7/31/2019 Empanelment Requirement

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NS-ENISO9001:2008/ISO9001:2008

HEALTH CARE TPA L

11Corp. Office: Alankit House, 2E/21 Jhandewalan Extn., New Delhi

Phone: 42541256- -67, E- health@alankit.60, Fax: 42541266 mail:

REQUIREMENT FROM HOSPITAL FOR EMPANELMENT ANNEXURE-I

1. Hospital Profilea. No. of Beds with details including I.C.U., N.I.C.U., etc.b. Detailed list of OT Equipments .c. RMOs Qualification.d. No. of Nurses with their Qualification.

e. OT size.f.

Laboratory facilities available In house & Name of the Pathologist & hisqualification

g.

X-ray facility available

In house & Name of the Radiologist & his qualification

h.

Pharmacy

Facility

In-house

i.

Ambulance Facilities.

2.

List of Consultant with their Qualification (necessary) & Certificate of Qualification

(ifpossible).

3.

Soft & Hard copy of Detailed Tariff List

which contains details

of room rent including(nursing care charges, RMOs charges), Package rates of all Operation/Treatments

in the prescribe format as shown below

(MANDATORY).

ROOM RENT CHARGES

CATEGORY OF ROOMRENT TYPE

GEN/CUB/WARD

SHARINGROOM

PRIVATEROOM

A/CROOM

ROOM RENT, NURSINGCARE CHARGES/DAY,RMOS CHARGES/DAY

CONSULTANT FEE/VISIT -

SPECIALIST

CONSULTANT FEE/VISIT -

SUPER

SPECIALIST

PACKAGE TARIFF

RATES

S.NO

PACKAGES

GEN-WARD

SHARING ROOM

SINGLE ROOM

1

PACKAGE

1

2

PACKAGE

2

PACKAGE TARIFF

PERCENTAGE INCREASE

S.NO

PACKAGES

GEN-

WARD(BASE)

SHARING

ROOM(%INCREASE)

SINGLE

ROOM(%INCREASE)

1

PACKAGE 1

2

PACKAGE 2

*% Increase is with respect to the General Ward

Package rates

of treatment/Operation should include

a.

Room rent, Nursing care charges.

b.

Investigation charges.

c.

Surgeon charges, Asst. surgeon charges, Anaesthesist charges.

7/31/2019 Empanelment Requirement

2/2

NS-ENISO9001:2008/ISO9001:2008

HEALTH CARE TPA LT

110Corp. Office: Alankit House, 2E/21 Jhandewalan Extn., New Delhi

Phone: 42541256- -67, E- health@alankit.c60, Fax: 42541266 mail:

d. OT charges, OT consumbales.e. Medicine charges.

4. Copy of PAN of the hospital (Mandatory).5. Copy of Registraion Certificate of Hospital.6. Proof of Excemption Certificate if possessed by Hospital, otherwise TDS will be

deducted on final bill (as per income tax rules).7. E-mail ID of the hospital.8. Name of the Grievance officer with mobile no.9.

Bank Account No. of the hospital (mandatory)

Note: Please mention for how many years the above agreed tariff would be available(with mutual consent)

ON RECEIPT OF ABOVE

AND AFTER APPROVAL,

FURTHER PROCESS OF

EMPANELMENT WOULD

START IN WHICH WE SEND THE BELOW

MENTIONEDDOCUMENT TO HOSPITALS.

1.

2 copies of MOU.

2.

Hospital Information Sheet.

3.

ECS form.

Hospitals are required to complete these document,

duly signed and stamped fromauthorized signatory

and send back to us for

final processing.

POINT TO BE NOTED

1. Reusable items are not payable like.

a.

C-ARM.

b.

REUSABLE EQUIPMENT CHARGES.

c.

PULSE OXYMETER.

d.

MONITOR CHARGES.

e.

LAPROSCOPIC INSTRUMENTS, ETC.

f.

NO DIET CHARGES.

g.

NO ADMISSION/ REGISTRATION CHARGES, FILES CHARGES,ETC.

h.

NO SEPARATE P HACO CHARGES.

i.

ROOM RENT ARE NOT PAYABLE IN DAYCARE EYE SURGERIES.

j.

SERVICE CHARGES AND ANY TYPE OF TAXES ARE NOTPAYABLE.

Payments

related to above mentioned

and similar

items

should be charged directly frompatients

before discharge.

2.

Disposable items are

payable, if used.

The Tariff rates given by the hospital would be applicable for 3 years from signingthe agreement and would not change during the period.