hospital-empanelment-criteria
hospital-empanelment-criteria
Hospital Empanelment Criteria for Network Hospitals (for availing cashless facility under health insurance policies)
Criteria | Definition |
Minimum number of beds (Other than single speciality hospitals like Eye/ENT) | 25 in Tier 1 Cities and 15 in other Cities |
Registration with local authorities | Mandatory (in applicable States) |
ROHINI ID | Mandatory |
NABH accreditation (Pre-entry level or higher) | Not mandatory but preferred |
Other licences | Drug licence for in-house pharmacy, Biomedical waste licence, Fire & Safety licence, AERB licence where radiology is available |
Infrastructure criteria | 1. Fully equipped ICU and OT 2. Round the clock qualified physicians and nursing 3. Should maintain and make daily records of patients available and accessible for insurance personnel |
Compliance with submission of NEFT/GST/MSME/KYC requirements | Mandatory |
Physical inspection of facilities/units | Mandatory |
Note: The minimum criteria mentioned above is mandatory for empanelment. However, in the event of the Provider not fulfilling any of the above criteria such as minimum bed requirement or requirement on physical inspection, such empanelment by TPA shall be subject to sign off by the Head of A & H Claims based on the merits of each case.
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