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Medical Empanelment for Hospital

What is Medical Empanelment?

Empanelment is an important exercise that directly influences the increased influx of patients requiring medical treatment/diagnostic intervention.

Empanelment has now become an important concern for every hospital to survive the market & retain their patients and yet we lack in an easy way to empanel hospitals with IC/TPA/Govt. & Private corporate/Health Schemes etc. In a simple sense, cashless is more tedious for hospitals than treating patients.

Empanelment has various benefits to any medical practice and helps you connect to the provider network which consists of Third Party Administrator (TPAs), Insurance Companies, Governmental agencies like ECHS, CGHS, DGEHS, MCD, DDA & others.

Basic Guidelines by IRDA regarding Medical Empanelment

According to the guidelines issued by “Insurance Regulatory and Development Authority (IRDA)”, if a healthcare facility wants to be recognized as a hospital, then it will be defined as:-

If an institution has “in–patient” facilities and provides daycare treatment to people for an illness or an injury and is already registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or under the enactments specified under the schedule of Section 56 (1) of the said Act or fulfills the following criteria:-

  • The hospital is required to have highly qualified nursing staff, for 24 hours a day.
  • The hospital is required to have at least 10 beds for its patients, who are undergoing medical treatment in the hospital. The 10-bed rule is applicable in towns that a have population of less than 10,00,000.
  • If the population of the town exceeds 10,00,000, then a minimum of 15 beds is required for patients at the hospital.
  • The hospital staff must be composed of highly trained and qualified medical practitioners, who are available 24 hrs a day.
  • The hospital is required to have a fully functioning operation theatre, where all the surgical procedures will be performed.
  • The hospital is also required to maintain a fully detailed record of its patients. And also make the patient records easily available to the concerned personnel of an insurance company.

The above-mentioned point constitutes the minimum criteria for any healthcare facility to be recognized as a hospital and different insurance companies can have different provider network requirements, as these insurance companies have their dependency on several factors such as “needs of their business, customer service quality, policy terms, and conditions”.

Benefits of Medical Empanelment

No matter the hardship but Hospital obviously benefits from getting themself empanelled, it will increase the trust of the patients in the hospital which in turn helps in increasing coverage of the patient base. The tag of empanelment on a hospital will assure the patients, that the hospital is fully committed to the betterment of their health and all the hospital medical services are up to the current benchmarks. It supports a Hospital to maintain a good position in society and is considered as an important Brand building exercise for the Hospital.

Nowadays new companies are being formed at a fast pace and even with the faster pace they are launching a new health scheme and keeping the hospital updated with such schemes and their processing puts the extra burden on hospitals, to pay extra on hiring staff filling data on portals, handling cashless etc. As there might not be any insurance literate staff in the hospital, and many times even doctors don’t know how to approach these specific companies because that's not their field.

Looking for Help in Medical Empanelment for your Hospital?

If you want to get your hospital registered / empanelled, then “Shreeji Healthcare Consultancy” is ready to help you along every step of the process. Our team of experts will take care of all the necessary paperwork and also liaison with the concerned departments. We promise to provide you with a completely hassle-free service.

Get in touch via 6354721824
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