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Govt & Insurance Companies Empanelments

Empanelment is a very important exercise which directly influences the increased flow of patients into the organization who require any kind of medical treatment.

BENEFITS OF EMPANELMENT AND GOVT.INSURANCE COMPANIES:

  • This benefits the coverage and the reach in patient base.
  • The organization can have direct access to patients through various other healthcare stakeholders.
  • It provides a lot of convenience to patients with the provision of a cashless facility.
  • As empanelment is through the verification process, patients perceive it as recognition especially in the cases of government empanelment.
  • It is like a practice for brand building exercise.
EMPANELMENT PROCESS

The process of empanelment consists:

  • Health facility mapping.
  • Contracting the providers that fulfill the set of criteria required.
  • After contracting the provider the requesting company sends a request to technology partner to install and activate RSBY OP technology.
  • The insurance company then trains empanelled providers on delivery of RSBY OP, the process of claiming, benefits package and the reimbursement of payment.
There is a provider network in the process of empanelment which consists:

  • Third party administrator. (TPA)
  • Many government agencies like the ECHS, CGHS, DGEHS, MCD, DDA, and others.
  • Tie-ups with corporate for health check-ups.
THIRD PARTY ADMINISTRATOR (TPA)

  • It is basically facilitations for providing a cashless facility for insurance companies.
  • Some insurance companies are directly involved with the hospital for the provision of this facility.
  • TPA is an intermediate body authorized by its empanelled insurance company with which the patient has a standard mediclaim policy.
  • The patients working with defense or central government have their own healthcare provision facility from the government body.
  • The healthcare facilities are issued an ID card and necessary papers to avail their cashless treatment at the empanelled hospital.
  • This ensures maximum convenience for the patients and a temporary financial relief in case the bills are huge.