Returned, reduced and rejected are different
A claim may be sent back for a missing document or clarification, may be admitted only partly because of applicable rates/non-payable items, or may be rejected because the treatment/expense is not admissible. Read the exact portal remark or written communication before deciding what to do.
Common reasons
- Emergency not established or 48-hour intimation not supported.
- Missing discharge summary, emergency certificate, prescription, investigation report, bill or receipt.
- Claim submitted outside the applicable time requirement without an accepted relaxation.
- Referral/authorisation missing where planned treatment required it.
- Mismatch in patient, card, bank or bill information.
- Duplicate/unreadable documents.
- Items or amounts not payable under applicable ECHS/CGHS rules.
What to do step by step
- Save the rejection/return remark exactly as shown.
- Match each remark to a document or factual issue.
- If it is a correctable deficiency, obtain the genuine missing document from the hospital/polyclinic and resubmit through the route instructed by ECHS.
- Keep the original Claim ID and proof of correction/resubmission.
- If the reason is not clear, ask the OIC Parent Polyclinic for the precise deficiency.
- If the issue cannot be resolved at polyclinic level, take the complete file to the concerned Regional Centre.
If original papers are lost
The official ECHS FAQ says a claim can be considered on duplicate papers when the original bills/receipts are lost, provided the case is supported by a letter from the hospital and an affidavit regarding loss of the originals. Confirm the current documentary format with the polyclinic before filing.
If you disagree with the decision
Prepare a short representation based on evidence, not only dissatisfaction: Claim ID, rejection reason, the policy/fact you believe was overlooked, and supporting documents. Submit through the responsible ECHS chain beginning with the polyclinic and Regional Centre. For general clarification ECHS publishes 1800-114-115.
How to avoid repeat problems
Before resubmitting, compare the portal data with the ECHS card, discharge summary, bill totals and bank details. Upload clear complete files and preserve originals. Do not create a fresh duplicate claim merely to bypass a return remark.
Frequently asked questions
Can ECHS pay less than I spent?
Yes. Admissible reimbursement can be limited by applicable CGHS/ECHS rates and non-payable items.
My originals are lost. Is the claim automatically impossible?
No. The official FAQ provides a duplicate-document route supported by a hospital letter and affidavit for loss of originals.
Should I create a new claim after rejection?
Not unless ECHS instructs you to. First act on the existing claim remark and preserve the original Claim ID.