🇮🇳 ECHSGPT – Veteran Healthcare Assistant

I am thrilled to announce the following:

ECHSGPT is online now!

How to Access ECHSGPT

Open the ChatGPT app (on your phone or computer).

If you don’t have it, download from Google Play Store / Apple App Store or go to chat.openai.com.

Log in (you can use Gmail or your email ID).

On the left side, click Explore GPTs.

In the search bar, type ECHSGPT.

Click on ECHSGPT – Veteran Healthcare Assistant.

To keep it handy, click Pin to Sidebar (like a bookmark).

Important Clickable Links

Here is the clickable link(You might have to create an account and login, I am not sure though.)
ECHSGPT: Veteran Healthcare Assistant (AI Assisted 24x7 Help Desk)
Video Overview:
Audio Podcast Overview
Your Trusted guide to the ECHSGPT:
Sample interactions:
A Mind Map

Important Note:
You may start with this prompt: "Give me top 100 FAQ I can ask the ECHSGPT"
Do try to question ECHSGPT. in your regional Language !Ensure voice mode is turned on.

Share with any one who is likely to benefit i.e all ECHS beneficiaries for sure.

🇮🇳 ECHSGPT – Veteran Healthcare Assistant

User Guide (Latest Version)

🔹 What is ECHSGPT?

ECHSGPT is your trusted digital assistant for the Ex-Servicemen Contributory Health Scheme (ECHS).
It helps veterans, ex-servicemen, and their families navigate ECHS rules, procedures, entitlements, and official circulars.
Provides step-by-step policy guidance with citations from official documents.

Fetches the latest circulars/notices from echs.gov.in and MoD at query time.

Always highlights updates with effective dates and clear explanations.

⚠️ No medical advice – consult your doctor or empanelled hospital for treatment.

🔹 What’s New?

📢 Latest feature updates (rotating view):
Demo Mode – Practice filling forms or navigating the portal with dummy data.

Accessibility Settings – Large Text Mode + Screen Reader Mode.

Printable Templates – Ready-to-use grievance and appeal letters.

Check the User Guide anytime for full feature list.

🔹 Key Features

1. Latest Rules with Updates

Always shows the most current policy.

Highlights ⚡ if recently updated.

Displays effective date of change.

Provides a Last Updated timestamp + direct link to the circular.

Old rules shown in Archive References (optional).

2. Benefits Calculator

Estimate:

Hospitalisation reimbursement

Stoppage charges

Claim limits for dependents

Uses simple inputs (days, type, category).

Never stores personal data.

3. Form-Filling Assistant

Step-by-step help for:

Reimbursement claim form

Card renewal application

Referral request

Explains exactly what goes where.

Shows common examples.

4. Portal Navigation Walkthrough

Screen-by-screen guidance with images:

Checking claim status

Downloading referral letters

Applying for card renewal

🎤 Voice narration in English + 7 regional languages.

5. Regional Centre/Polyclinic Directory

Select State/City → Get:

Address, phone, and email contacts

Always updated from latest MoD/ECHS data.

6. Escalation Roadmap

Clear grievance escalation path:

OIC Polyclinic

Regional Centre

Central Organisation (CO, ECHS)

Ministry of Defence (DESW)

Includes timelines + contact details.

7. Voice Responses + Multilingual Support

Every answer has a 🎤 Play button.

Languages: English (default), Hindi, Tamil, Kannada, Malayalam, Punjabi, Marathi, Bengali.

Spoken answers include:

⚠️ Disclaimer (policy/process only)

Thank-you note for veteran’s service

🎺 Patriotic bugle tone (optional, can be muted per session).

8. Session Summary

Auto-generated after 10 min inactivity or when session ends.

Includes: queries, rules, citations, Change Impact Notes.

Export options: Copy, Text, PDF, or Email.

Veterans can combine session summary + latest circular alerts in one email.

9. New Circular Alerts

📢 Alerts if a circular is issued within last 30 days.

Option to Check & Email me latest circulars now.

SMS/WhatsApp delivery (number used once, deleted after).

Only policy/process updates (no personal reminders).

10. Community Insights

Veterans can see peer experiences (claims, hospitals, referrals).

Posts are ECHSGPT-approved only (to prevent misinformation).

Future expansion: Telegram channel, admin-moderated only.

11. Accessibility Features

Large Text Mode for readability.

Screen Reader Mode for visually impaired veterans.

12. Offline Access

Download key ECHS documents (Brochure, Handbook, SOPs, Compendium).

Available in English + regional languages.

13. Priority Support for Widows/Dependents

Dedicated Widow/Dependent Mode with:

Card transfer guidance

Reimbursement process

Eligibility simplified explanations

Extra empathetic tone.

14. Feedback & Ratings

After each session: “👍 Was this helpful? 👎”

Optional feedback to improve answers.

15. Printable Templates Library

Ready-to-use applications and letters:

Grievance to SHO

Appeal to Regional Centre

Dependent inclusion request

Available in English + regional languages.

16. Simple Language Mode

Veterans can ask in plain words.

Example:

“My daughter married, is she covered?”

Response: “⚖️ According to Brochure 2023, Ch.2 §2.3 – Married daughters are not eligible.”

🔹 Privacy & Security

ECHSGPT never stores your ECHS card number, Aadhaar, DOB, or medical history.

Phone numbers/emails for alerts are used once and deleted after sending.

Privacy Note:

“📢 If you want to receive this update by SMS/WhatsApp, please provide your phone number. Your number will be used once to send this message and will be deleted immediately after.”

🔹 How to Access the User Guide

Inside ECHSGPT → Help / User Guide button.

Interactive, expandable menu + voice narration.

Downloadable PDF (English default, regional language on request).

Includes “What’s New” section for latest feature highlights.

👉 This User Guide ensures every veteran and family member can confidently use ECHSGPT for ECHS guidance.

Most Mundane 100 FAQ Prompts

📌 Top 100 ECHS FAQs – Grouped by Category

1️⃣ Eligibility & Membership (12)

Who is eligible for ECHS membership?
Are widows of ex-servicemen entitled to ECHS facilities?
Can dependent parents be included in ECHS?
What is the age and income criteria for dependent parents?
Are unmarried/widowed/divorced daughters eligible for ECHS?
Are disabled children covered under ECHS?
Can in-laws (parents of spouse) be included in ECHS?
Are adopted children eligible for ECHS?
What are the income criteria for dependents?
Can dependents who start earning be removed and later re-added?
Is membership compulsory for all ex-servicemen pensioners?
Are Short Service Commissioned Officers (SSCOs) covered?

2️⃣ ECHS Smart Card (10)

How do I apply for a new ECHS card?
What documents are required for card application?
What is the fee for an ECHS card?
How long does it take to get a card after application?
What should I do if my ECHS card is lost or damaged?
How do I update my dependent details in the card?
Can I use the card in any city across India?
How do I renew my ECHS card after expiry?
Is Aadhaar mandatory for card issuance?
Can temporary cards be issued in emergencies?

3️⃣ Polyclinic Facilities (10)

What facilities are available at an ECHS polyclinic?
Can I directly visit a polyclinic without appointment?
Are medicines available at polyclinics?
Can I collect medicines for a longer duration?
What happens if the polyclinic does not have prescribed medicine?
Are diagnostic tests available at polyclinics?
Are dental treatments covered at polyclinics?
Can polyclinics issue referrals for private hospitals?
What is the role of OIC (Officer-in-Charge) Polyclinic?
Can I visit any polyclinic across India?

4️⃣ Empanelled Hospitals (10)

How do I know which hospitals are empanelled under ECHS?
Can I choose any empanelled hospital for treatment?
What types of hospitals are empanelled (private, trust, etc.)?
Is prior referral required for treatment in empanelled hospitals?
Can I go to an empanelled hospital in another city?
Are dental clinics empanelled under ECHS?
What happens if an empanelled hospital is dis-empanelled during my treatment?
Can I change hospital after referral?
Is there a limit on the number of visits to empanelled hospitals?
How are empanelled hospitals monitored for quality?

5️⃣ Referral System (10)

How do I get a referral from ECHS polyclinic?
Can I get a referral without physically visiting the polyclinic?
What is the validity period of a referral?
Can I get a referral for follow-up treatment?
Can referrals be issued for planned surgeries?
Is referral needed for emergencies?
Can I get referral for multiple specialities in one visit?
What if referral is denied at polyclinic?
Are referrals valid pan-India?
Can I directly go to hospital in case of life-threatening emergency?

6️⃣ Treatment Coverage & Procedures (12)

Which treatments are fully cashless under ECHS?
Are cancer treatments covered under ECHS?
Are organ transplant surgeries covered?
Are joint replacement surgeries covered?
Is dialysis covered under ECHS?
Are infertility treatments covered?
Are cosmetic surgeries covered?
Are psychiatric/mental health treatments covered?
Is AYUSH treatment covered under ECHS?
Are ICU and ventilator charges covered?
What is the ceiling on room rent in empanelled hospitals?
Can I claim ambulance charges?

7️⃣ Reimbursements & Claims (12)

How do I claim reimbursement for treatment in non-empanelled hospitals?
What is the time limit for submitting reimbursement claims?
What documents are required for claim submission?
Can I claim for emergency treatment in a non-empanelled hospital?
What is the process for reimbursement of home isolation treatment (COVID)?
Can I claim for treatment abroad?
How long does it take to get reimbursement?
Can I track the status of my claim online?
What if my reimbursement claim is rejected?
Can I appeal against a claim rejection?
Are travel charges reimbursable?
What is the maximum reimbursement limit?

8️⃣ Medicines & Pharmacy (8)

Are medicines given free under ECHS?
Can I get life-long medicines for chronic diseases?
What is the process if medicines are not available in polyclinic?
Can medicines be collected by family members?
Can medicines be issued for more than one month at a time?
Are imported medicines provided?
Is insulin covered under ECHS?
Can I get medicines delivered at home?

9️⃣ Special Provisions (6)

What facilities are available for war-disabled veterans?
Are 100% disabled dependents given special consideration?
Are treatment facilities available for World War II veterans?
What is the policy for ECHS widows regarding renewal and continuation?
Are martyrs’ families given any additional facilities?
Are differently-abled dependents given lifelong coverage?

🔟 Administration & Escalation (8)

What is the role of Regional Centres in ECHS?
How do I lodge a grievance with ECHS?
What is the contact number of the ECHS helpline?
How do I escalate unresolved complaints?
What is the grievance redressal timeline?
Can I use CPGRAMS for ECHS-related complaints?
Who can I contact for technical issues with the ECHS portal?
How do I contact my Station HQ (SHO) for ECHS matters?
What are the working hours of ECHS polyclinics?
Where can I download all official ECHS circulars and orders?

⚡ GPT-5 Power Prompts

1️⃣ Structured Analysis & Policy Guidance

Prompt:
“Act as a compliance officer. I will paste a government policy document. Summarize its key rules in bullet points, highlight ambiguities, and suggest 3 implementation checklists for different stakeholders (administrator, end-user, auditor).”
Why it’s powerful: Forces GPT-5 into multi-role analysis + outputs actionable checklists.

2️⃣ Scenario-Based Reasoning

Prompt:
“Imagine you are a retired Army officer applying for a healthcare benefit. Walk me through the process in first person, narrating the documents you collect, offices you visit, and potential obstacles. Then switch to the perspective of an administrator and explain how the same case looks from their side.”
Why it’s powerful: Demonstrates perspective-shifting + realistic simulations.

3️⃣ Knowledge Extraction from Long Texts

Prompt:
“I will paste a 10-page policy document. Extract: (1) all deadlines, (2) all monetary limits, (3) all exclusions. Present them in a clean 3-column table.”
Why it’s powerful: Converts unstructured rules into machine-readable tables.

4️⃣ Flowcharts & Process Mapping

Prompt:
“Create a step-by-step flowchart (with Mermaid syntax or text-based diagram) for how a reimbursement claim flows from veteran → polyclinic → regional centre → central office. Highlight decision points where claims may be rejected.”
Why it’s powerful: GPT-5 can visualize complex systems and output structured diagrams.

5️⃣ Role-Based Guidance

Prompt:
“Explain ECHS membership eligibility in three versions: (a) for a veteran, (b) for a widow, (c) for a dependent child. Highlight what is common and what is unique.”
Why it’s powerful: Automatically adapts tone and content for multiple audiences.

6️⃣ Summarization + Cross-Comparison

Prompt:
“Compare ECHS, CGHS, and Ayushman Bharat in terms of: (1) eligibility, (2) coverage, (3) referral system, (4) empanelled hospitals. Show the result in a comparative table with source citations.”
Why it’s powerful: Multi-policy cross-comparison in structured format.

7️⃣ Conversational Memory & Simulation

Prompt:
“Pretend you are an ECHS polyclinic OIC. I will act as a veteran coming with different queries. Handle my questions step by step as if in real life, referring to official SOPs where needed. Keep track of what I’ve already asked so I don’t repeat.”
Why it’s powerful: Demonstrates long-term conversational memory and realism.

8️⃣ Multilingual / Regional Adaptation

Prompt:
“Translate this ECHS eligibility guide into Hindi, Tamil, and Marathi while keeping medical/legal terms in English. Format neatly in sections.”
Why it’s powerful: GPT-5 can generate multilingual structured outputs with selective translation.

9️⃣ Voice-Friendly Summaries

Prompt:
“Rewrite the following SOP in simple spoken language, short sentences, and numbered steps so it can be read aloud as a voice guide for veterans.”
Why it’s powerful: Creates audio-friendly policy guides.

🔟 Rapid What-If Simulation

Prompt:
“If ECHS introduced telemedicine for chronic disease follow-up, what would be the top 5 benefits, 5 risks, and 3 implementation steps, citing lessons from CGHS and private sector telehealth models?”
Why it’s powerful: Combines policy reasoning + forecasting + benchmarking.

⚡ Advanced GPT-5 Power Prompts for ECHS

1️⃣ Membership & Eligibility

Prompt:
“Summarize ECHS membership rules for (a) veterans, (b) widows, (c) dependent parents, and (d) disabled children. Show in a comparative table with columns: Category | Eligibility | Documents Required | Renewal Rules. Cite brochure/handbook page numbers.”

✅ Output: Structured side-by-side eligibility matrix.

2️⃣ ECHS Smart Card Lifecycle

Prompt:
“Create a flowchart of the ECHS Smart Card lifecycle: application, payment, verification, printing, delivery, renewal, and lost/damaged replacement. Mark which steps are done by the veteran, polyclinic, regional centre, and card issuing authority.”

✅ Output: Process flowchart for easy reference.

3️⃣ Referral Simulation

Prompt:
“Roleplay as an ECHS polyclinic doctor. I will act as a veteran with knee pain needing surgery. Walk me through how you would: (a) examine, (b) issue referral, (c) route to empanelled hospital, (d) explain costs covered. Then switch to the perspective of the veteran narrating the steps taken.”

✅ Output: 2-perspective simulation (doctor + veteran).

4️⃣ Hospital Coverage Comparison

Prompt:
“List 5 major empanelled hospitals in Delhi under ECHS, compare them on: (1) speciality coverage, (2) room rent entitlement, (3) super-speciality treatments available, (4) exclusions. Provide in a table.”

✅ Output: Location-specific hospital comparison.

5️⃣ Emergency Scenario Walkthrough

Prompt:
“Explain what happens if a veteran suffers a heart attack while traveling in a non-empanelled city. Step through: immediate treatment, document collection, reimbursement claim, time limits, and escalation if claim is delayed. Present as numbered steps.”

✅ Output: Clear emergency SOP.

6️⃣ Reimbursement Filing Guide

Prompt:
“Generate a checklist of documents required for reimbursement claim in case of non-empanelled hospital emergency treatment. Group them into: Patient Documents, Hospital Documents, Financial Documents, Certification. Add timelines for submission.”

✅ Output: Document checklist for claims.

7️⃣ Dependent Coverage Edge Cases

Prompt:
“List tricky cases of dependent eligibility — (a) married daughter separated from husband, (b) parent with pension above income ceiling, (c) adopted child, (d) disabled son above 25 years. For each, state if eligible or not, with citation.”

✅ Output: Grey-zone dependency rules clarified.

8️⃣ Medicines & Chronic Care

Prompt:
“Summarize ECHS medicine rules for chronic patients: duration of issue (normal vs. pandemic relaxation), collection by representative, alternate brand substitution, and procedure if medicines not available at polyclinic. Show in FAQ format.”

✅ Output: Concise medicine rules.

9️⃣ Widow Entitlement Transition

Prompt:
“Explain step-by-step what a widow of an ESM must do to continue ECHS benefits after her husband’s death. Include: documents to submit, card update procedure, renewal validity, and escalation if regional centre delays.”

✅ Output: Survivor benefit guide.

🔟 Grievance Escalation Map

Prompt:
“Generate a grievance escalation ladder for ECHS: Polyclinic → Station HQ → Regional Centre → Central Organisation → CPGRAMS. Show timeline for response at each level. Format as a neat flow diagram.”

✅ Output: Escalation roadmap for complaints.

1️⃣1️⃣ Cross-Scheme Benchmarking

Prompt:
“Compare ECHS vs CGHS vs Ayushman Bharat in terms of: (1) eligibility, (2) empanelled hospitals, (3) reimbursement timelines, (4) medicines supply, (5) referral system. Present in a 5-column comparative chart.”

✅ Output: Quick comparative policy snapshot.

1️⃣2️⃣ Voice-Friendly SOPs

Prompt:
“Rewrite the ECHS claim reimbursement SOP into 12 short spoken steps that can be read aloud to elderly veterans. Use simple language, avoid jargon, and number the steps clearly.”

✅ Output: Audio-ready SOP guide.

🔥 Power Questions to Challenge ECHSGPT

Outstation Emergency in Non-Empanelled Hospital
“While traveling, I had a heart attack, got treated in a non-empanelled hospital, and paid cash. Build a step-by-step reimbursement plan with timelines, document checklist, admissible heads of claim, and a template appeal if ‘non-emergency’ is cited to reject.”
Pushes: emergency criteria + timelines + document sufficiency + appeal path.
Mid-Treatment Dis-Empanelment
“My surgery was pre-approved at an empanelled hospital that got dis-empanelled mid-treatment. What gets paid, who pays, and how do I document continuity of care? Provide a letter draft to Regional Centre and a fallback reimbursement path.”
Pushes: contract continuity + beneficiary protection + documentation.
Transplant: Donor Costs & Package Limits
“For a kidney transplant under an empanelled centre, detail coverage for the donor’s pre-op workup, hospitalisation, consumables/implants, and post-op follow-up. Map package vs. non-package items and how to pre-authorise exceptions.”
Pushes: nuanced inclusion/exclusion + pre-auth pathways.
Dependent Income Turns Ineligible Mid-Year
“My dependent parent crosses the income ceiling in December. From which date do benefits stop, how do I update the card, and what happens to an ongoing treatment started before ineligibility?”
Pushes: status change effects + ongoing care protection.
Widow Continuation with Name/Record Mismatch
“After my husband’s demise, my Aadhaar/pension records have a spelling mismatch. Give me a precise widow-continuation checklist, affidavit formats, and whom to approach if card reissuance is held up.”
Pushes: survivor transition + KYC rectification.
Disabled Son >25 Years: Lifelong Eligibility
“Build a proof checklist for certifying permanent disability for my 28-year-old son, the periodicity of re-validation (if any), and how to handle out-station treatment referrals.”
Pushes: disability eligibility + evidence standards.
Referral Validity & Multi-Specialty Chain
“Create a decision tree for getting one referral that leads to diagnostics → orthopaedics → anaesthesia fitness → surgery → post-op physio. Where do fresh referrals or endorsements become mandatory?”
Pushes: referral chaining + validity windows.
Cashless Denial at Desk: ‘Package Not Covered’
“The hospital front desk denied cashless saying ‘no package code’. List on-the-spot actions, who to call, how to convert to approved package/individual line items, and how to record this to avoid later rejection.”
Pushes: real-time resolution + coding.
Mixed Bills: Empanelled + Non-Empanelled
“My procedure started in an empanelled hospital, but ICU transfer happened to a non-empanelled facility. Split the bills into admissible portions, show calculation method, and produce a covering note for claim.”
Pushes: proportional adjudication + documentation mapping.
High-Cost Implants & Brand Substitution
“Show me how to ensure admissibility for a specific stent/implant brand when the package has a ceiling. Include pre-auth template, clinical justification notes, and fallback reimbursement if the bill exceeds the cap.”
Pushes: package ceilings vs. justified exceptions.
Ambulance Across Cities (Inter-Facility Transfer)
“Ambulance shifted me 180 km between hospitals. What is reimbursable (BLS/ALS/km limits/oxygen), what papers must the hospital/ambulance furnish, and how are multiple legs calculated?”
Pushes: nuanced ambulance rules + rate application.
Room Entitlement vs. Upgrade with Co-Pay
“I’m entitled to a certain room category, but I opted for a higher category. Show cost-sharing logic across bed charges, nursing, OT, implants, and investigations so I don’t lose coverage for everything.”
Pushes: proration logic + non-denial safeguards.
Time-Barred Claim Rescue
“My claim was filed beyond the stipulated days. Draft a representation citing reasons (ICU, postal delay, bereavement), attach proofs, and build a case for condonation with the right authority chain.”
Pushes: exception handling + speaking order request.
Medicine Supply: Chronic Care + Stock-Outs
“I’m on lifelong meds. Create a plan covering regular issue duration, attendant-collection, brand substitutions, and what to do when the polyclinic is out of stock (including local purchase/AFMS supply notes).”
Pushes: continuity of care + supply pathways.
Home Isolation (Infectious Disease) Reimbursement
“I managed COVID-like home isolation with doctor supervision. What parts are reimbursable (consults, monitoring devices, meds), required proofs, and how to pre-empt common rejection reasons?”
Pushes: non-hospital care adjudication.
Tele-Consult + Referral Legality
“A specialist did a tele-consult and advised admission. Can the polyclinic issue referral based on tele-notes? Provide the exact documentation trail and any limits on tele-referrals.”
Pushes: evolving care models + documentation sufficiency.
Out-of-Station Portability & RC Migration
“I live 6 months in City A and 6 months in City B. Map how to handle RC/Polyclinic linkage, medicine continuity, and referral portability without repeated KYC hassles.”
Pushes: portability + duplication avoidance.
Appeal after Rejection: Evidence Matrix
“My reimbursement was rejected for ‘incomplete records’ and ‘non-emergency’. Build an appeal kit: point-wise rebuttal matrix aligned to clauses, missing-doc checklists, and a timeline ladder (PC → RC → Central Org → CPGRAMS).”
Pushes: structured redressal + clause-based rebuttal.

Ultra-Challenging ECHS Scenarios (Beyond #1–18)

Abroad Evacuation + Treatment
“Air-evacuated from Nepal to Delhi, received initial care abroad and definitive surgery in India. Map admissibility across borders, currency conversion, what rates apply for the foreign leg, pre-auth/retro-auth, and how to avoid ‘non-empanelled abroad’ rejection.”
Post-Implant Device Recall
“A coronary stent brand implanted last month is officially recalled. What’s covered for explant/re-implant, who authorizes, how are consumables billed, and how do I preserve chain-of-custody evidence to prevent denial?”
Package Break + Unlisted Consumables Mid-Surgery
“During ‘package’ surgery, surgeon uses critical unlisted consumables (type-B) due to intra-op finding. Show how to code, split, and justify line-items so the base package remains cashless while extras are admissible.”
Concurrent Double Coverage (ECHS + Ayushman + Private Insurer)
“Hospital wants to bill three payers. Lay out primary/secondary/tertiary settlement order, ‘no-profit’ limits, documentary proofs, and how to prevent duplication that later triggers recovery from me.”
Court Stay vs. Circular Revision
“A rate-cut circular took effect on 15 May; High Court stayed it on 28 May; my admission spans 20–31 May. Which tariff applies to each day? Compute the exact differential and build a representation with dates.”
ALS Ambulance + Air Ambulance, Multi-Leg
“Ground ALS 120 km → Air ambulance → Ground BLS 40 km. Detail per-leg admissibility, papers needed (ECG, vitals, referral), km slabs, oxygen/vent charges, and how to pre-empt ‘non-emergency transport’ objections.”
Robotic Surgery Not in Package List
“Treating team advises robotic prostatectomy. Build an exception pathway: clinical dossier, technology justification, cost benchmark to CGHS, who approves, and fallback reimbursement if only conventional package is sanctioned.”
Chemotherapy Across Two Cities + Cold-Chain Drugs
“I alternate residence between Pune and Chandigarh mid-chemotherapy. Plan referrals, drug continuity via LP/cold-chain, audit trail for dose cycles, and avoid denial for ‘change of RC/PC’.”
Mental Health: Involuntary Admission & Confidentiality
“Emergency psychiatric admission (MHA-2017 context). What ECHS paperwork is permissible without violating patient consent laws? Who signs, how are follow-ups/referrals managed, and what’s reimbursable?”
Tele-ICU Second Opinion Influencing Surgery
“Remote intensivist advised emergent surgery. Can tele-notes trigger ECHS referral and pre-auth? Specify exact documentation to satisfy later audit.”
Orthopaedic Implant: UDI, Import Shortage, Substitution
“Required implant model unavailable; hospital proposes alternate brand. Lay out UDI/batch documentation, substitution consent, pricing parity proof, and protection against ‘brand-upsell’ disputes.”
Time-Barred Claim with ICU/Postal Proof
“Filed 20 days late due to ICU + postal disruption. Construct a condonation plea with evidence map, authority chain, and a ‘speaking-order’ draft.”
Maternity + NICU for Dependent Daughter
“Unmarried dependent daughter delivers; newborn needs NICU. Clarify mother’s and newborn’s eligibility, immediate documentation to avoid denial, and billing split for obstetric vs. neonatal.”
Research/Clinical Trial Participation
“Enrolled in a trial during cancer care at an empanelled centre. What routine-care costs are admissible vs. sponsor-paid? Build a clean billing boundary and audit trail.”
Proton Beam Referral (Non-local, Limited Centres)
“Local hospital recommends proton therapy. Chart inter-city referral mechanics, prior approvals, tariff mapping to CGHS, and accommodation of planning scans outside package.”
Home Palliative Care + Equipment Rental
“End-stage illness managed at home: oxygen concentrator rental, morphine under supervision, nurse visits, tele-rounds. What’s reimbursable, documentation cadence, and how to avoid duplication with pharmacy issues?”
Multi-Morbidity During Cashless Stay
“Admitted for CABG; acute GI bleed occurs. How to extend referral to new specialty, create parallel packages or line-items, and keep the non-cardiac episode admissible without fresh admission?”
System Outage During Pre-Auth
“ECHS portal down at 2 a.m.; surgery cannot wait. Produce a manual pre-auth fallback kit (emails, stamps, timestamps), post-facto upload protocol, and wording to avert ‘no pre-auth’ denials.”
GST/Tax Errors on Package Bills
“Hospital added GST on a package supposed to be all-inclusive. How do I correct invoice, claim refund/adjustment, and ensure ECHS reimburses only the admissible base?”
Implant Upgrade with Co-Pay, Preserve Rest Cashless
“I chose a higher-end implant with personal top-up. Design a proration model so only the delta is out-of-pocket while OT/ICU/consults remain cashless; include model invoice templates.”
Widow’s Posthumous Claim + Card Not Yet Updated
“ESM dies during treatment; bills arrive after. Build a pathway for widow to file/receive reimbursement while card records are mid-update—include heirship proofs and interim identifiers.”
Dental Implants in Staged Grafting
“Sinus lift + bone graft + staged implantology. Break into admissible phases, pre-auth points, radiology evidence, and stop common rejections (‘cosmetic’, ‘non-standard’).”
Audit Red-Flag: Overlapping Admissions
“Insurer data shows I was ‘admitted’ at two facilities same day (one is a day-care). Draft a forensic rebuttal with logs, discharge timings, and encounter codes; request internal audit trail.”
Retrospective RC Migration with Pending Claims
“I moved RC linkage after filing two claims at the old RC. Show how to track, chase, and get final settlement without starting over; include how to prevent ‘jurisdiction’ ping-pong.”

🚀 Omega-Tier ECHS Power Prompts

(Beyond #1–24)

25) Rolling Tariff + Mid-Stay Upgrades
“My admission spans two tariff notifications; I upgraded room class mid-stay. Compute day-wise admissibility and proration across room, OT, ICU, investigations, and implants; draft an invoice correction note and RC representation.”

26) Third-Party Liability Accident + ECHS
“I was hit by a commercial vehicle; hospital billed ECHS. Build a dual-track: cashless care + recovery from insurer/TPA without double payment. Provide indemnity wording and audit-proof settlement steps.”

27) Rare Disease High-Cost Therapy (Non-CGHS Code)
“Prescribed an ultra-rare biologic not in standard lists. Create an exception dossier: clinical justification template, price discovery vs. CGHS analogues, approval chain, and fallback reimbursement with caps.”

28) Elective Surgery Converts to Emergency During Pre-Auth Outage
“Planned procedure turned emergent when system was down. Produce a time-stamped manual pre-auth kit (email/fax note formats), theatre log extracts, and post-facto upload checklist to avoid ‘no approval’ rejection.”

29) Split Episode Across Financial Years
“Workup in March, surgery in April. Map referral validity, package continuity, and which FY budget head applies. Provide a document index linking pre-op diagnostics to the final package.”

30) Robotic Add-On Inside Conventional Package
“Hospital proposes conventional package + robotic assistance surcharge. Show admissible vs. non-admissible components, approval wording, and how to protect cashless base while paying only the delta.”

31) Cross-City Chemo with Cold-Chain & Home Support
“Cycles in two cities; interim doses at home with nurse supervision. Build a continuity plan: referrals, cold-chain evidence, nurse visit admissibility, and cycle ledger to withstand audit.”

32) Staged Orthopaedics: Graft → Implant → Rehab
“Three stages over 6 months. Partition referrals, pre-auth points, admissible implants/consumables each stage, and prevent ‘cosmetic’/‘experimental’ denials with imaging evidence matrix.”

33) Device Recall & Explant Logistics
“Implanted device recalled. Draft an explant/re-implant pathway (who authorizes, proof of recall, custody chain), billing split for theatre/consumables, and claim pack that avoids duplication.”

34) Tele-Referral Chain with Multi-Specialty Endorsements
“Tele-consult triggers cardio + nephro + anaesthesia endorsements. Design a single referral spine with add-on endorsements, validity windows, and a sign-off log acceptable to audit.”

35) Overlapping Day-Care vs Inpatient Episodes
“Same day procedures billed as IP and day-care at two facilities. Create a forensic reconciliation: timelines, encounter codes, discharge/admission proofs, and a rebuttal letter to clear ‘double claim’ flags.”

36) Interest for Delayed Reimbursement
“My claim is cleared months late. Identify if interest/compensation applies, compute from milestone dates, and draft a speaking-order request with annexed timeline.”

37) Posthumous Claim + Heirship & Card Pending Update
“ESM passed away mid-treatment. Build a widow’s claim path: heirship proofs, interim identifiers, how to file without card update, and a covering letter that avoids jurisdiction ping-pong.”

38) Multi-Leg Ambulance (ALS→Air→BLS) with Medical Necessity Proof
“Construct per-leg admissibility with rate slabs, oxygen/vent charges, and the clinical criteria notes (ECG/vitals) to pre-empt ‘non-emergency transport’ objections.”

39) Clinical Trial Overlap at Empanelled Centre
“Oncology care overlaps with a sponsored trial. Demarcate sponsor-paid vs. ECHS-admissible routine care, create a billing boundary SOP, and an audit statement for the RC.”

40) Mental Health Involuntary Admission + Privacy
“Emergency psychiatric hold under law. Generate an admissibility + documentation pack that respects consent/confidentiality while satisfying ECHS audit and referral rules.”

41) Proton/Carbon Therapy at Limited Centres
“Non-local advanced radiotherapy recommended. Build an inter-city referral/approval route, tariff mapping to CGHS references, and accommodation for planning scans outside the main package.”

42) Package Break with Essential Non-Listed Consumables
“Intra-op switch to non-listed items. Code and justify line items so base package stays cashless; include surgeon note templates and supply chain proofs.”

43) GST/Tax Rectification on ‘All-Inclusive’ Packages
“Hospital added GST erroneously. Draft invoice correction request, compute admissible base vs. tax, and produce a reconciliation sheet for RC processing.”

44) Personal Top-Up for Premium Implant Without Losing Cashless
“I opted for a higher-end implant. Create a proration model + model invoices so only the implant delta is self-paid; keep OT/ICU/consults fully cashless.”

45) Time-Barred Claim with Evidence-Backed Condonation
“Submit a condonation brief citing ICU stay, postal logs, and bereavement. Provide authority chain, annexure list, and a speaking-order draft.”

46) Dual-Scheme Entanglement (ECHS + Employer Insurance)
“Employer TPA and ECHS both involved. Set the primary/secondary sequencing, non-duplication affidavit, and net-of-settlement computation to avoid future recovery.”

47) Out-of-Station Portability for Six-Month Migration
“Live half-year in two cities. Design RC/Polyclinic linkage, medicine continuity (LP/indent), and referral portability without repeated KYC—plus a tracking sheet.”

48) Complication During Cashless Stay → New Specialty Add-On
“Admitted for CABG; acute GI bleed occurs. Extend referral to new specialty, show package addition vs. line-item carve-out, and preserve cashless status.”

49) Home Palliative Care: Equipment Rental + Nursing Cadence
“Oxygen concentrator, morphine supervision, nurse visits, tele-rounds. Define what’s reimbursable, documentation cadence, and pharmacy alignment to avoid duplicate pay.”

50) Policy Conflict Detection & Harmonization
“Scan the ECHS corpus for internal contradictions on referrals, ceilings, or timelines. Produce a clause-by-clause conflict map, propose harmonized wording, and attach draft circular language.”

Key Points

Each prompt forces multi-document synthesis, calculations/proration, templates (letters, invoices, affidavits), flowcharts, and escalation ladders.
When you pick one, I’ll deliver a fully cited, printable playbook strictly from the official ECHS corpus.

Next Steps

Tell me which 2–3 scenarios you want solved first.
Share your role (veteran/widow/dependent) and your city (for local empanelment context).
I’ll return complete, clause-referenced guides with checklists, drafts, and decision trees—ready to use or share.

Escalation Contacts

ECHS Helpline & Regional Centres: as per www.echs.gov.in.
Station HQ (SHO): for local administrative support.
Grievance: CPGRAMS (pgportal.gov.in) if unresolved by RC/Central Org.

Disclaimer

I provide policy/process guidance only—no medical advice. Final admissibility depends on the latest official ECHS orders; in any conflict, the official documents prevail.

Monday, September 8, 2025