Empanelment is an important exercise which directly influences increased influx of patients requiring medical treatment/diagnostic intervention. Empanelment has various benefits to any medical practice. Empanelment is a process in which there is a provider network.
Various benefits to any medical practice.
- Increased coverage in patient base,
- Access to patients directly through other healthcare stakeholders.
- Providing convenience to patients with the provision of cashless facility
- More credibility to the practice as empanelment is a through verification process and patients perceive this as recognition especially in cases of government empanelment.
- Brand building exercise for the practice
- The practice /health care set up which is empanelled with this network provide cashless or charge a minimum to avail of diagnostic services or hospitalization
This provider network consists of:
- Third Party Administrator (TPAs)
- Insurance Companies
- Governmental agencies like ECHS, CGHS, DGEHS, MCD, DDA & others
- Corporate tie ups for health check ups
1. Third Party Administrator (TPAS)
TPA is essentially facilitators for providing the cashless facility for the insurance companies. Some insurance companies are directly involved also with the hospital for provision of this facility. They channelize a system to regulate the tie-ups/empanelment for hospital. TPA is an intermediary body which is authorized by its empanelled insurance company with which the patient has a standard Mediclaim Policy.
2. Insurance Companies
A company that offers insurance policies to the public, either by selling directly to an individual or through another source such as an employee’s benefit plan. An insurance company is usually comprised of multiple insurance agents. An insurance company can specialize in one type of insurance, such as life insurance, health insurance, or auto insurance, or offer multiple types of insurance.
3. Governmental agencies like ECHS, CGHS, DGEHS & others
Governmental agencies means an executive, legislative, or judicial agency, department, board, commission, authority, institution, unit, or instrumentality of the federal government or of a state or of a county, municipality, conservation and reclamation district, hospital organization or other political subdivision of a state.
- Ex-Servicemen Contributory Health Scheme (ECHS)
The ECHS was launched with effect from 01 Apr 2003. With the advent of this scheme. Ex-servicemen pensioners and their dependants who were only entitled for treatment in service hospital are now authorised treatment, not only in service hospitals, but also in those civil/private hospitals which are specifically empanelled with the ECHS.
- Central Government Health Scheme (CGHS)
CGHS was started under the Indian Ministry of Health and Family Welfare in 1954 with the objective of providing comprehensive medical care facilities to Central Government employees, pensioners and their dependents residing in CGHS covered cities. It has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under CGHS of specific treatment procedures listed under CGHS rate list, are advised by a specialist in a central government/state government specialist hospitals or a CGHS Medical Officer, without any requirement of any other referral (permission) letter.
- Delhi Government Employees Health Scheme (DGEHS)
DGEHS was launched in April 1997 with a view to provide comprehensive medical facilities to Delhi Government employees and pensioners and their dependants on the pattern of Central Government Health Scheme. All health facilities (hospitals / dispensaries) run by the Govt. of NCT of Delhi and autonomous bodies under Delhi Government, local bodies viz. MCD, NDMC, Delhi Cantonment Board, Central Government and other Government bodies [such as AIIMS, Patel Chest Institute (University of Delhi) etc.] are recognized under the scheme. In addition, some Private Hospitals/Diagnostic centers notified from time to time are also recognized/ empanelled as referral health facilities.
4. Corporate tie ups for health check ups
Companies which involve jobs with risky nature need to have tie ups with hospitals to address to the medical emergencies that might surface on a regular basis. In such a scenario, it is important to have a formal tie up the hospital to keep the process smoother and faster.
Corporate Health Checkup : A healthy employee equals a flourishing business. When the workforce is hale and hearty, productivity behind the desk increases many fold.At present, organisations and corporates are emphasising enormously upon their employee’s health. Corporate health checkups are a mandate with every company. Such unhealthy ways of living may lead to several diseases. Unfortunately, lifestyle diseases like heart ailments, diabetes, high blood pressure and certain cancers remain asymptomatic in their initial stages and do not exhibit pronounced symptoms. Due to this, diseases lay hidden and go unnoticed for a long duration until they reach their late stages when the treatment and management becomes extensive, expensive and difficult.