Empanelled with Govt. / Public Sector / Banks (attach self attested copies of work orders/empanelment letters) Name of the Organization Year since empanelled
Empanelled. Hospital also undertakes to hold all the requirements of law in so far as these apply on them and in accordance with the provisions of the law and regulations which are enacted by the Central & State Governments, local bodies from time to time including the system required for disposal of Bio‐Medical Waste as per the environment law.
Empanelled. Hospital will instruct / convey to their team of doctors, attached consultants to provide treatment to the member(s) for which he / she is hospitalized / admitted, only for the required number of days which is absolutely necessary and to carry out investigation and treatment required for that particular ailment.
Empanelled. Hospital will give 10% discount on Schedule of Charges. Further discount on volume of business on mutually agreed terms.
Empanelled. Hospital shall provide inpatient Services to a member in Planned Surgical/Chronic Cases only after the hospital had received Authorization letter from the AHCL in advance. However In case of Emergency Empanelled Hospital shall attend to the Patient immediately and also process the Pre‐authorization request with all details filled there in simultaneously which should be sent to AHCL forgetting required approval. Any Mis‐representation by the Hospital would call for rejection of the request/Claim and AHCL would not be held responsible for the same in any manner whatsoever.
Empanelled. Hospital will submit the final xxxx to AHCL along with all the necessary documents / reports as per the agreed Schedule of Charges preferably within 7 days from the date of discharge of the Member(s). In case of failure to submit the claim within 30 days AHCL will not be held responsible for the payment of the said claims.
Empanelled. Hospital declares that, their undertaking and declaration with respect to this agreement are pre‐requisite for the TPA to enter into an agreement and without these undertaking / declaration, the TPA would not have been willing to enter into an agreement with Empanelled Hospital. These undertakings / declarations will be in force for the entire duration of this agreement and minimum three years after this agreement is terminated.
Empanelled hospital/diagnostic center shall submit original hard copies of bills along with duly signed detailed discharge summary and chronologically placed clinical sheets/investigation reports/blood bank notes/IPD notes (if needed)/ clinical reports/films/pouches/invoices/price stickers/utilization certificates/OT Notes/ pre and post operation radiological images for procedures/wrappers and invoice for drugs costing more than Rs. 5000/- or any other requirement (as per T&C of MoU which the hospitals and diagnostic centers have with ESIC) etc, which were uploaded in the system in support of claim, within 7 (seven) working days and not beyond 30 days to the ESIC/ESIS Hospital/Institution from where referral was generated. Any bill/claim submitted beyond should be accompanied with online/offline waiver (as applicable) from ESIC/ESIS Hospital/institution and BPA shall not adhere to TAT while processing such claims. The claim should be physically submitted at Regional Office as soon as the BPA has processed the bills.
Empanelled. Health Care Provider means a hospital, a nursing home, a district hospital, a CHC, or any other health care provider, whether public or private, satisfying the minimum criteria for empanelment and that is empanelled by the SHA in accordance with terms of this Contract for the provision of health services to the Beneficiaries under AB- PMJAY
Empanelled. Hospital declares that, they have never committed a criminal offense which prevents them from admitting indoor Patients and that no criminal charge of any kind has ever been filed against them for Medical Negligence against the Hospital/Medical personnel by the Medical Association/Council/Court. They also undertake to inform the AHCL regarding any complaint of medical Negligence which may be filed against them during the period of this agreement.
