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.
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.