1. Why Hospitals Need Empanelment Consultancy

Empanelment with TPAs and government schemes like CGHS, DGEHS, ECHS, Ayushman Bharat, and GIPSA panels enhances patient access, cashless facility availability, and overall hospital revenue. A consultancy helps manage eligibility, documentation, negotiations, and process integration to ensure smooth onboarding and long-term compliance.

2. Scope of Empanelment Consultancy Services

Choose consultants offering end-to-end support, including:

• Identification and prioritization of empanelment opportunities (TPA, CGHS, GIPSA, ECHS, DGEHS, Ayushman)

• Eligibility assessment and application preparation

• Rate negotiation and MoU signing

• Coordination with empanelment authorities

• SOPs for cashless billing, pre-auth, and claims

• Training for billing, insurance desk, and front office teams

3. Experience with Government and Private Panels

Select consultants with strong experience in:

• GIPSA (General Insurance Public Sector Association) empanelment

• CGHS (Central Government Health Scheme)

• DGEHS (Delhi Government Employees Health Scheme)

• ECHS (Ex-Servicemen Contributory Health Scheme)

• Ayushman Bharat (PM-JAY) scheme

• TPAs like Medi Assist, FHPL, Vidal Health, etc.

• Compliance with IRDAI and National Health Authority (NHA) guidelines

4. Tailored Solutions for Your Hospital Type

Ensure the consultant can customize services for:

• Eye hospitals, diagnostics, surgical centers, maternity homes, or multispecialty setups

• NABH-accredited or entry-level hospitals seeking empanelment as a growth strategy

• Hospitals in Tier 2/3 cities aiming for government empanelments to expand patient reach

5. Cost Considerations

Empanelment consultancy cost varies by service scope and number of panels:

Additional costs may apply for post-empanelment support, follow-ups, and integration with hospital billing systems.

6. Training, Support & Compliance Readiness

Consultants should offer:

• Pre-authorization and billing staff training

• SOPs and documentation templates for each panel

• Dashboard & claim tracking process setup

• HIS/ERP integration with empanelment workflows

• Claim rejection audit and resolution support

• Post-empanelment handholding for 3–6 months, including renewal coordination