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Hospital Criteria

 

The Selected Shall Confirm To the Following
Criteria for Empanelment of Public Hospitals
All Government hospitals (including Community Health Centers) and ESI hospitals can be empanelledprovided they possess the following minimum facilities
  • Telephone/Fax,
  • Internet connectivity
  • A Personal Computer
  • Two smart card readers and
  • Fingerprint verification machine or a standalone machine matching the given specifications
  • The facility should have an operational pharmacy and diagnostic services, or should be able to link with the same in close vicinity so as to provide ‘cash less’ service to the patient. The diagnostic service should include testing of clinical specimens, X-rays and ECG etc.

Criteria for Empanelment of Private Providers

  • At least 10 inpatient medical beds for primary inpatient health care. The requirement of minimum number of beds can be reduced in consultation with the State Government/ Nodal Agency based on available infrastructure in rural areas.
  • Fully equipped and engaged in providing Medical and/ or Surgical facilities. The facility should have an operational pharmacy and diagnostic services, or should be able to link with the same in close vicinity so as to provide ‘cash less’ service to the patient. The diagnostic service should include testing of clinical specimens, X-rays and ECG etc.
  • Those facilities undertaking surgical operations should have a fully equipped Operating Theatre of their own.
  • Fully qualified doctors and nursing staff under its employment round the clock.
  • Maintaining of necessary records as required and providing necessary records of the insured patient to the Insurer or his representative/Government/Nodal Agency as and when required. The list of documents to be kept at the hospital ends are:
    • Copy of discharge summary
    • Indoor case papers and OT records (which shall have daily treatment update)
    • Final bill
    • Copy of investigation reports
    • Any other relevant document
  • Fully qualified doctors and nursing staff under its employment round the clock.
  • Registration with service Tax Department.
  • Telephone/Fax, internet connectivity. Each hospital/health service provider shall posses a Personal Computer with 2 smart card readers and a fingerprint verification machine or a standalone machine matching the required specifications. These hardware and software will be procured through a vendor selected by either the Insurance Company/ TPA or SNA. The specification of the kit items would be
    • Internet connectivity
    • Dedicated telephone/ fax line
    • Computer should be capable of supporting all devices as mentioned above
    • Optical biometric scanner for fingerprint verification as per specification mentioned below:
      • Thin optical sensor
      • Minimum 500 ppi @ 8bit per pixel
      • Active area: 13mm x 20mm
      • 1:1 search
      • Tunable false acceptance rate
    • Smart card readers; 2 smart card reader (one each for hospital authority and beneficiary card) would be required with the following specification,
      • PCSC compliant
      • Read and write all microprocessor cards with T=0 and T=1 protocols
    • Other devices like printer, modem, etc may be required as per software. The same would be specified by the insurance company at the time of empanelling the hospital.
  • The Hospital should agree to the cost of packages for each identified medical/surgical intervention/procedures as approved under the scheme. These package rates will include Bed charges (General Ward), Nursing and Boarding charges, Surgeons, Anesthetists, Medical Practitioner, Consultants fees etc, Anesthesia, Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances etc, Medicines and Drugs, Cost of Prosthetic Devices, implants, X-Ray and Diagnostic Tests and any other expense directly relate to the clinical treatment of the patient and food to patient. Expenses incurred for diagnostic test and medicines up to 1 day before the admission of the patient and cost of diagnostic test and medicines up to 5 days of the discharge from the hospital for the same ailment / surgery and transport expenses form part of package. The package also covers the entire cost of treatment of the patient from date ofreporting to his/her discharge from hospital and 5 days after discharge and any complications while in hospital, making the transaction truly cashless to the patient.

 

 

 

 

 

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