Pre-upload claim check for ECHS hospitals

See the deduction before ECHS does.

PreVouch reads the whole claim file and tests the bill against the CGHS rules. Your team fixes the file before upload.

Rules from the CGHS OM of 3 October 2025
Each deduction risk cites its rule and page
Your clerk makes every decision

How a finding reads

Code checkHighest band: Certain

Sampling consumables billed separately

Blood collection tubes, needles, lancets used for drawing samples are part of the lab test cost and not billable as separate “consumable” to CGHS.

CGHS OM 03.10.2025 · Annex IV §3 · page 322

Owner: Billing
Action: Remove the line
Amount: Code computes it from your bill

The clerk decides. The log keeps the name and the time.

The rule text comes from the PreVouch rule catalog. This panel holds no patient data.

Why it matters

The payer audits every bill.

After upload, each deduction becomes a query to answer or money to chase. Before upload, it is one correction to the file.

PreVouch moves the check to the point where your team can still act.

₹571.03 crore

CGHS deducted this amount from hospital claims in 2016–21. That is 9.54% of the money that hospitals claimed.

9.54% deductedAll money claimed, 2016–21

Source: CAG Report 17 of 2022. These figures are for CGHS. We found no public deduction figure for ECHS.

What your team gets

Five changes at the billing desk.

Fix the file while it is still yours.
PreVouch runs after the bill is final and before upload. Each finding gives one action.
See lines billed below the rate.
The rate check also notes a line billed below the CGHS rate. A person confirms that the lower rate is correct.
Check a finding on its page.
The cited page opens beside the finding. For a clinical finding, the screen quotes the words for it and the words against it.
Send each task to its owner.
Copy one task list for Billing, Pharmacy, Nursing, Lab, Radiology, Physio, Dietetics, Purchase, doctors and the ECHS desk.
Keep a record of each decision.
The log adds each decision with the name and the time. Nobody edits an old entry. A correction is a new entry.

What it checks

36 rules test each claim.

The rules come from Annexures II to IV of the CGHS OM and from the CGHS rate list. The rate table holds all three city tiers.

16rules run as code. They test the bill against the rate list and the OM. The same bill gives the same answer.

20rules read the clinical record. A model looks for the fact. A second read checks each quote on its cited page.

Rates and arithmetic 5

Billed rate differs from the CGHS rate for the claim's tier and rate column
Line amount is not rate × quantity
Head totals or bill total do not match the lines

Tests and reports 5

A test billed beside a panel that already contains it
Test billed with no report for that date
Bedside tests billed exceed the readings on the flow sheet or the ordered frequency

Consumables and non-admissible items 9

Sampling consumables billed separately
Item on the non-admissible list
ECG billed separately during the admission

Procedures and packages 6

Second or third procedure in one OT session billed at full rate
Procedure inside the package period of an earlier procedure billed at full rate
Procedure billed but no report describes it

Bill against the notes 7

Drug units billed differ from the order or the administration record
Consultant visits billed exceed visits the notes document
Physiotherapy sessions billed exceed sessions in the notes

Documents and entitlement 4

Implant supported only by a proforma or MRP letter, not a GST tax invoice
Package billed at a ward level other than the card entitlement
Stay runs past the referral or approval period with no extension on file

How it works

The machine reads. Your team decides.

Your team

PreVouch

Add the claimAdd the folder. Set the city tier, rate column and card ward. Give a source for each.
ReadPreVouch reads each page. If the bill totals do not reconcile, the run stops for a person.
TestCode tests rates and arithmetic. A model tests the bill against the clinical record.
VerifyA second read checks each quote on its cited page. A finding that fails leaves the totals.
DecideThe clerk opens the cited page. The clerk confirms, fixes, disputes or rejects.
UploadYour team uploads the corrected file. PreVouch does not submit claims.
Record the outcomeYour team enters the ECHS letters. People use them to improve the rules.

Bands set the order of work.

Each finding carries a band. A finding that comes from a model stays at Likely or below until a clerk confirms it on the page.

CertainCode proved it, or a clerk confirmed it.
LikelyThe record supports it. A person must look.
PossibleWorth a look. The record does not settle it.

Status

Where PreVouch stands today.

PreVouch is in early access. You should know what works and what does not exist yet.

Working now

The rule catalog and the CGHS rate table.
The full check on a small set of past ECHS claims, compared with the ECHS remarks. These claims helped us build the rules, so they do not prove accuracy.
The clerk's review and the log of each decision.
Entry of ECHS outcomes, kept apart from the tool's output.

Not yet

An accuracy figure. We will give one only after we score a sealed set of claims against ECHS outcomes.
Daily use at a hospital. The first pilots will run beside your current desk.
A hosted service. We agree hosting with each pilot hospital.
Claim submission to the ECHS portal. Your team stays in charge of the portal.

After ECHS replies

PostVouch tests the deduction.

PostVouch is a separate product. It tests each ECHS query or deduction against the CGHS OM and your claim file. A hospital can use it alone.

For each query it recommends one action, and it quotes the clause or says that it found none. Your team acts on the portal.

AcceptA rule supports the deduction.
NMIECHS needs more information, and the file can supply it.
JustifyThe file supports the billed item.

Questions

What hospitals ask first.

Does PreVouch replace my billing clerk?

No. This tool advises. The clerk decides. Each finding waits for a person, and a person can reject it with a reason.

How accurate is it?

We do not publish a percentage yet. ECHS outcome data must support a figure first. So far we have compared the findings with ECHS remarks on a small set of past claims.

Where do patient files go?

We agree hosting and data terms in writing with each hospital before any claim file moves. PreVouch sends page images to an AI model service to read them. The agreement names the service.

Which files does it read?

It reads the claim folder as it will go to ECHS. That means the bill, ICP, lab, radiology, summary, invoices, drug records and OT notes. It takes PDF, JPG and PNG files, and it reads scans.

Which rules does it use?

It uses the CGHS OM of 3 October 2025, Annexures II to IV, and the CGHS rate list. A new ECHS letter can add or change a rule.

We mostly bill CGHS. Can we use it?

The rules are CGHS rules. We built and tested PreVouch on ECHS claims. Tell us your main scheme on the form, and we will say what we can offer.

What do we need to run it?

You need a desktop or laptop computer with a current browser. PreVouch is not a phone app, because the clerk reads the finding and the cited page side by side.

What does it cost?

We have no public price yet. We will agree the terms with each pilot hospital.

Early access

Bring PreVouch to your billing desk.

Early access is for hospitals empanelled with ECHS or CGHS.

You send this form.We reply to the work email that you give.
We talk to your billing head.We look at how your claim files leave your system.
We agree the terms.We write down hosting, data and responsibility before any file moves.
You run a pilot.PreVouch runs beside your current desk, and your team compares the results.