Rajasthan Updates RGHS Rules: New Approval Process for OPD Tests Comes into Effect from July 13

The Rajasthan government has announced significant changes to the Rajasthan Government Health Scheme (RGHS), introducing a revised approval process for outpatient (OPD) diagnostic investigations. The updated guidelines are aimed at making the approval system faster, more transparent, and more efficient for beneficiaries and healthcare providers.

According to the latest notification, the revised procedure will become effective from July 13, 2026

, and will apply to all eligible routine OPD investigation requests submitted on or after that date.

Routine Tests Up to ₹2,000 Will Not Require Prior Approval

One of the key changes under the revised guidelines is the removal of the pre-authorization requirement for routine OPD diagnostic tests costing up to ₹2,000.

Under the new system, beneficiaries can undergo eligible investigations within this limit without obtaining prior approval through the RGHS portal. The move is expected to reduce waiting time and improve access to routine diagnostic services.

Pre-Authorization Mandatory Above ₹2,000

For OPD investigations where the total estimated cost exceeds ₹2,000

, hospitals will now be required to obtain approval through the RGHS online portal before conducting the tests.

Healthcare providers must submit a pre-authorization request along with supporting medical records so that the request can be reviewed under the revised approval process.

The requirement is intended to ensure appropriate utilization of medical investigations while maintaining transparency in claims.

Emergency Cases Exempt from Prior Approval

The Rajasthan State Health Assurance Agency (RSHAA), operating under the state's Medical and Health Department, has clarified that emergency situations will continue to receive special consideration.

In genuine emergency cases, doctors will be allowed to prescribe and conduct necessary investigations immediately without waiting for prior authorization.

However, hospitals must subsequently upload all relevant clinical documents, medical records, and the justification for the investigations on the RGHS portal to complete the documentation process.

Documents Required for Approval Requests

For investigations requiring pre-authorization, hospitals will need to upload several supporting documents through the RGHS portal, including:

• OPD prescription.
• Patient's medical history.
• Previous diagnostic reports, if available.
• Clinical justification explaining the need for the recommended investigations.

These documents will help authorities evaluate the medical necessity of the requested diagnostic procedures.

Faster Decision Timelines Introduced

The revised guidelines also establish defined timelines for processing approval requests.

According to the new framework:

• Urgent diagnostic requests should receive a decision within one hour.
• Routine cases should be processed within three hours.

The objective is to minimize delays in patient care while ensuring timely administrative decisions.

Automatic Approval if Deadline Is Missed

An important feature of the revised system is the introduction of a deemed approval mechanism.

If the Third-Party Administrator (TPA) fails to issue a decision within the prescribed time limit, the request will automatically be considered approved. This provision is intended to prevent unnecessary delays in treatment caused by administrative processing.