally and also due to their distant location from Nagpur.

So, Chief Medical Superintendent, S. E. C. Railway/Nagpur invites “ Expression of

Interest (EOI)” from all the willing Private Hospitals located at Rajnandgaon, Chhindwara

and in & around Nagbhir in Nagpur Division of SECR for entering into tie-up for railway

patients of S. E. C. Railway/Nagpur Division and CTSE Card holders of entire Indian

Railways through MOU (Memorandum of Undertaking) in nominated identified specialities

and specialised investigations. The details are available through website

www.secr.indianrailways.gov.in (Pathway : South East Central Railway About us

Division Nagpur Medical Topics Specific to Department).

FOR “ EOI “ DOCUMENT

EOI document and format should be downloaded from our above mentioned website.

The responses on the prescribed format (as enclosed in Annexure : A, B & C should be submitted to the office of Chief Medical Superintendent, S. E. C. Railway, Nagpur – 440 004 on or before 29.10.2018. For any further clarification Office of Chief Medical Superintendent, S. E. C. Railway/Nagpur may be contacted.

ANNEXURE : “A”

PRESCRIBED FORMAT APPLICATON FOR

EXPRESSION OF INTEREST (EOI) FOR ENTERING INTO TIE UP WITH PRIVATE HOSPITALS AT RAJNANDGAON, CHHINDWARA & IN AND AROUND NAGBHIR IN

NAGPUR DIVISION OF SECR FOR THE PATIENT OF NAGPUR DIVISION AND CTSE CARD HOLDERS OF INDIAN RAILWAYS

*** EOI FOR PLACE - . ___________________ (RAJNANDGAON/CHHINDWARA/IN & AROUND NAGBHIR)

1. NAME OF THE HOSPITAL :- _____________________________________________________________ Add. : ________________________________________________________ _____________________________________________________________ Tel. No. : _________________________ E-mail id :___________________

2. EXPERIENCES OF WORKING IN PRIVATE SECTOR/GOVT. SECTOR(ATTACH DETAILS OF MOU) ___________________________________________________ ___________________________________________________________________ ___________________________________________________________________

3. WE AGREE TO PROVIDE THE SERVICES TO THE RAILWAY BENEFICIARIES IN

FOLLOWING DISCIPLINES (REF : ANNEXURE : “A” OF EOI) ---------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------

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4. (a) WE AGREE TO PROVIDE SERVICES AT CGHS NAGPUR RATE- 2014, Feb

2015, Sep 2015. NON-NABH/NABH : ________________________________________ NON-NABL/ NABL : _______________________________________

(b) FOR THOSE SERVICES/INVESTIGATIONS/TREATMENT MODALITIES, WHICH ARE NOT LISTED IN THE CGHS RATE, OUR HOSPITAL WILL PROVIDE THE SERVICES ON LAR AS PER ANNEXURE C, F. (c) FOR THE ITEMS NOT INCLUDED IN CGHS & LAR OUR HOSPITALS WILL PROVIDE SERVICES AT 30% DISCOUNT OF EXISTING HOSPITAL RATE.

5. i) WE ALSO AGREE TO PROVIDE SERVICES ON BILL SYSTEM OF PAYMENT TO RAILWAY BENEFICIARIES HAVING RAILWAY MEDICAL CARD /RELHS CARD OR CTSE CARD HOLDERS OF INDIAN RAILWAYS

ii ) FOR CTSE CARD HOLDERS OF INDIAN RAILWAYS – WE AGREE TO

PROVIDE SERVICES THROUGH TPA AS DETAILED IN THE TERMS & CONDITIONS

6. OUR HOSPITAL OFFERS TO PROVIDE FREE AMBULANCE SERVICES (TYPE

OF AMBULANCE) FOR ALL REFERRAL PATIENTS TO AND FRO IN THE LOCAL MUNICIPAL AREA. NAME OF MUNICIPAL AREA :

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7. WE ENCLOSE THE IN HOUSE HUMAN RESOURCES/SPECIALISATIONS, WHICH ARE AVAILABLE WITH OUR HOSPITAL (AS PER ANNEXURE…) THE INFRASTRUCTURAL FACILITIES OF OUR INSTITUTION IS ALSO ENCLOSED AS PER ANNEXURE _______.

8. OUR HOSPITAL HAS BEEN RECOGNISED FOR TREATMENT, INVESTIGATIONS SUPPLY OF BLOOD AND ITS PRODUCT TO THE FOLLOWING GOVT. ORGANISATION/SEMI-GOVT. ORGANISATION/ PRIVATE ORGANISATION( AS PER ANNEXURE…) : _______________________ ___________________________________________________________________

9. WE HOPE OUR ORGANISATION WILL BE CONSIDERED FOR TIE-UP WITH S.E.C. RAILWAY/NAGPUR FOR PROVIDING SERVICES TO THE RAILWAY BENEFICIARIES/CTSE CARD HOLDERS OF INDIAN RAILWAYS. (All documents are to be signed and stamped by the Authorized signatory on all pages).

SIGNATURE AUTHORIZED SIGNATORY (NAME- )

ADDRESS -------------------------------------- ----------------------------------------------------- PHONE NUMBER----------------------------- E MAIL ID--------------------------------------------

SEAL/STAMP

***

ANNEXURE : “B”

LIST OF IDENTIFIED AND NOMINATED SPECIALTIES REQUIRED FOR TIE UP

I. Nephrology, Dialysis, Nephro Surgery.

II. Urology & Uro Surgery

III. Neurology, Neuro-Surgery

IV. Endocrinology, Endocrine Surgery

V. Gastroenterology & Surgery

VI. Paediatric & Neonatology, NICU, PICU, Paediatric Surgery

VII. Plastic Surgery, Burns

VIII. Oncology & Onco Surgery, Chemotherapy, Radiotherapy

IX. General Surgery

X. General Medicine

XI. Orthopaedics

XII. Obstetrics & Gynaecology

XIII. Eye

XIV. ENT

XV. a) Cardiology

b) Cardio-vascular surgery

XVI. Chest speciality

NOTE - Please tick { } the specialities in which you are willing for tie-up

***

ANNEXURE : “ C ” PROFORMA FOR QUOTATION OF RATES WITH CGHS PRIVATE HOSPITALS AT RAJNANDGAON, CHHINDWARA AND IN & AROUND NAGBHIR IN NAGPUR DIVISION OF SECR FOR EOI (EXPRESSION OF INTEREST) : Sr.No. Rate of items Existing rate Rate offered

1. For items covered under CGHS rate

CGHS rate Nagpur – 2014, Feb 2015, Sep 2015 (NABH/Non NABH, NABL / Non NABL) Ministry of Health & FW website http//msotransparent. nih.in/cghsnew/indexasp

We agree to provide services at CGHS rate Nagpur 2014, Feb 2015, Sep 2015 – NABH, NON-NABH, NABL, NON-NABL

2. For items not covered under Sr.no.1 as above but for which LAR is available (detailed in Annexure ‘F’)

Existing LAR

We agree to provide services at LAR enclosed as Annexure

3. For items not covered under 1 & 2 as above

30% discount of existing Hospitals rates

We agree to provide services at 30% discount of existing Hospital rates.

Note : The lowest quoted rates amongst the empanelled centers will be applicable to all

(Name and Signature with seal /rubber stamp)

ADDRESS --------------------------------------

-----------------------------------------------------

PHONE NUMBER-----------------------------

E MAIL ID--------------------------------------------

***

ANNEXURE ‘D’

DETAILS OF TERMS & CONDITIONS OF EOI

The Medical Department of Nagpur Division of South East Central Railway (SECR/NGP) is providing comprehensive medical care facilities to the Employees/ Retired Employees RELHS Card Holders (Retired Employees Liberalised Health Scheme), their eligible family members and such other categories of beneficiaries as are decided from time to time. The Medical Department of SECR/NGP proposes to provide treatment facilities, diagnostic facilities to Railway medical beneficiaries in the CGHS empanelled Hospitals or Private Hospitals locally if CGHS empanelled Hospitals is not available. Chief Medical Superintendent, S.E.C.Railway/Nagpur on behalf of President of India proposes MOU with Private Hospitals to provide the emergency medical services in & around Nagbhir, Rajnandgaon & Chhindwara. Hence willingness is called from Health Care Organization - Private Hospitals located at Rajnandgaon, Chhindwara in & around Nagbhir. 1. DEFINITIONS & INTERPRETATIONS 1.1 The following terms and expressions shall have the following meanings for purposes of this Agreement.

1.1.1 “Agreement” shall mean the Agreement and all Schedules, supplements,

appendices, appendages and modifications thereof made in accordance with the terms of this Agreement.

1.1.2 “Benefit” shall mean the extent or degree of service the beneficiaries are entitled to receive as per the rules on the subject.

1.1.3 “Bill Processing Agency (BPA)” means the agency appointed by IRMS for

processing of Data/Bills of all Railway Beneficiaries referred by it and CTSE beneficiaries (CTSE stands for Cashless Treatment Scheme in Emergency, which has been launched by Railway for its RELHS Beneficiaries) attending the empanelled Private Hospitals without being referred by it and for making payment.

Note - However at present the bills of Railway beneficiaries holding

Railway Medical Identity Card / RELHS Card will be passed

departmentally till further advice.

Contd….2...

….2….

1.1.4 “Card” shall mean the new CTSE Plastic Photo Identity Card bearing details including Aadhar no. of the beneficiary, issued by any competent authority of Railway Personnel department MIC shall mean ‘Medical Identity Card/RELHS Card’ issued by any competent authority of Railway Personnel Department, bearing the name of the Railway Employee or ex-Railway Employee respectively and their family members.

1.1.5 “Card Holder” shall mean a person having the CTSE Card (a specimen of which has been shown to the hospital and a prototype has also been provided). In addition there will be two more types of cards that the hospital may be presented with by railway beneficiaries – MIC of serving Employees and MIC of RELHS beneficiaries (RELHS Card) Retired Employees Liberalized Health Scheme)

1.1.6 “CTSE Beneficiary” shall mean a person who is eligible for coverage of CTSE and hold a valid CTSE Identity Card for the benefit. Railway Beneficiary shall mean any person (Employee & his dependents/Retired Employee & his dependents who is eligible to comprehensive medical care by Medical Department of SECR/NGP and has been issued or whose name is included in a Medical Card issued by competent authority and has not become ineligible on any account.

1.1.7 “Coverage” shall mean the types of persons to be eligible as the beneficiaries of the Scheme to health services provided under the Scheme, subject to the terms, conditions and limitations.

1.1.8 “Emergency” shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the early convenience, be detrimental to the health of the patient or will jeopardize the life of the patient.

1.1.9 Empanelment” shall mean the hospitals, authorized by the Railway for treatment/investigations purposes for a particulars period.

1.1.10 “Hospital” shall mean the tie up Hospital, (Name) while performing under this Agreement providing medical investigations, treatment and the healthcare of human beings.

1.1.11 “De-recognition of Hospital” shall mean debarring the hospital on account of adopting unethical practices or fraudulent means in providing medical treatment to or not following the good industry practices of the health care for the CTSE/Railway beneficiaries after following certain procedure of inquiry.

1.1.12 “Party” shall mean either the Railway or the Hospital and “Parties” shall

mean both the Railway and the Hospital.

Contd….3

….3….

1.1.13 “CGHS Package Rate” shall mean all inclusive - including lump sum cost of inpatient treatment/day-care/diagnostic procedure for treatment under emergency from the time of admission to the time of discharge including (but not limited to) (i) Registration charges. (ii) Admission charges (iii) Accommodation charges including patients diet. (iv) Operation charges (v) Injection charges (vi) Dressing charges (vii) Doctor/consultant visit charges (viii) ICU/ICCU charges. (ix) Monitoring charges. (x) Transfusion charges and Blood processing charges (xi) Pre Anesthetic check up and Anesthesia charges. (xii) Operation theatre charges (xiii) Procedural charges/Surgeon’s fee (xiv) Cost of surgical disposables and all sundries used during hospitalization (xv) Cost of medicines and consumables (xvi) Related routine and essential investigations (xvii) Physiotherapy charges etc. (xviii) Nursing care charges etc.

Package rates also include two postoperative consultations.

1.1.14 Cost of Implants /stents / grafts are reimbursable in addition to package rates as per CGHS ceiling rates or as per actual, whichever is lower.

1.1.15 In case of beneficiary demands a specific Brand of Stent/Implant and give his consent in writing, the difference in cost over and above the ceiling rate may be charged from the beneficiary, which is non-reimbursable/not payable by BPA or Railway. This component will be shown distinctly in the bill for sake of transparency.

1.1.16 During In-patient treatment of the Railway beneficiary, the hospital will not ask the beneficiary or his/her attendant to purchase separately the medicines/ sundries/ equipment or accessories from outside and will provide the treatment within the package rate, fixed by the CGHS which includes the cost of all the items. However, the following items are not admissible for reimbursement /Payment by BCA/Railway.

Toiletries

Sanitary napkins

Talcum powder

Mouth fresheners

Diet charges for patient attendant/s

Telephone bills

Any other item as decided by Railway

1.1.17 In cases of conservative treatment / where there is no CGHS package rate -

(a) calculation of admissible amount would be done item wise as per CGHS rates (b) If there is no CGHS rate, the existing LAR of empanelment Hospital, SECR, Nagpur Division will be applicable.

Contd….4

….4…. (c) If there is no CGHS rate calculation would be done considering 30% discount on hospital rate of particulars items / procedures of that particular Hospital.

1.1.18 Package rates envisage up to a maximum duration of indoor treatment as follows :-

Up to 12 days for Specialized (Super Specialties) treatment Up to 7 days for other Major Surgeries Up to 3 days for Laparoscopic surgeries and 1 day for day care / Minor (OPD) surgeries.

However, if the beneficiary has to stay in the hospital for his/her recovery for a period more than the period covered in package rates, the additional bill amount may be allowed to the hospital, which shall be limited to accommodation charges as per entitlement investigations charges at approved rates, doctors visit charges (not more than 2 visits per day by specialties/consultants) and cost of medicines for additional stay). The circumstances for such extended stay should be supported by relevant medical records and certified as such by hospital. 1.1.19 No additional charge on account of extended period of stay shall be allowed if that extension is assessed to have been necessitated due to Hospital Acquired Infection (HAI), infection as a consequence of surgical procedure / faulty investigation procedures etc. The decision of Railway/BPA will be final in this regard. 1.1.20 The empanelled health Care Organization cannot charge more than CGHS approved rates when a patient is admitted with valid CTSE Card under non –emergency situation from the CTSE beneficiary. In case of any instance of overcharging the overcharged amount over and above CGHS rate (except inadmissible items and difference paid due to implant/stent of a specific brand chosen by CTSE beneficiary) shall be considered as unethical by the hospital and may lead to cancellation of contract. The same conditions apply for serving or other retired railway personnel and their family members whose name is included in Railway Medical Identity Card (MIC/RELHS). 1.1.21 “BPA” shall mean a Third Party Administrator authorized by Railway to process the medical bills raised by hospital or to carry out medical audit. 1.1.22 Medical Department of SECR/Nagpur has empanelled the (Name) ___________________________________________________________________hospital for CTSE scheme for all the specialities available in the Hospital. It shall also refer any of its beneficiaries for a treatment / procedure which is not available in-house at the local health institution of railway

Contd….5

….5….

1.1.23 For any interaction with Railway the hospital shall be interacting with the signing authority, or one of his authorized officers of this agreement. However a superior office of the signing authority may call for any report by the hospital. 2. DURATION OF AGREEMENT The Agreement shall remain in force for a period of 2 years or till it is modified or revoked, whichever is earlier. The Agreement may be extended for another year subject to fulfillment of all the terms and conditions of this Agreement and with mutual consent of both parties. Patients already admitted to the hospital during currency of MoU, will however, be continued to be provided treatment which shall be paid by Railway as per his MoU. 3. CONDITIONS FOR PROVIDING TREATMENT/SERVICES

A. GENERAL CONDITONS

The hospitals shall be empanelled for identified facilities/services available in

the health care organization as approved by CGHS.

The Hospitals shall investigate/treat the CTSE beneficiaries only for the emergency condition for which the patient has reported to them. Likewise the Railway beneficiaries referred by the Railway hospital shall be treated/investigated only for the condition referred. No undue/unnecessary investigation shall be done by the hospital. It is agreed that Railway beneficiaries shall be attended to on priority. For the smooth functioning of the scheme the Second part has agreed to have good speed internet connectivity, install appropriate card reader, finger print scanner etc. as specified by Railway/BPA. The Second Part shall also send its concerned employees for training/orientation organized by Railway/BPA to familiarize them with the provisions of the scheme. Medical Department, SECR/Nagpur has the right to monitor the treatment provided in the Private Hospitals. BPA shall provide training for the whole procedure of registering patient preparing clinical reports of patient and obtaining authorization of the treatment to the nominated hospital personnel. The process flows attached with this agreement is deemed to be an integral part of this Agreement.

Contd….6 ….6….

B. ADDITIONAL PROCEDURE/INVESTIGATIONS The hospital has been empanelled for emergency treatment of the CTSE beneficiaries. For any material/additional procedure/investigation other than the emergency condition for which the authorization was initially given, would require the permission of the competent authority. Likewise if Medical Department, SECR/Nagpur refers a patient whether CTSE beneficiary or any other of its beneficiary the treatment given should be confined to the condition for which the patient has been referred by the Railway Health Institution. Similarly for additional procedure / investigation other than the condition for which initial authorization was given would require permission of competent authority.

C. PROCEDURE WHERE A CTSE PATIENT REPORTING IN EMERGENCY NEEDS TREATMENT IN A SPECIALTY (s) WHICH ARE NOT AVAILABLE IN THE HOSPITAL.

The Hospital shall not undertake treatment of cases, reporting to them, in specialities which are not available in the hospital. But it will provide necessary treatment to stabilize the patient and transport the patient safely to the nearest recognized hospital under intimation to Railway Authorities. However, in such cases, the hospital will charge as per the CGHS rates only for the treatment provided.

D. CHANGES IN INFRASTRUCTURE/STAFF TO BE NOTIFIED TO RAILWAY

The Hospital shall immediately communicate to Railway Authorities about any change in the infrastructure / Shifting of premises of the hospital. The empanelment will be temporarily withheld in case of shifting of the facility to any other location without prior permission of Railway.

E. ANNUAL REPORT

The Hospital will submit an annual report regarding number of admitted CTSE beneficiaries, bill submitted to the Railway and payment received. Similar report for the referred patients/Railway beneficiaries treated by the hospital may also be submitted. Annual audit report of the hospital will also be submitted with the statement. The Hospital shall submit all the medical records in digital format.

F. MEETINGS

Authorized signatory/representative of the empanelled health care organizations shall attend the periodic meetings held by Railway required in connection with improvement of working conditions and for redressal of grievances.

Contd….7 ….7….

G. INSPECTIONS

During the visit by Railway officials, including BPA, the empanelled health care organization’s authorities will cooperate in carrying out the inspection.

H. NO COMMERCIAL PUBLICITY

The Hospital will not make any commercial publicity projecting the name of Railway or Government of India. However, the fact of empanelment under IRMS shall be displayed at the premises of the empanelled health Care Organization indicating that the charges will be as per CGHS approved rates.

4. TREATMENT IN EMERGENCY The following ailments may be treated as emergency which is illustrative only and not exhaustive, depending on the condition of the patient.

Acute Coronary Syndromes (Coronary Artery Bye-pass Graft / Percutaneous Transluminal Coronary Angioplasty) including Myocardial Infarction. Unstable Angina. Ventricular Arrhythmias, Paroxysmal Supra Ventricular Tachycardia. Cardiac Tamponade. Acute Left Ventricular Failure / Severe Congestive Cardiac Failure. Accelerated Hypertension. Complete Heart Block and Stoke Adam attack. Acute Aortic Dissection.

Acute Limb, Ischemia, Rupture of Aneurysm, Medical and Surgical shock and peripheral circulatory failure.

Cerebro - Vascular attack – Strokes, Sudden unconsciousness, Head injury, Respiratory failure, decompensated lung disease, Cerebro-Meningeal, Infections, Convulsions, Acute Paralysis, Acute Visual loss.

Acute Abdomen pain. Road Traffic Accidents/ with injuries including fall. Severe Haemorrhage due to any cause. Acute poisoning. Acute Renal Failure Acute abdomen pain in female including acute Obstetrical and Gynecological

emergencies. Electric shock. Any other life threatening condition.

In emergency the hospital will not refuse admission or demand an advance payment from the beneficiary or his family member and will provide credit facilities to the patient whether the patient is a serving employee of Railway/Retired employee or pensioner availing CTSE facilities, on production of a valid Railway Medical Identity Card/ RELHS Card. The refusal to provide the treatment to bonafide Railway Beneficiaries in emergency cases on credit basis without valid ground, would attract disqualification for continuation of empanelment.

Contd….8

….8…. In case of CTSE Beneficiary the nature and appropriateness of the emergency is subject to online verification, which may be verified, inspected or medically audited by the nominated authority on random basis at its own discretion.

The Hospital will intimate all instances of patients (CTSE beneficiaries/Railway beneficiaries) admitted as emergencies without prior permission to Railway authorities / BPA appointed by Railway within the prescribed time, preferably immediately. 5. ENTITLEMENTS FOR VARIOUS TYPES OF WARDS CTSE and other Railway beneficiaries are entitled to facilities of private, semi-private or general ward depending on their pay drawn in basic pay/basic pension. These entitlements are amended from time to time and the latest order in this regard needs to be followed. The entitlement at present is as follows :- (Photo copy of RELHS Card in case of CTSE and Retired Railway Employees / Current salary slip for Railway Employees is to be submitted).

SN Basic pay (7th Pay Commission) Entitlement 01 Up to Rs.47,600/- General Ward 02 Rs.47,601/- to 63,100/- Semi-private ward 03 Rs,63,101/- and above Private ward

The CTSE Identity Card will have the entitlement of the patient endorsed. The website shall also be indicating the entitlement at the time of reporting the admission to the Railway and BPA. For the patients referred by railway the entitlement of ward shall be endorsed on the referral letter itself.

a. Private ward is defined as a hospital room where single patient is accommodated and which has an attached toilet (lavatory and bath). The room should have furnishings like wardrobe, dressing table, bed-side table, sofa-set, carpet etc. as well as a bed for attendant. The room has to be air-conditioned.

b. Semi-Private Ward is defined as a hospital room where two to three patients are accommodated and which has attached toilet facilities and necessary furnishings.

c. General ward is defined as a hall that accommodation four to ten patients.

Contd….9

….9…. Treatment, in higher category of accommodation than the entitled category is not permissible for payment by Railway or reimbursable. If the patient or his/her attendant opts for a higher class than admissible under extent rules mentioned above (Para 5), as modified from time to time, the difference in cost of treatment including room charges, procedure and treatment cost, investigations etc. would have to be borne by patient’s representative. A written declaration to the effect should be taken before such change is carried out and it can be collected from the patient or his / her representative directly by the hospital. This should be indicated distinctly in the bill raised in the interest of transparency.

6. APPROVED RATES TO BE CHARGED

6.1 The empanelled health care organization shall charge from the Railway beneficiary as per the rates for a particular procedure / package deal as prescribed by the CGHS and attached as Annexure (rate list) which shall be an integral part of this Agreement. The rates notified by CGHS shall also be available on web site of Ministry of Health & Family Welfare at http//msotransparent.nih.in/cghsnew/index asp.

6.2 The package rate will be calculated as specified in the tender document. No other additional charge on account of extended period of stay shall be allowed if, that extension is due to infection as a consequence of surgical procedure or due to any improper procedure and is not justified. The decision of Railway will be final in this regard.

6.3 The procedure and package rates for any diagnostic investigation, surgical procedure and other medical treatment for Railway beneficiary under this Agreement shall be as per the latest CGHS rate applicable for the city of NAGPUR during validity period of this Agreement. The empanelled health care organization agrees that during the In-patient treatment of the Railway beneficiary, the Hospital will not ask the beneficiary or his attendant to purchase separately the medicines/sundries/equipment or accessories from outside and will provide the treatment within the package deal rate, fixed by the CGHS which includes the cost of all the items. Appropriate action, including removal form RAILWAY empanelment and / or termination of this Agreement, may be initiated on the basis of a complaint, medical audit or inspections carried out by Railway teams / appointed BCA. The hospital shall agree to charge CGHS rates to Railway Employees / Pensioners on production of valid I-Card / Documentary proof, even though treatment is not sought as Railway beneficiary. 7. MODE OF PAYMENT FOR TREATMENT OF BENEFICIARIES There shall be three classes of patients.

- CTSE Beneficiaries reporting to Hospital directly. - Railway Beneficiaries referred by Railway Hospitals to the empanelled

hospital. - Railway Beneficiaries (other than CTSE members) reporting to Hospital

directly. Contd….10

….10…. In respect of the CTSE beneficiaries for emergency authorized or otherwise treatment / procedures the services shall be undertaken / provided on credit. No payment shall be sought them (except for the initial deposit as advised by the Railway time to time) and the bills should be submitted to the BPA and Office of the CMS/SECR/Nagpur. The detailed process flows for both situations are contained in annexes (Annexure ‘E’ – 1.1). For the railway beneficiaries referred by Railway Hospitals to the empanelled hospital the bill shall be processed departmentally. The bill shall be submitted in triplicate to Chief Medical Superintendent, S.E.C. Railway/Nagpur on monthly basis (as per DOD) with all necessary enclosures viz, the detailed bill for the total period of treatment (date wise), discharge summary, original referral letter of Chief Medical Superintendent, S.E.C. Railway/Nagpur undertaking from the employee for the treatment undergone Copy of Railway Medical Identity Card for employee and RELHS (Retired Employee Liberalized Health Scheme) Card for retired employees, permission letter in original for procedures & costly medicine/out of package requirements, Package of costly items – Implants stents/Injections used for patients. The bill should be submitted within one month from the discharge of patient. Bills submitted after one month from the date of discharge will not be entertained. Railway Beneficiaries (other than CTSE members) reporting to Hospital directly, without any referral letter from Railway, shall be clearing their bills with the hospital themselves, Railway shall not be liable in any way for these bills. However the hospital agrees and undertakes to make the bill as per CGHS rate or hospital rate, whichever is lower.

8. BILLS PROCESSING AGENCY (BPA) Bill Processing Agency (BPA) would charge a processing fee @ 2% of claimed amount and service tax thereon with a minimum of Rs. 12.50/- and maximum of Rs. 750/- per bill. This amount shall be deducted from the payable amount to the hospital by Railway while making payment to the hospital and the same shall be paid to the BPA by Railway. Railway reserves the right to revise these charges from time to time in case of revision by CGHS or even otherwise. 9. NOTIFICATION OF NODAL OFFICERS Empanelled health care organization shall notify two Nodal Officers for Railway beneficiaries, one of them being of the rank of Depute Addl.CMS, who can be contacted by Railway beneficiaries in case of any eventuality. Their names and contact details will be notified on web-site.

Contd….11

….11…. Likewise Railway shall notify at least two Medical Officers to authorize the emergency treatment for the patients admitted in the Hospital and other administrative works for which the hospital can contact these Officers. Their names and contact will be displayed on website. 10. INFORMATION TO BE PROVIDED TO THE BPA BY HOSPITALS OF EMERGENCY ADMISSIONS For CTSE Card holder :- The Hospital will intimate to the BPA and to Railway within two (2) hours during day time and 4 (four) hours during night time of such admission through the website maintained for the purpose. The identity and eligibility of the patient as CTSE beneficiary shall be confirmed on the website immediately. The authorization for emergency treatment shall be given or denied by the concerned railway Medical Officer within 24 hours of the clinical report being submitted by the hospital. Treatment in no case would be delayed or denied for the reason that authorization by Railway is not forthcoming. The workflow in respect of such patient is attached with this agreement in annexes. Post discharge, the hospital would upload bills and other documents as per requirement of Railway and BPA within seven days. For Railway Beneficiaries holding Medical Identity Card / RELHS Card :- The bills should be submitted in physical form to Chief Medical Superintendent, S.E.C. Railway/Nagpur on monthly basis. (as per date of discharge, PART BILLS FOR THE MONTH WILL NOT BE ACCEPTED) within one month of the date of discharge. The bills sent one month after discharge will not be entertained, with the exception that Competent Authority (CMS/SECR/NGP) decision will be final.

11. SUBMISSION OF BILLS TO BILL PROCESSING AGENCY In case of CTSE beneficiaries, where credit bills are to be sent to Railway, the Private Empanelled health care Organizations shall submit the electronic bill to the Bill Processing Agency and physical bill to the concerned CMS office for processing of bills. In case of Referred patients where credit bills are to be sent to Railway, the Private Empanelled health care Organizations shall submit the physical bill to Chief Medical Superintendent, S.E.C. Railway/Nagpur.

12. PROCESSING OF CLAIMS/BILLS BY THE BPA

For CTSE Beneficiaries :-

The Hospital shall be expected to upload the bill, on the website, for a particular episode within 7 days of the discharge of the patient.

Contd….12

….12…. Bill Processing Agency (BPA) shall put up a scrutinized statement of the bill within 15 days of submission of the bill by the hospital, as per the extant rules, raising objections if any, on the website. If the hospital has anything to state on the scrutinized statement than it will do so within 2 days, otherwise it will be presumed that hospital agrees with the scrutinized statement.

Once the BPA and hospital has come to an agreement on the amount of bill to be paid, BPA shall submit it to CMS/SECR/Nagpur office. The Hospital shall submit the physical copy of the corrected bill to CMS/SECR/Nagpur office which shall raise query/objections. If any, within 4 working days. After approval CMS/SECR/Nagpur office shall submit the bill to associate Accounts Department (within 15 working days of clearing of last query). Account Department will pass the bills and make the payment to the hospital and BPA within 15 working days. BPA fee is 2% of the amount of the bill raised by the hospital (minimum Rs. 12.50 and maximum Rs. 750).

Note :- The process flows charts in emergency situation, non-emergency situation, referred patients etc. attached as annexes to this agreement. The patient may be from some railway unit other than the agreement signing unit but the bill shall be cleared by the assigned Railway Health Institution and associate accounts department. If required the local accounts shall raise a debit note to the concerned railway accounts unit later.

Railway reserves the right to make recoveries, if any from future bills of hospitals as the case may be

For CTSE Card Holder :-

The BPA during the course of the auditing will restrict the claims as per CGHS rules and regulations BPA will also examine in terms of :

(a) Appropriateness of treatment including screening of patients records to identity unnecessary admissions and unwarranted treatments.

(b) Whether the planned treatment is shown as emergency treatment. (c) Whether the diagnostic, medical or surgical, procedures that were not

required were conducted by hospital including unnecessary investigations. (d) Maintaining database of such information of CTSE and railway beneficiaries

for future use. (e) Whether the treatment procedures have been provided as per the approved

rates and the packages. (f) Whether procedures performed were only those for which permission had

been granted or the patient was referred. The BPA shall record their findings and intimate the same to the Private Hospitals concerned with a copy endorsed to Railway authority of the city.

Contd….13

….13….

For Railway Medical Card / RELHS Card holder :- The necessary claim / bill will be processed by Office of Chief Medical Superintendent, S.E.C. Railway/Nagpur.

13. MEDICAL AUDIT OF BILLS There shall be a continuous Medical Audit of the services provided by the empanelled Private Hospital by railway or its nominated agency.

14. DUTIES AND RESPONSIBILITIES OF EMPANELLED HEALTH CARE ORGANIZATIONS

It shall be the duty and responsibility of the empanelled Hospital at all times, to obtain, maintain and sustain the valid registration, recognition and high quality and standard of its services and healthcare and to have all statutory / mandatory licenses, permits or approvals of the concerned authorities under or as per the existing laws.

15. NON ASSIGNMENT The empanelled Hospital shall not assign, in whole or in part, its obligations to perform under the agreement, except with the Railway’s prior written consent and its sole discretions and on such terms and conditions as deemed fit by the Railway. Any such assignment shall not relieve the Hospital from any liability or obligation under this agreement. 16. EMPANELLED HEALTH CARE ORGANIZATION’S INTEGRITY AND OBLIGIATONS DURING AGREEMENT PERIOD The empanelled Hospital is responsible for and obliged to conduct all contracted activities in accordance with the Agreement using state-of-the-art methods and economic principles and exercising all means available to achieve the performance specified in the Agreement. The Hospital is obliged to act within its own authority and abide by the directives issued by the Railway. The Hospital is responsible for managing the activities of its personnel and will hold itself responsible for their misdemeanors, negligence, misconduct or deficiency in services, if any.

Contd….14

….14…. 17 PERFORMANCE BANK GUARANTEE (PBG) Health Care Organizations that are recommended for empanelment after the initial assessment shall also have to furnish a Performance Bank Guarantee worth Rs. 2 Lakh (Rupees Two lakh) only valid for a period of 30 months i.e. six months beyond empanelment period to ensure efficient service and to safeguard against any default (PBG for charitable Organizations would be 50% of above amount). In case of single specialty hospital it PBG shall be worth Rs. 50,000 (Rupees Fifty thousand) only. 18. FORFEITURE OF PERFORMANCE BANK GUARANTEE AND REMOVAL FROM LIST OF EMPANELLED ORGANIZATIONS In case of any violation of the provisions of the MOA by the health care Organizations empanelled under Railways such as

1. Refusal of service 2. Undertaking unnecessary procedure. 3. Prescribing unnecessary drugs/test 4. Over billing 5. Reduction in staff / infrastructure / equipment etc. after the hospital has been empanelled. 6. Non submission of the report, habitual late submission or submission of incorrect data in the report. 7. Refusal of credit to eligible beneficiaries and direct charging from them. 8. If not recommended by NABH/NABL/QCI at any stage. 9. Discrimination against Railway beneficiaries vis-à-vis general patients. 10. De-empanelment by CGHS/ECHS/ESI. The amount of Performance Bank Guarantee will be forfeited and the Railway shall have the right to de-recognize the health Care Organization as the case may be Such action could be initiated on the basis of a complaint, medical audit or inspections carried out by Railway teams at random. The decision of the Railway will be final. 19. LIQUIDATED DAMAGES

The Hospital shall provide the services as per the requirements specified by the Railway in terms of the provisions of this Agreement. In case of initial violation of the provision of the Agreement by the Hospital such as refusal of service or direct charging from the CTSE beneficiaries (and referred patients) or defective service and negligence, the amount equivalent to 15% of the amount of Performance Bank Guarantee will be charged as agreed Liquidated Damages by the Railway, however, the total amount of the Performance Bank Guarantee will be maintained intact being a revolving Guarantee.

Contd….15

….15….

In case of repeated defaults by the Hospital the total amount of Performance Bank Guarantee will be forfeited and action will be taken for removing due Health Care Organization from the empanelment of Railways as well as termination of this Agreement.

For over-billing and unnecessary procedures, the extra amount so charged

will be deducted from the pending / future bills of the Hospital and the Railway shall have the right to issue a written warning to the Health Care Organization not to do so in future. The recurrence, if any, will lead to the De-recognition from Railway.

20. TERMINATION FOR DEFAULT The Railway may, without prejudice to any other remedy for breach of Agreement by written notice of default sent to the Hospital terminate the Agreement in whole or part. 20.1 If the empanelled Hospital fails to provide any or all of the services for which it has been empanelled within the period (s) specified in the Agreement or within any extension thereof if granted by the Railway pursuant to Condition of Agreement or if the Health Care Organization fails to perform any other obligation (s) under the Agreement. 20.2 If the hospital in the judgment of the Railway has engaged in corrupt or fraudulent practices in competing for or in executing the Agreement. 20.3 In case of any wrong doings as specified in Memorandum of Agreement by one hospital Railway reserves the right to remove all empanelled hospitals of that particular group from its empanelled list of hospitals. 21. INDEMNITY The empanelled Hospital shall at all times, indemnify and keep indemnified Railway / the Government and BPA against all actions, suits, claims and demands brought or made against it in respect of anything done or purported to be done by the Health Care Organization in execution of or in connection with the services under this Agreement and against any loss of damage to Railway / the Government in consequence to any action or suit being brought against the Railway/the Government along with (or otherwise), Health Care Organization as a Party for anything done or purported to be done in the course of the execution of this Agreement. The Health Care Organization will at all times abide by the jobs safety measures and other statutory requirements prevalent in India and will keep free and indemnify the Railway from all demands or responsibilities arising from accidents or loss of life, the cause or result of which is the Hospital negligence or misconduct.

Contd….16

….16…. The Health Care Organization will pay all indemnities arising from such incidents without any extra cost to Railway and will not hold the Railway responsible or obligated Railway/ the Government may at its discretion and shall always be entirely at the cost of the Health Care Organization defend such suit, either jointly with the Health Care Organization enter or singly in case the latter chooses not to defend the case. 22. ARBITRATION If any dispute or difference of any kind whatsoever (the decision whereof is not herein otherwise provided for) shall arise between the Railway and the Hospital, upon or in relation to or in connection with or arising out of the Agreement, shall be referred to for arbitration by the CMD of the SECR who will give written award of his decision to the Parties. The decision of the CMD/SECR will be final and binding. The provisions of the Arbitration and Conciliation Act 1996 shall apply to the arbitration proceedings. The venue of the arbitration proceedings shall be at the city of CMD office i.e. CMD/SECR’s office/Bilaspur.

23. MISCELLANEOUS 23.1 Nothing under this Agreement shall be constructed as establishing or creating between the Parties any relationship of Master and Servant or Principal and Agent between Railway and the Health Care Organization. The Health Care Organization shall work or perform their duties under this Agreement or otherwise. 23.2 The Health Care Organization agrees that any liability arising due to any default or negligence in not represent or hold itself out as agent of the Railway. 23.3 The Railway will not be responsible in any way for any negligence or misconduct of the Health Care Organization and its employee for any accident, injury or damage sustained or suffered by any IRMS beneficiary or any third party resulting from or by any operation conducted by and on behalf of the Hospital or in the course of doing its performance of the medical services shall be borne exclusively by the hospital who shall alone by responsible for the defect and / or deficiencies in rendering such services. 23.4 The Hospital shall notify the Government of any material change in their status and their shareholdings or that of any Guarantor of the in particular where such change would have an impact on the performance of obligation under this Agreement. 23.5 This Agreement can be modified or altered only on written agreement signed by both the parties.

Contd….17

….17…. 23.6 Should the Hospital get wound up or partnership is dissolved, The RAILWAY shall have the right to terminate the Agreement. The termination of Agreement shall not relieve the hospital or their heirs and legal representatives from the liability in respect of the services provided by the Health Care Organization during the period when the Agreement was in force. 23.7 The Hospital shall bear all expenses incidental to the preparation and stamping of this agreement. 24. OTHER SERVICES TO BE PROVIDED The empanelled Private Health Care Organization will on the request of RAILWAY, agree to provide training to RAILWAY medical, Para-medical and nursing staff. 25. EXIT FROM THE PANEL The Rates fixed by the CGHS for the city of NAGPUR shall continue to hold good unless revised by CGHS. In case the notified rates are not acceptable to the empanelled health care Organization, or for any other reason, the health care Organization no longer wishes to continue on the list under Railway, it can apply for exclusion from the panel by giving one month notice. Patients already admitted shall continue to be treated as per agreed rates between the two parties. 26. NOTICES 26.1. Any notice given by one party to the other pursuant to this Agreement shall be sent to other party in writing by registered post or by facsimile and confirmed by original copy by post to the other Party’s address as below. Railway : Chief Medical Superintendent, S.E.C. Railway/Nagpur, Kamptee Road, In front of Gurudwara, PO – Bezonbagh, Nagpur – 440014 (MS). Hospital with address :- ___________________________________________________________ (Name) __________________________________________________________________

26.2. A notice shall be effective when served or on the notices effective date, whichever is later. Registered communication shall be deemed to have been served even if it returned with remarks like refused, left, premises locked etc.

Contd….18

….18….

IN WITNESSES WHEREOF, the parties have caused this Agreement to be signed and executed on the day, month and the year first above mentioned. Signed by Chief Medical Superintendent S.E.C. Railway/Nagpur For and on behalf of The President of India In the presence of (Witnesses) 1. ___________________________ 2. ___________________________

Signed by For and on behalf of ________________ Duly authorized vide resolution no. ________________ Dt. ____________ of ______________________________ In the presence of (Witnesses) 1. ___________________________ 2. ___________________________

***

Annexure – 1.1

Process Flow in empanelled hospital In a perceived emergency patient reports to empanelled hospital with new Plastic CTSE Photo-identity Card bearing Unique CTSE Card no. and deposit some money as per his/her the entitlement of ward. The CTSE card contains all relevant information in the form of barcode/QR code also.

As per instructions in the MoU the hospital logs on to the website maintained by M/S UTIITSL for the Cashless Scheme (CTSE). Hospital shall insert the card of the patient in card reader from which relevant details shall be automatically captured and sent to the site, digital finger printer of the patient shall also be sent. The site searches its database and confirms the identity and eligibility of the patient. (Backend UIDAI website shall be used). A contract mobile number shall also be recorded on website by hospital as given by patient/relative

Hospital prepares a clinical report of the patient within 4 hrs which is uploaded on the website. Immediately a SMS is received by the railway authorized medical officer for that hospital to check the clinical report. A SMS is also received by the patient that clinical report has been sent by hospital to the authorized medical officer along with Name of Railway doctor and his cell no.

If the case falls within defined emergency situation the AMO authorize the treatment on website. Patient receives SMS and Hospital gets online authorization

If the case does not fall within defined emergency situation, the AMO declines authorization and the hospital is advised to either send the patient to the railway hospital in ambulance or instruct the patient to report to railway hospital at a convenient time and date. The same information is delivered to the patient also through SMS simultaneously.

The patient is treated, initial deposit is refunded and discharge by the hospital. Online bill is submitted to M/s. UTIITSL which scrutinizes the bills, gets it corrected if necessary, and on being satisfied forwards it to Medical Department of Railway. Hospital submits the physical copy of bill to concerned CMS.

Hospitals raises the bill of investigations and treatment given till that time. After adjusting initial deposit (made by the patient) rest of the bill will be cleared by Railway. In case the patient choose to continue the treatment beyond this time, the entire bill for this subsequent duration will be paid by the Patient at rate decided in MoU.

After concurrence of Finance bill is paid to the hospital and the deducted amount of fees, as per agreed, rates is paid to M/s. UTIITSL

M/s. UTIITSL scrutinizes the bill. On being satisfied that minimum investigations were done to reach the diagnosis sends it to CMS office. The unnecessary investigations and treatment shall not be reimbursed. Rest of the steps, remain same. Note - Above procedure has been further explained in Annexure 2.

Annexure 1.2

Process flow in Non- Emergency without referral from AMA

(In such cases normally patient is expected to come to Railway Hospital. Under CTSE, this provision has been kept to cover the cases which mistakenly go to private empanelled hospital). Patient reports to empanelled hospital with CTSE card bearing Unique Card number

There are instructions that the hospital should log on to the websites maintained by M/S UTIITSL for the scheme. Hospital gives the Unique number of the patient. The site searches its database and confirms the identity and eligibility of the patient.

If it is obvious that patient is not suffering from any emergent medical condition, patient is advised to go to Railway Hospital at a convenient time. Otherwise after deposition of money (as per the entitlement) by patient, hospital shall admit and will do the essential investigations to reach the diagnosis. Once it is established that the patient is not suffering from any emergent medical condition, it will discharge the patient and instruct him to report to Railway hospital or send him to Railway Hospital in its ambulance. In such cases, hospital will retain the deposit as partial payment towards the bill.

M/S UTIITSL shall examine the bill raised by hospital, ensure that no superfluous investigations were done. The bill for the minimal investigation to arrive at the diagnosis shall be processed for payment by Railway.

Online and physical copy of M/S UTIITSL cleared bill shall be submitted to the CMS/MD/CMO office which, on being satisfied, shall forward it to associate account for vetting and payment to the hospital. If the card is registered in a different zone, then the Finance Department shall raise a debit note for internal accountal purposes. The M/S UTIITSL charges are 2% of the raised bill amount, minimum Rs. 12.50/- maximum Rs. 750/- plus Rs. 1/- per bill for SMS. This amount Rs. 1/- will be paid by Railway per bill.

Annexure - 1.3

Backend process flow for establishing the proposed system M/S UTIITSL uploads software to enable RELHS beneficiaries to apply for CTSE ID Card online. Links to this site are provided at all railway websites.

Personnel Department issues advertisements in newspapers and mass media inviting applications from RELHS beneficiaries for becoming a member of new Cashless Treatment Scheme in Emergency. A link shall be provided for online CTSE application at different Railway websites.

On receiving the completed application form along with copy of Aadhar Card, PPO and RELHS Card and Demand Draft for fee, Personnel Department will : 1. Validate the details 2. Authorize M/S UTIITSL to generate the new CTSE phto-identity card. 3. M/S UTIITSL will update the database (already containing name, age, date of retirement, last pay drawn etc.) with Aadhar nos. and other details, if missing 4. M/S ITIITSL shall issue the new Plastic Photo Identity Card to each beneficiary through speed post.

At the same time Medical Department will empanel all CGHS recognized hospitals (and if required more) throughout the country at nearest available CGHS city rates. Medical Department will enter into a detailed MoU with the hospitals defining emergency conditions and terms of payment.

M/S UTIITSL shall develop the software as per the treatment process flow defined under different headings. The site will use the database of ARPAN. Note - Personnel Department shall constantly update the database at ARPAN. The M/S UTIITSL database shall communicate periodically with ARPAN database and update itself.

As soon as the database is provided by Personnel Department to the M/S UTIITSL the scheme shall be launched. All beneficiary issued the new card, shall be able to use the cashless scheme, with immediate effect.

Annexure - 1.4

Process Flow In Emergency without Referral From AMA in Non-empanelled Hospital

Patient reports to non- empanelled hospital.

Since it is a non-empanelled hospital. Patient is treated and charged

After discharge patient claims reimbursement which is processed as per extant rules.

Annexure – 1.5

Process Flow for treatment where Railway beneficiary attends empanelled Hospital without his / her CTSE card

Patient reports to empanelled hospital without CTSE card

Patient reports that he/she is a CTSE beneficiary. Hospital asks for relevant number of the patient. Hospital logs on to the website maintained by M/S UTIITSL for the RELHS Cashless Scheme (CTSE), gives the relevant number and finger print of the patient. The site searches its database and confirms the identity and eligibility of the patient. (Backend UIDAI website shall be used). Note : In this scenario, it is essential to send the finger print of the patient and confirm identity at this stage itself, the process cannot be deferred.

Once the identity is confirmed, rest of the process remains the same as given in Annexure- 1. Note - In case authorization of the identity of beneficiary is not obtained, at the beginning itself, Railway will not foot the bill (Reimbursement can be claimed by the beneficiary later on as per Annexure 4). In exceptional circumstances, authorization may be allowed after some time of admission. In that case the patient will have to foot the bill till that time. The cashless billing cycle under this scheme shall start from the time of authorization.

Annexure – 1.6

Process Flow of Referral of Patients Patient reports to a Railway Health Institute. The Medical Officer (M.O.) feels that the patient needs medical attention at a private recognized hospital. The MoU with private recognized hospital has been signed by the CMS/MD of that Division/CH only

The MoU has been signed by some other Division or Central Hospital

After following due procedure for referral the referral letter is generated from the UTIITSL website and given to patient or the patient transported to the hospital (as the situation may be).

Following the due procedure for referral, referral letter is generated from the website. An e-mail is generated to the CMS/MD of the Division/ CH which has signed the MoU with Hospital. The CMS/MD of the referral unit also talks to the CMS/MD of MoU signing units telephonically and informs him of the referral .

Patient reports to the referral hospital, hospital cross checks the referral letter from the website and admit the patients.

Three copies of the referral letter are printed which states that referring unit shall accept debit note from the MoU signing unit. One copy is handed over to patient, one is sent to associate accounts and one is kept in CMS/MD record. The MoU signing CMD/MD has also received the copy of referral letter in e-mail.

Treats for the disease for which the patient has been referred

The patient report to the referral hospital. Hospital cross checks the referral letter from the website and informs the MoU signing CMS/MD through website of Patient reporting to the Hospital

Discharge the patient Treat the patient and discharge

Uploaded the bill at website Bill is uploaded on Website

Bill Clearing Process as described elsewhere

Cleared by MoU signing CMS/MD

Debit note is raised to the referral unit

ANNEXURE : 1.7 Escalation Matrix of SMSs in case of no response

Clinical report is received with SMS alert by AMO within 04 Hrs. of admission. He is suppose within next 20 Hrs. (Total 24 Hrs. of admission )

In case AMO fails to respond CMS will get an alert at 24 Hrs. of admission

In case of no response CMD will Get an alert at 36 Hrs. and AGM at 47 Hrs.

ANNEXURE : E

CGHS RATE NAGPUR

Sr. No. CGHS RATE PARTICULAR NAME OF THE WEBSITE

1. NAGPUR 2014 Rates are available at the website http//msotransparent.nih.in/cghsnew/indexasp

2. FEBRUARY 2015 3. SEPTEMBER 2015

ANNEXURE : F LAR

S.L. Name of items LAR

NON NABH NABH 1 Perianal Abcess 9450 10500

2 Incision & Drainage Intermediate 9450 10500

3 Incision & Drainage Major 10500 14000

4 Aspiration of Sup cold abscess 6480 7200

5 Anal Dialatation 4000 4589

6 I&D of Ischio Rectal Abscess 12825 14850

7 Strangulated Hernia 34200 38700

8 Thoracotomy For Major Procedure 55575 64200

9 Jejuno Jejunal 21375 24750

10 Duodeno Jejunal 21375 24750

11 Drainage of Liver Abscess 29925 34650

12 Biliary & Gastric Bypass 42750 50000

13 Duodenal band release 9166 10186

14 Nephropexy 8253 9170

15 Limited Decortication 12833 14259

16 Truncal Vagotomy 9166 10185

17 Cardiomyotomy + Fundoplication 10999 12222

18 Isthemectomy 7333 8148

19 Cervical Abscess 3000 3567

20 Cervical Abscess + Debridement 4500 5096

21 Submandibulor Gland Biopsy 4500 5096

22 SS Gland Stone Excision 5499 6111

23 SS Gland Abscess Drainage 4500 5096

24 Parotid Abscess 4500 5096

25 Choledochocyscectomy 14666 16296

26 Sigmoidopexy 10999 12222

27 Ceacopexy 7333 8148

28 Proctocolectomy 14666 16296

29 DT + Pleural Biopsy 8258 9176

30 DT + Lung Biopsy 9167 10186

31 DT + Lymphnode Biopsy 10999 12222

32 Staging Thoracoscopy 10999 12222

33 Empyema Drainage 10999 12222

34 Extensive Decortication 14500 16296

35 Foreign Body Oesophagus 11000 12222

36 Mediastinoscopy + Biopsy 14500 16296

37 Diagnostic Lapraoscopy + Biopsy Lymphnode (One)

9166 10185

38 Diagnostic Laprascopy + LN Biopsy (Multiple) 9166 10185

39 Diagnostic Laprascopy + Lymph N + Liver Biopsy (Multiple)

9166 10185

40 Diagnostic Laprascopy For post Op Complications

10999 12222

41 Diagnostic Laprascopy for Foreign Body 9166 10185

42 Spleenoraphy 10999 12222

43 Splenic Abscess 10999 12222

44 Choledochojejunostomy 10000 11204

45 Sigmoidectomy Benign 9166 10185

46 Sigmoidectomy Difficult 12000 14259

47 Sigmoidectomy Tumor 12000 14259

48 Cholecystoduodenal Fistula 11000 12733

49 Choledochocystojejunostomy 9166 10185

50 Desmoid Tumor Small 4500 5096

51 Desmoid Tumor Large 8253 9170

52 Divarification of Recti 5499 6111

53 Umblical Sinus 4500 5604

54 Fore Foot Amputation 7333 8148

55 Haematocele 5959 6622

56 Pyocele 4500 5096

57 ERCP+Stenting 17100 19800

58 ERCP Stent Removal 8990 9900

59 ERCP+Pancreatic Stenting 17955 20790

60 Intubation 945 1050

61 Open Biopsy Pleura Lung 26362 28500

62 Lobectomy Wedge, Segment/Lobe 40612 47025

63 Decortication Thoracotomy Ex Tumour 29212 33825

64 Diagnostic Pleural Aspiration 300 459

65 Percutaneous Lung Aspiration B 5500 6577

66 Bedside Bronchoscopy 3000 3976

67 Bronchoscopy with Biopsy 3500 4130

68 Pleural Biopsy 2700 3227

69 Pulmonary Exercise Testing 500 500

70 Bronchoscopy with TBNA 12000 13150

71 Radio Iodine TH Ablation 10 38250 42500

72 Radio Iodine TH Ablation 8 30600 34000

73 Radio Throid Ablation Therapy 25000 28475

74 Radio Iodine Th 10MCI W/o Scan 4500 5525

75 Radio Iodine TH 15 Ml W/o Scan 5500 6800

76 Radio Iodine Th 30m CI Scan 12000 15300

77 Radio Iodine Th 30 MCI Scan 13000 15300

78 Radio Iodine Th 30 M CI W/o Scan 11475 12750 79 RadioIodine Thy Ablation Dose1 15000 17850

80 M.R.C.P. 1912 2125

81 Endoscopy Sedation 3420 3960

82 Endoscopy +Banding 4275 4950

83 Endoscopy +Dilatation A 6412 7425

84 Endoscopy +Balloon Dilatation 11115 12870

85 Endoscopy+Gastric Balloon Dilatation 11115 12870

86 Gastric Polypectomy 10260 11880

87 Endoscopic APC 11115 12870

88 Endoscopy +Gastropathy Banding 5985 6930 89 Endoscopy+PEG 8122 9405

90 Emergency Endoscopy 7695 8910

91 Emergency Endoscopy Banding 10260 11880

92 Small Bowel Endoscopy 5557 6435

93 Side Viewing Endoscopy 7695 8910

94 Intra Operative Endoscopy 8550 9900

95 Endoscopy+Injection Therapy of Ulcer 7267 8415

96 Endoscopy+Nj Tube+Ryles Tube 7195 7920

97 Endoscopy +Dye Injection 3847 4455

98 Endoscopy Hydatic Cyst Alcohol Inj 5985 6930

99 Endoscopic Clip 10260 11880

100 Colonoscopy 3420 3960

101 Colonoscopy +Sedation 4275 4950

102 Colonoscopic Polypectomy 7695 8910

103 Colonoscopic Hot Biopsy 4322 5005

104 Colonoscpoic Balloon Dilatation 11115 12870

105 Colonoscopic APC 12825 14850

106 Colonscopic Clip 8550 9900

107 Colonoscopic Sems 11115 12870

108 Central Line 2565 2970

109 Enema 171 198

110 Exchange Transfusion 196 227

111 Harvesting 21375 24750

112 Plasma Exchange 4275 4950

113 Plasma Exchange Procedure with Kit 17100 19800

114 Post Operative Epidural Analgesia 427 495

115 SDP Transfusion 855 990

116 Steam Inhalation 85 99

117 Endosono Diagnostic+Anaesthesia 6840 7920

118 Endosono FNAC+Anaesthesia 21375 24750

119 Endosono Cystogastroscopy+GA 29925 34650

120 Chemotherapy Adult 2137 2475

121 Chemotherapy Child 1710 1980

122 Chemotherapy IV 1410 1633

123 Chemotherapy IV & Intra Thecal 2992 3465

124 Disphosehamide Therapy 470 544

ORTHOPEDICS 125 Dressing Major 403 403

126 Putti Platt Reconstn of shoulder

26362 30525

127 Trigger Thumb 14961 17325

128 Condylar Plating D.C.S. 22800 26400

129 Patellectomy 34912 40425

130 Club Foot Release ( Bilateral) 30400 35200

PLASTIC SURGERY 131 Simple Z Plasty Any Where 16387 18975

132 Z plasty -Scar Excision Without Skin graft 24937 28875

133 Simple Scar Face 16387 18975

134 Complicated Scar Face /Multiple Scars 39187 45375 135 Microsurgical Repair of wounds 30637 35475

136 Microsurgical Free Flap+skin graft& Others 28000 51975 137 Face mole or cyst excision 13537 15675

138 Ear Reconstruction 30637 35475

139 Contracture Release +skin Graft Finger 25250 38775

140 Contr Release +Skin Graft more Fingers 39187 45375

141 Other Contractures 39187 45375

142 Contr. Release with flap& skin graft 30637 35475

143 Vas Recanalisation (Magnification) 24937 28875

UROLOGY & NEPHROLOGY

144 DJ Stenting 7560 8400

145 Endoscopic Removal of Urethral Stone 14962 17325 146 Endoscopic Ventro Suspension for Stress 19237 22000 147 Trochar Cystostomy 12112 14025

148 Ureteroscopy Diagnostic 12112 18975

149 Removal of D.J. Stent 9975 11550

150 Basketing 16387 18975

151 Heparin Free Dialysis 2520 2800

EYE 152 ILM Peeling 5985 6500

153 C3 F8 (Perfluropropane gas) 5652 6200

154 PFCL Injection(Perflurocarbon) 4322 5000

155 Endo Laser(EL) 5652 6500

156 FGE 4322 5000

157 ERM Removal 4322 5500

158 TSC (Cryo) 4322 5500

159 Membrance Peeling(MP) 4322 6000

160 Mitomycin C ( MMC) 1296 1500

161 Tricort Injection 3458 4500

162 Lasik Surgery 14535 16300

163 Argon Diode Laser Suture Lysis 1463 2300 164 Argon Laser Diabetic Maculopathty 1463 1640

165 Argon Laser Other Macular Diseases 1463 1640

166 Argon Laser Lattice & Holes Photocoagulation 1463 1640

167 Argon Laser Pupiloplasty ( Each sitting) 1862 2500

168 Argon Laser Iridoplasty ( Each Eye Per) 1862 2500

169 Corneal Tissue Processing Charges 2527 3660

170 Color Vision Check 232 350

171 Diode CPC Procedure 2527 3000

172 Punctal Cautery 232 350

173 Trans Conjunctival Cryotherapy 1662 2000

174 Yag Laser Anterior Surface IOL Cleaning 1662 2000

175 Yag Laser Treatment of Ant. Flap./Contration 1662 2000

176 Removal of cortex 5685 6500

177 Synecholysis 5685 6500

178 Conj Autografting 4987 6500

179 Conj Hooding 3657 4500

180 Conjuctival Resection 3657 4500

181 Limbal Allograft 10972 11550

182 PK /LK/Patch Graft 15960 16800

183 Pterygium with conj Graft 5685 6500

184 Conjuctival Patch G ( Autograph) 6650 7000

185 Endonasal DCR 15295 17100

186 Exploration Orbit 25000 32200

187 LID Reconstruction Minor 6650 8000

188 LID Recontruction –Major 27930 29400

189 REV Ptosis 6317 7000

190 REV of Scar-Minor 4322 5000

191 REV of scar-Major 8312 9750

192 Unilateral Rectus Recession & Resection 7980 8500

193 Vertical Recti Surgey 15960 17800

194 Band Cutting 4987 6250

195 Choroidal Tap 4322 4750

196 Endo laser Photo Coag 4322 5000

197 Open Cryo 3325 4500

198 AC Wash AC Reformation 2992 3700

199 Iridectomy (isolated) 2660 2800

200 Vitrectomy +Endo Laser Endoidathermy+FGE 39900 45000

201 Vitrectomy+Endolaser+Endodiathermy+Silicon Oil 43225 48500

202 IOL Rem/Epinucl REM 18620 20600

203 IOL Repositioning 17290 19600

204 Alcon Constellation Pack(MIVS) 21280 30000

205 Lid Tumor Excision with Lid Reformation/Repair 10260 11800

206 Membrance Peeling (MP ) Membractomy) 4275 5500

207 Surgical Irdectomy 5248 6000

208 Major reconstructive Surgery 26362 29750

209 Tumor of Iris 22800 25000

210 Needling & Aspiration 16387 18250

211 Examination Under G.A 2422 3000

213 Cataract Extraction/Glucoma 22800 26000

214 Endolaser Surgery 6650 8000

215 BBG Staining 4655 5500

216 SRF Drainage 2422 3550

217 Endodiathermy 4322 5000

218 Endodrainge 3325 4000

219 Graft Implantation with Glue 6650 8500

220 Repositoning of Subluxated IOL 6650 8500

221 Ologen 3325 4000 222 SF6/SFU 1000 1150

223 Cost of Avastin 6650 7800

224 Synoptophore exercise (for one week) 400 525

225 Air Injection 2018 2400

226 Anterior Stromal Puncture 4037 4600

227 C/L Corneal Evalluation Charges 2422 2800

228 C3 R Collagen Cross Linking/per Eye 13727 14800

229 Corneal Tear Repair Large 16150 18500

230 Corneal Tear Repair-I 12112 14750

231 Corneal Scleral Tear Repair-II 20591 24500

232 Fluorescein Staining 80 100

233 Gunderson FLAP 6460 7800

234 Intac-per Eye 80750 85000

235 Kerarings Each Eye 58140 61200

236 keratoconus investigations 1292 1460

237 Lasik workup 600 700

238 Penetrating Keratoplasty-DLX 20995 23100

239 Punctal Surgical Closure 1615 1800

240 Relaxation compression suturing 3633 4000

241 Schirmmers Test 120 150

242 Chemical Injury First Aid 1008 1150

243 Conjunctival Suturing level-II 1615 1850

244 Conjunctival Suturing Level-III 3633 4250

245 EUA-Fundus 2018 2800

246 Pupilloplasty 8075 9500

247 Supratarsal Steroid Injection 1211 1400

248 Synechiolysis 2826 3500

249 Yag PI 1211 1400

250 Three SNIP ( per Eye) 2422 3000

251 Evisceration and reconstruction Level - 2 16180 18500

252 Fine Needling aspiration Biopsy 4037 5000

253 Lacrimal Sac Abscess Drainage 1615 1800

254 Laser DCR 10013 11500

256 Tumour Debulking 6460 7800

257 Xanthalesma Excision 6460 7800

258 silicon oil injection 1275 3500

259 IOL Explantation 12112 14000

ENT

260 Ethimoidectomy 16387 18975

261 Fracture Nasal Bones 14250 16500

262 I&D of Thyroglossal Cyst 12112 14025

263 Nasal Cautery 10687 12375

264 Pre Auricular Sinus-Unilateral 10000 10000

265 Pre Auricular Sinus Bilateral 14962 17325

266 I&D of Par Pharyngeal Abscess 12112 14025

267 I&D Tonsillar Abscess 12750 14025

NEURO SURGERY

268 Craniotomy Craniopharyngioma 28642 33825

269 Craniotomy Cysts 28642 33825

270 Craniotomy Acoustic Neuroma 28000 38000

271 Operation for canal stenosis(Lumbar) 32062 35000

DENTAL & PERIODONATAL SURGERY

272 Ceramic Crowns 2660 3500

273 Dual Cure Fillings 1330 2000

274 Ultrasonic Scaling 1330 1750

275 Root Canal Treatment with Endomotor 2660 3500

276 Periodontal Bone Graft 1330 1700

277 Post and Core 1995 2275

278 Laser operculectomy 3325 3500

279 Periodontal Abcess 1330 1575

280 Extraoral Abscess 2660 4200

281 Smoothening of sharp edges 133 210

282 Cement -Zine Phosphate -Lining and filling 213 336 283 Silver Filling Simple Filling 342 500

284 Complex 684 910

285 Indirect pulp capping by light cure with calcium base material per tooth

984 1000

286 Glass Inomer restoration type-II Glass inomer cement filling

342 540

287 Type IX Glass inomer Cement filling 684 1050

288 RVG Dental X.Ray 85 135

289 Sub Gingival Scaling 855 1190

290 Gingival Curettage(per Quadrant) under Local 855 1330

PERIODONTAL SURGERIES

291 Periodontal Surgery for deep pocket with willman techique per Quadrant by specialist M.D.S.( perido) Bone Extra

3420 4200

292 Periodontal Surgery for deep pocket with willman techinque full mouth by specialist M.D.S. ( Perio) Bone Exta

11970 12000

293 Gingivoplasty Procedure under local anesthesia per tooth

698 910

294 zinc Oxide Eugenol-Dressing of tooth 171 270

RADIOLOGY CHARGES

295 USG Charges ( Bed side) 600 600 296 CT Spleenoporto Venography 5000 6000 297 CT Facial Bone 3000 3750 298 CD Charges 150 150 299 3D Reconstuction 1500 3750 300 CT Urography 4000 5300 301 CT ABD+Midthigh 5000 5625 302 CT Chest+Midthigh 3075 3075 303 CT Hip Joint 3000 3750 304 MRI Veneography 1800 2200 305 MRI Spinogram 800 1100 306 MRI Diffusion 2000 2250 307 MRI-I 4000 4500 308 MRI T.L. Spine 2500 2500 309 MRI Cisternography 4000 4500 310 USG Chest 500 600 311 USG Skull 500 600 312 Colour Doppler Both Limbs 1660 1660 313 Digital X.Ray On Mobile 150 150 314 Digital X.Ray Chest 63 63 315 Digital X. Ray KUB 150 150 316 Digital X. Ray C.S. Spine 220 275 317 Digital .X. Ray L.S. Spine 220 275 318 Digital X. Ray D.L Spine 220 275 319 Digital X. Ray Thoracic Spine 220 275 320 Digital X. Ray Dorsal Spine 220 275 321 Digital X. Ray Elbow 175 220 322 Digital X. Ray Femur AP-LAT 200 247 323 Digita X.Ray Forearm AP-LAT 200 247 324 Digital X.Ray Hand AP LAT 200 247 325 Digital X.Ray Heel AP LAT 270 270 326 Digital X. Ray Hip JT 125 165 327 Digital X. Ray Hip Jt Both Side 275 300 328 Digital X. Ray Humerus 200 200 329 Digital X.Ray Both Knee 375 440 330 Digital X. Ray LEG AP-LAT 200 247 331 Digital X.Ray Mandible 125 150 332 Digital X.Ray Mastoid 125 150 333 Digital X.Ray Nasal Bone LAT 125 128 334 Digital X. Ray Patella AP-LAT 225 250 335 Digital X.ray Pelvis 150 150 336 Digital X. Ray PNS 128 128

337 Digital X.Ray Shoulder AP 130 150 338 Digital X. Ray Tibia AP-LAT 175 220 339 Digital X.Ray Wrist AP-lAT 175 220 340 Digital X.Ray Wrist for Bony Age 175 220 341 Digital X.Ray Coccyx AP-LAT Sacrum 175 270 342 X.Ray Facial Bone 175 270 343 Digital X. Ray Facial Bone 175 270 344 Digital X.Ray Foot AP Obliq 175 270 345 Digital X. Ray Whole Spine 250 800 346 Digital X. Ray Neck 230 275 347 X.Ray Mandible AP LAT 250 300 348 Nephrostogram 1500 1500 349 Renal Doppler 828 828 350 3D CT Any region 3000 3750 351 3D Scan Anamoly 886 886 352 4D 30 Wks Anamoly 2000 2550 353 4D Anamoly L II (18-22 wk) 2000 2550 354 4D Anamoly Scan 2000 2550 355 4D Sonography 2000 3000 356 Brain Scan C GHA/DTPA(Planar) 3500 4080 357 C.T. 3D Joint 3000 3750 358 C.T. 3D Shoulder Right/Left 3500 3750 359 C.T. Angio Neck+Brain 5000 7650 360 C.T. Arthography Whole 7500 7500 361 C.T. Bone Densitometry ( 1 Side) 1377 1530 362 C.T. Brain+Petrous 2000 2550 363 C.T. Calcium Scoring 3825 4250 364 C.T. Cervical With CV Junction 3000 3000 365 C.T. Chest ( Bronchoscopy) 3000 3200 366 C.T. Contrast Charges 500 500 367 C.T. Foot with 3D Recon 3500 3750 368 C.T. Limited Body 2295 2550 369 C.T. Limited HNF 1900 2126 370 C.T. Myelogram(One Part) 3000 3500 371 C.T. Pelvis with 3D Reconstuct 3000 3750 372 C.T. PNS Axial & Coronal 3250 3250 373 C.T. Renal Angiography 5000 6325 374 C.T. Scanogram 1000 1275 375 C.T. Urography 4000 5500 376 C.T. Virtual Colonoscopy 4500 5000 377 Colo Doppler Peripheral Double 1800 2000 378 Colo Doppler Peripheral Single 900 1000 379 Contrast Brain(Non-Ionic) 100 170 380 Contrast Charges(Brain) 200 200 381 Contrast Charges(Non-Ionic) 450 510 382 Gastric Emptying Study(Solid) 3825 4250 383 Gastric Emptying Study 3825 4250 384 Gastric Emptying Study(Liquid) 3825 4250 385 Gastrograffin Meal with Cont. 350 425 386 Gastrograffin Swallow(W. Cont) 250 318.5 387 Hypotonic Duodenography 750 850 388 I.V.P. Contrast Charges 700 700 389 Lumbar Myelogram Contrast extra 700 700

390 Maternal Screen Quadraple USG 2500 3000

391 Maternal Screen Triple USG 2000 2000 392 MRI (Screening) Whole Spine 1150 1150 393 MRI Contrast Charges 2000 2000 394 MRI Face 3750 3750 395 MRI Venography 2200 3750 396 Neurosonography 600 600 397 Oesophageal Transit Scan(ROTS) 3500 4250

398 Peritoneal Scan 3000 4250 399 Trodat Scan 9945 11050 400 Tumor Scintigraphy 4500 5100 401 USG Screening Chest Thy ABD 400 500 402 USG Screening for ABD & Pelvis 400 450 403 USG Screening for lower abdo 290 350 404 USG Screening for Upper Abd 343 350 405 X.Ray Bone Test(VCA) 300 340 406 X.Ray for bony Age ( 2 views) 1500 1500 407 X.Ray Skull Spl. View (Stn Twn) 190 200 408 X.Ray Wrist(oblique) View 100 170 409 X.Ray(Emergency) 400 400 410 CT Myelography 2800 2800 411 CT Small Parts 1500 1500 412 CT any 1 region HRCT 3000 4000 413 CT Any screening Scan 1995 2300 414 USG 4D Scan 1496 1925 415 USG B Scan (Orbit) 1200 1200 416 MRI Spectroscopy 4000 6930 417 Colour Doppler LL Venous 1 side 638 822

418 Pelvimetry 128 148 419 X.Ray Pelvis Later View 150 150 420 Follicular Study(four Day) 1000 1000 421 Fluroscopy Guided Proc(Disp. Extra) 3200 3714 422 Ultrasound Chest 500 500 423 Trans Rectal Ultrasound 750 800 424 Barium Enteroclysis (Conventional) 2500 2500

425 Fluoroscopy 450 525 426 Gastrografin Swallow 1500 1789 427 TIFFA Scan 1282 1425 428 TVS Biopsy 2300 2972 429 Ultra Sound Neurosonogram 600 700 430 Myelogram 2000 2000 431 IVP with Non-Ionic Contrast 1400 1400 432 CT Scan Emergency Charges 500 700 433 CT Facial Bones 3500 3750 434 Contrast-Non-Ionic (100 ml) 1500 1500 435 Radiology-Disposables (Cat-II) 1000 1425 436 CT Cisternography 2500 3500 437 CT Scan ( Extra Film) 300 300 438 CT Spine(Plain& Contrast) 4000 4000 439 CT Chest (Plain & Contrast) 3000 3000 440 CT High Resolution Chest( HRCT) 2904 3000

441 CT Brain Scan(plain & Contrast) 1900 2588 442 CT Joints 3000) 3500 443 CT Upper Abdomen(plain & Contrast) 4000 4000 445 Bronchography without contrast 1000 1224

446 ACE( Angiotensin Converting Enzyme) 769 891

447 Acute Hepatits Pannel 4132 4350 448 ADA 427 455 449 Alcohol 600 723 450 Anaerobic Culture 800 1000 451 Anion Gap 360 440 452 Anti LKM 750 850 453 Anti Endomysial Antibody 1900 2200 454 Anti GBM Antibody 1425 1500 455 Arthritis Profile 155 155 456 ASO 285 450 457 Basophils 66 70 458 Biopsy Large Body 200 200 459 Bone Marrow Trephine Biopsy 1425 1500 460 C3 Level 500 650 461 Cholinesterase 570 655 462 Chyluria 75 84 463 CK NAC 300 400 464 Clot Retraction Time 50 100 465 Clotting Time 40 43 466 Cytogenectics 4000 4000 467 Digoxin Level 450 536 468 Free T3 380 380 469 Free T4 380 380 470 Gamma Interferon 2850 3000 471 H1N1 4500 5525 472 HAM Test 350 408 473 HAV IgM 750 850 474 HBc IgM 750 850 475 HBeAb 459 510 476 HBeAg 702 781 477 HBsAb 600 765 478 HBV DNA PCR Qualitative 4000 4250 479 HBV DNA PCR Quantitative 5000 5916 480 HCV Ab 450 632 481 Hep E IgM 1147 1275 482 HEV IgG 1147 1200 483 HIV by card 285 300 484 HLAB 1662 1750 485 HPE Large` 1425 1500 486 HPE Medium 950 1000 487 IgM anti HBc 750 800 488 KLB 60 85 489 KOH Mount Fungus Smear) 60 85 490 LE Cells 80 100 491 Leptospira IgG 900 950 492 Leptospira Igm 900 950 493 Mantoux Test 100 132 494 Parasitic Index 80 150 495 Porphobilinogen 90 100 496 Protien E 3087 3250 497 PTTK 190 200 498 Rubella 665 700 499 Skin Cliping 142 150 500 Sputum Microscopy 100 100

501 Sr Oestrogen 380 400 502 Sr IgE Total 570 612 503 Toxoplasma 655 690 504 TPHA 150 150 505 Torch IgM 1200 1428 506 Urine Hemoglobinuria 332 350 507 Urine Myoglobinuria 54 61 508 Vibrio Cholera Culture 315 350 509 Widal Slide Test 114 120 510 Methaemoglobulin 486 540 511 Flowcytometry 5900 6840 512 Immunohistochemisty on Trephin Biopsy 1434 4750 5000

513 Chromogranin A 4819 5355 514 Weil Felix Reaction 650 941 515 BCR ABL Quantitative Assey 5180 5400 516 SCL 70 IgG Antibodies 2090 2200 517 BTK GNC & Lymphocyte Analysis 2470 2860

518 MDS Pannel 7524 7920 519 BNP 1520 1650 520 DVT Profile 5415 5700 521 Chickengunia IgM 600 765 522 17 Ketogenic Steroids(urine) 1100 1224 523 17-Hydroxy Ketosteroids urine 1500 1700 524 5 Hydroxy Indole Acetic Acid 918 1020 525 Acetyl Choline Receptor Ab. 2500 3570 526 AllergyT For Dust 1500 1785 527 Androsteindione 693 1428 528 Anti GBM Antibody 818 918 529 Anti HBc(Total Antibody) IgG 900 1020 530 Anti HBc (Total Antibody) IgM 900 1020 531 Anti LA 950 1275 532 Anti Microsomal Antibody 918 1020 533 Anti Smooth Muscle Antibody 1350 2500 534 Anticetromere AB 826 918 535 Antimitochondrial Antibody 596 663 536 ASCA-IgA 1530 1700 537 Bcr Abl (Philadelphia) 3213 3570 538 Bicarbonate 100 137 539 Blood for Iodine 6502 7225 540 Buccal Mucosa for Sex Chromos 90 102 541 Capillary Fragility 40 51 542 CD-45(RA) 1652 1836 543 Cold Agglutinins 137 153 544 Conjunctival Smear 120 120 545 Cryoglobulins 91 102 546 Cyclosporin Level (C2 Level) 1000 1836 547 Cysticercosis Antibody 252 765 548 Drug Sensitivity For AFB 400 510 549 ERPR Receptor 2000 2295 550 Factor V 4320 5000 551 Female Fertility Profile 841 935 552 Foetal Erythrocytes 40 51 553 Gliodin Antibody 1200 1360 554 HCV RNA Quantitative 5000 5000 555 Hepatitis 'C' Viral Load (HCV) 6150 6834

556 Hepatitis 'B' Core Antigen (HBc) 826 918 557 Her-2 1836 2040 558 HLA-A&B 4590 5100 559 HLA DR 4590 5100 560 HLA B27 Typing 1500 2040 561 HLA-B 5701 3825 4250 562 HLA-DR Percent 1292 1436 563 Immunoglobulin-D(Surface) 1300 1530 564 INHIBIN A 900 1020 565 INHIBIN B 1700 1938 566 Intrinsic Factor Antibody 1100 1275 567 Kappa Light Chains 1600 2040 568 Lambda Light Chains 1600 2040 569 Leptospirosis DNA Detection 1800 2125 570 Mullerian Inhibiting Substance 1200 1445 571 Mito Mutation Test 22000 24480 572 Mucopolysaccharides (MPS) Screen Quanlitative

Urine 459 510 573 Mumps IgM 1000 1190 574 N- Tellopeptide(Urine) 2000 2295 575 NMO Antibody 2200 2550 576 Pappa Pregancy Test 1000 1275 577 Parietal Cell Anitbody 1600 1870 578 Paul Bunnel test infectious monoucleosis test

Serum 200 263

579 PCR(CMV) 3200 3570 580 PCR Retrovirus (quantitative) 4131 4590 581 PFT (Complete) 472 525 582 ImmunoCap test 750 918 583 Protien Electrophoresis(Urine) 459 510 584 Quantative Est. HB -S 580 680 585 RO Titer 1100 1326 586 Rubella Antibody IgM/IgG 300 357 587 Serum ADH 2100 2550 588 Serum Gastrin 482 536 589 serum Lead 2937 3264 590 Serum Maganese Level 1600 1870 591 Serum Nicotin Level 900 1020 592 Serum PH 100 127.5 593 Stool (Clostridium Diffi. Toxina) 1600 1836 594 Tacrolimus Level 2600 3060 595 Theophylline 400 459 596 Thoracic Myelogram Contrast ex 1100 1275 597 Thyroid Stimulating Immunoglob 3200 3570 598 TSH Receptor Antobody LATS, TSI Serum 3400 3978 599 Typhi Dot IgM 400 450 600 Urinary Hydroxy Proline 1300 1530 601 Urine Calcium Oxalate 24 Hrs 1500 1700 602 Viral Load For HBV 2700 3060 603 Acetone Serum 684 720 604 ALK-1 1710 1980 605 ASA Total 598 693 606 Biopsy Phosphate Therapy 4275 4950 607 Blood &Blood Product 769 1210 608 Blood Components Fresh Frozen Plasma 439 509

609 Blood Components PRO 2034 2356

610 Blood Letting 256 297 611 Blood Transfusion 189 210 612 Blood Transfusion(FFP) 256 270 613 Blood Trasnfusion(PC) 256 270 614 Blood Transfusion(PRC) 256 270 615 Blood Trasnfusion(WB) 256 270 616 Dengue fever NS1 Antigen 600 600 617 BRAF V 600 5771 6682 618 EGFR 4916 5692 619 F 1P 121 PGDFR Assay 3847 4455 620 Factor Assay-Other Factor 1129 1308 621 Factor XIII 213 247 622 Faeces Examination 128 135 623 Fungal Culture 513 540 624 Gastric Aspirate for AFB Test 150 150 625 Gastro Intestinal Bleed Study with technetium 1349 2992 3465

626 Haemoglobinuria 171 180 627 Haemosiderin 114 127 628 Jak 2 5500 5500 629 L.E. Cell 65 69 630 MDS Panel 7524 8712 631 Methaemoglobin 560 649 632 Microfilaria Detection 100 133 633 Myeloma Panel by FISH 10500 11700 634 Myoglobin Urine 188 198 635 P.B. Test( Avitex) 384 445 636 Paul Bunnel Test 513 594 637 PH Chromosome (RO PCR) 5130 5400 638 PSA (Prostate Specific Antigen) ELISA 684 720

639 Rapid AFB Culture 359 416 640 Rapid Blood Culture 400 422 641 Stem Cell Transplantation 4275 4950 642 Urine for Fat-globule 80 80 643 Urine for RBC 80 80 644 Urine Metachromatic granules 60 70 645 Lactose intolerance 724 805 646 HBsAg Spot 180 200 647 HCV Spot 284 333 648 Brucella Latex Agglut 450 525 649 Double Lumen Sub Clavian Catheter 1436 1663 650 Hepa Filler 855 990 651 Infusion Pump 113 126 652 Plasma Filter 8550 9900 653 Pulse Oxymeter 110 126 654 Syringe Pump 110 126 655 C-Pap Machine per hour 138 154 656 Phototherapy 114 132 657 Exchange Transfusion flat Rate Each time 9061 9061 658 Pneumatic compression for knee 636 707 659 Alfa Bed 213 225 660 Nebulization Charges ( per day) 157 175

OBSTETRICS & GYNECOLOGY

661 Ant & Posterior Colporraphy 8550 9900 662 Wedge Resection of ovary 22087 25575 663 Hysterotomy with/without ligation 22800 26000 664 Cryosurgery 7837 9075

LAR ( MISC. )

665 Vac application 15000/- 15000/- 666 Pneumatic compression (

intermittent - Hand air gloves ) 1050/- 2000/-

667 CVP Catheterisation ) 1400/- 1750/- 668 Electro convulsive therapy (ECT) 2100/- 2500/- 669 Packed Red Cells (PRC) 1450 1450

670 Platelate Concentrate (PC) 400 400

671 Cryoprecipitate 250 250

672 NAT Testing charges for Blood 1000 1000

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