24 - Business Services (Class 2) - Com. T.Ganesan

 Rules, Rights & Rites -25 Transition to Revised CGHS Rates 2025 and Transaction Management System (TMS) 2.0

 

I usually post all important items related to official rulings, union news, and other general matters on my YouTube channels: Yourskayveeyes (English) and Anbudan Kayveeyes (Tamil).

However, due to the recent spate of orders and the high volume of information being received, I have not been able to convert every item into a video. Therefore, I am introducing these new slots to post current matters and updates that have not yet been published on YouTube. This ensures you stay informed on every detail, even if a video hasn't been made yet …………….Kayveeyes

Transition to Revised CGHS Rates 2025 and Transaction Management System (TMS) 2.0

• The Revised CGHS Rates shall be effective from 00:00 hrs. (midnight) on 13.10.2025.
• Instructions apply to all CGHS-empanelled HCOs (Hospitals, Dental Clinics, Diagnostic Centres, etc.) in all CGHS cities.
• HCOs are directed that no CGHS beneficiary shall be returned to CGHS merely for the purpose of generating a new referral.
• All new patient registrations from 00:00 hrs on 13.10.2025 onward shall be done only in "TMS 2.0".
• TMS 1.0 Closure: No fresh case or pre-authorization registrations shall be created in "TMS 1.0" after 00:00 hrs on 13.10.2025.

Registration and Billing Guidelines

In-Patient Treatment (IPD Cases)

Scenario	Registration Platform	Rate Application
	New cases (on or after 13.10.2025)	Only TMS 2.0		Revised Rates
	Ongoing Medical Management (started before 13.10.2025)	Continue the case in TMS 1.0		Old Rates for services up to 12.10.2025, then Revised Rates for services on/after 13.10.2025.
	Surgical/Radiotherapy packages booked before 13.10.2025	Continue under TMS 1.0		Old Rates until the package is completed.
	Additional Surgical Package added on/after 13.10.2025 (during an Old Rate package)	Upload on TMS 1.0		Revised Rates

Out-Patient & High-Frequency Treatments

Treatment Type	Period	Platform	Rate Application
	OPD Services	Up to 23:59 hours on 12.10.2025		TMS 1.0		Old Rates
	OPD Follow-up	On/after 13.10.2025		New registration in TMS 2.0		Revised Rates
	High-frequency therapies (Dialysis, Chemo, etc.)	Before 13.10.2025		TMS 1.0		Old Rates
	High-frequency therapies (Dialysis, Chemo, etc.)	On or after 13.10.2025		TMS 2.0		Revised Rates

Handling of Referrals (Manual Uploads)

• Valid Referrals (up to 3 months before 12.10.2025): The HCO shall register and submit the claim in TMS 2.0 (via manual path), upload the original referral memo, and select the newly notified code(s) from the Revised Rates.
• If a code was removed or renamed, the HCO shall not send the beneficiary back to the WC. The HCO must select the appropriate substitute code/package in TMS 2.0 (manual path). A short note referencing the original memo and clinical indication must be recorded. Online approval from AD City is required where necessary.
• HCOs must upload the original referral/memo and maintain an e-note in TMS 2.0 linking the original memo to the booked revised code(s) for audit trail.

• HCOs must ensure the activation of billing clerk/MEDCO IDs, functional testing of TMS 2.0, updating internal billing systems, and completing all pending TMS 1.0 claims.
• All cases/services provided up to and including 12 October 2025 must be registered in TMS 1.0 by 23:59 hrs IST on 12 October 2025.
• Refusing, delaying, or deferring service on the grounds of "fresh referral memo required" or any intentional denial will lead to penalties, including:
• De-empanelment for a minimum of two years.
• Blacklisting proceedings.
• Other penalties as per Clause 14.6 of MoA 2025.
• Technical queries for TMS 2.0 and HEM portal have dedicated toll-free numbers (14588 and 14413, respectively).
• Non-technical queries can be escalated to the Additional Director of the City (Level 1) or via email to the designated CMOs (Level 2).

(MOH & FW CGHS No.5016/CGHS(HQ)/HEC/2024 (Part I)/1/3809236/2025 dated 12/10/2025)