Government Health Scheme Tie-Up
Guidance regarding empanelment process for PMJAY, CGHS, ECHS, ESIC, and State Health Schemes.
About Our Empanelment Services
Our Consultancy provides guidance regarding the empanelment process for PMJAY (Ayushman Bharat), CGHS, ECHS, ESIC, State Health Schemes, and other authorized programs.
We help hospitals navigate the complex documentation and compliance requirements to serve government beneficiaries effectively.
Objective
To provide high-quality, safe, and equitable healthcare services to beneficiaries in line with:
- NABH standards for patient care and rights.
- Transparency in billing and entitlement communication.
- Accountability and efficiency in claim processing.
- Ethical medical and financial practices.
Major Government Scheme Benefits
We support empanelment for the following major schemes:
PMJAY (Ayushman Bharat)
- Cashless hospitalization up to ₹10 lakh per family.
- Covers over 1,500 procedures.
- Zero out-of-pocket expenses for beneficiaries.
- NABH-accredited hospitals are preferred.
CGHS (Central Govt)
- For Central Govt employees & pensioners.
- Cashless & reimbursable treatment at package rates.
- Includes OPD, IPD, diagnostic & emergency.
- NABH compliance ensures quality norms.
ECHS (Ex-Servicemen)
- For ex-servicemen and dependents.
- Cashless treatment in empanelled hospitals.
- Comprehensive coverage including surgeries.
- Focus on rehabilitation and diagnostics.
ESIC (Employees State Insurance)
- For industrial/organized sector employees.
- Medical, surgical, and maternity care.
- Cashless healthcare for eligible citizens.
- NABH standards ensure proper records.
NABH Alignment in Scheme Implementation
Empanelled hospitals must ensure adherence to the following NABH guidelines:
| NABH Standard | Requirement |
|---|---|
| PRE (Patient Rights) | Beneficiaries are informed about entitlements, coverage limits, and exclusions. |
| AAC (Access & Care) | Prompt admission and appropriate care are provided to eligible patients. |
| IMS (Info Management) | Secure, accurate, and confidential data handling for scheme beneficiaries. |
| CQI (Quality Improvement) | Monitoring of claim processing, patient feedback, and service turnaround. |
These principles ensure transparency, patient safety, and accountability.
Process for Scheme Beneficiaries
Verification
Patients present scheme card/ID for verification at the front desk.
Pre-Auth
Hospital submits request to government portal or nodal agency.
Treatment
Once approved, patients receive cashless treatment per guidelines.
Discharge
Discharge summary and claim documents submitted for settlement.
Feedback
NABH-compliant feedback and grievance mechanisms.
Benefits of Tie-Ups
Access to quality healthcare for all socio-economic groups.
Cashless hospitalization for eligible beneficiaries.
Standardized treatment costs as per approved rates.
Reduced financial burden on patient families.
Compliance with NABH and scheme quality parameters.
Transparent claim management and documentation.
Why Choose Us?
Experience
Empanelment under major Central & State schemes.
NABH-Mitra
Ensuring authentic and accurate services.
Helpdesk
Dedicated support for hospitals & organizations.
Speed
Quick turnaround for approvals and discharges.
Our Commitment
“Accessible care, assured quality — serving the nation through government healthcare partnerships.”
We believe that quality healthcare is a right, not a privilege.
