Hospital Empanelment & Revision of MOU:

 

  1. Empanelment form(Click to download)
  2. Utilization sheet/New Procedure list(Click to download )
  3. Chapter IV/Annexure-1(Click to download )
  4. IRDA Annexures Circular(Click to download )
  5. Complete SOC (Both current and previous TWO years).
  6. Registration Certificate.
  7. Number of beds.
  8. Status of various Accreditations like NABH/QCI/JCI etc.
  9. List of TPA s providing cashless and Two MOU with TPA'S.
  10. List of Insurance Companies with whom Hospital has agreement and Two MOU with private insurers.
  11. Scanned Copies of Two Bills and Two Discharge summary as per IRDA standard format.
  12. Declaration on letter head that your hospital was not black listed or red flagged for involvement in any fraud with any insurance company.