TPA and Insurance Empanelment (Cashless Network Tie-ups)

What insurers check

Insurers follow IRDAI's definition of a hospital. A typical insurer empanelment policy — IFFCO-Tokio's, for example — asks allopathic hospitals for:

• at least 10 in-patient beds in towns with a population under 10 lakh, or 15 elsewhere;
• qualified nursing staff and a qualified doctor in charge round the clock;
• a fully equipped operation theatre of its own for surgical procedures;
• daily patient records accessible to the insurer;
• registration under the Clinical Establishments Act or the state's equivalent law.

For AYUSH hospitals the bar is at least 5 in-patient beds, a qualified AYUSH practitioner in charge round the clock, dedicated AYUSH therapy sections and accessible daily records — the same criteria NABH uses for entry-level AYUSH hospital certification.

The ROHINI ID

Insurers ask for a unique ROHINI ID before considering empanelment. We register you on the ROHINI portal first so the rest of the process does not stall.

Documents insurers typically ask for

• Application and due-diligence form, and the agreement or MoU on stamp paper
• Hospital schedule of charges (tariff) and any discount letter
• ROHINI ID, PAN, cancelled cheque, GST registration
• Clinical establishment registration (or shops and establishments registration where no clinical establishments law applies)
• NABH certificate or acknowledgement, if held
• KYC of the owning entity and authorised signatory
• List of existing insurers and TPAs
• Infrastructure photographs, pathologist details or outsourced lab arrangements
• Biomedical waste, fire safety and pollution certificates

Public sector insurers: GIPSA PPN

The four public sector insurers — New India Assurance, Oriental Insurance, United India Insurance and National Insurance — form GIPSA and contract hospitals into a Preferred Provider Network with agreed package prices for specific procedures. Private insurers run their own preferred networks. Package rates are commercial and negotiated; accreditation, clean claim history and good documentation all improve your position.

How we help

We register you on ROHINI, prepare a tariff that will survive insurer scrutiny, build the document set once and adapt it for each insurer and TPA, and follow up to agreement. Hospitals already working towards NABH get the most out of insurance tie-ups.