CGHS Medical Reimbursement Claim (MRC) – Internal Workflow Explained

The Central Government Health Scheme (CGHS) provides a mechanism for beneficiaries to claim reimbursement for medical expenses under approved conditions. While beneficiaries submit claims to their respective CGHS Wellness Centres, the actual processing and approval are handled internally by CGHS officials through a structured digital workflow known as the Medical Reimbursement Claim (MRC) System.

Note for Beneficiaries:
This article explains the official internal process used by CGHS offices to verify and approve reimbursement claims after submission. It is not the process that beneficiaries follow to submit claims — rather, it shows what happens inside the CGHS system after your claim is received.

📥 Download Official CGHS MRC Process User Manual (PDF)

Overview of the CGHS MRC Workflow

The CGHS MRC system operates through a multi-level workflow to ensure transparency, accuracy, and accountability in claim processing. Each role in the system performs specific tasks — from data entry to verification and final payment approval.

Part 1: Claim Initiation (DEO/DA or Nursing Officer)

The process starts after a claim is received from the beneficiary. The Data Entry Operator (DEO), Dealing Assistant (DA), or Nursing Officer logs into the CGHS portal to initiate the reimbursement process.

Key Steps:

• Login with authorized credentials and select the appropriate MRC role.
• Click on the “Medical Claim” (MRC) module.
• Enter the Beneficiary ID (Ben ID) to fetch details like name, card type, and parent Wellness Centre.
• Fill in claim-related information such as Claim Date, Checklists (General, Hospitalization, OPD, etc.), and Bank Details.
• Click “Draft Save” to generate a Claim ID, then review and “Final Save” to forward the claim to CMO I/C.

Part 2: Multi-Level Approval Process

Once initiated, the claim passes through several levels of verification and approval within the CGHS system.

Level 1: CMO I/C (Wellness Centre In-Charge)

• Reviews the claim submitted by DEO/DA.
• If complete, forwards it to DA MRC.
• If incomplete, returns it to DA WC with remarks for correction.

Level 2: DA MRC (Dealing Assistant at MRC Section)

• Checks completeness and correctness of claim data.
• Forwards the claim to CMO MRC or returns it for correction if required.

Level 3: CMO MRC

• Reviews all documents and calculates the Admissible Amount (must be ≤ claimed amount).
• Options available:
• Approve & Forward to AD MRC for verification, or
• Approve & Forward to DDO MRC for direct payment processing.

Level 4: AD MRC (Assistant Director – Verification)

• Performs the final check for correctness of claim and admissible amount.
• If approved, forwards to DDO MRC for payment.

Part 3: Final Disbursement by DDO MRC

• The Drawing and Disbursing Officer (DDO MRC) verifies and authorizes final payment.
• Adjusts the Paid Amount if necessary, enters Date of Payment, and clicks “Save”.
• This completes the internal claim settlement process.

Conclusion:
The CGHS Medical Reimbursement Claim (MRC) workflow ensures each claim undergoes multiple levels of scrutiny — from data entry to final disbursement — handled by designated CGHS officials. This internal system promotes transparency and accuracy in processing medical reimbursements submitted by CGHS beneficiaries.

📄 Download the Official CGHS MRC Process PDF

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