ESIC-Standard Operating Process for Online Bill Processing

May 24, 2019 | by Avantis RegTech Legal Research Team

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The Employees’ State Insurance Corporation (ESIC) on May 21, 2019, lays down Standard Operating Procedure (SOP) on referral generation by ESI Institutions and online processing of bills pertaining to empanelled hospitals or diagnostic centres. ESIC is providing comprehensive medical care facility to its beneficiaries and their dependents through ESIC or ESIS Hospitals & Dispensaries as well as empanelled hospitals & diagnostic centres. ESIC has decided to appoint a Bill Processing Agency (BPA) for processing the claims of empanelled hospitals or diagnostic centres and recommending the payment to be released. So, that the expenditure incurred on medical services provided by the empanelled hospital or diagnostic centre shall be paid by ESIC directly to the empanelled facility after the bill is processed by BPA. The BPA provides a transparent system for online referral generation and bill processing for scrutiny and processing of all bills (SST/Secondary/Investigations etc.) of empanelled hospitals or diagnostic centres for beneficiaries referred from ESIC Hospitals and bills for only super speciality treatment in case of ESIS hospitals.


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