All You Need To Know About CGHS Empanelment

The Central Government Health Scheme (CGHS) was introduced in 1954 with the aim of providing comprehensive medical care to central government employees, pensioners and their dependents residing in CGHS-covered areas. The scheme is currently operational in about 75 cities across India.

In order to be able to avail of the benefits of the scheme, one has to get oneself empanelled with a CGHS-recognized hospital or dispensary. The process of empanelment is fairly simple and straightforward.

In this article, we will take you through the entire process of CGHS empanelment step-by-step.

1. What is CGHS Empanelment?

CGHS empanelment is the process where in a medical facility (hospital, clinic, dispensary, etc) is registered with the Central Government Health Scheme (CGHS). Once a provider is CGHS-empanelled, they can provide medical services to the beneficiaries of CGHS, who include central government employees, pensioners, and their dependents.

Generally, a provider needs to satisfy some minimum criteria before they can be considered for empanelment. These criteria may vary depending on type of provider and the location. The application for empanelment can either be made online or by submitting a hard copy of the application form.

Once a hospital or dispensary has been empanelled, they can provide medical coverage to CGHS beneficiaries as well as receive funds from CGHS for the services provided. CGHS also provides further incentives to CGHS-recognized hospitals for performing certain types of surgeries or treatments.

2. The process of CGHS Empanelment

The process of CGHS empanelment may vary depending on the type and location of the provider, but in general there are certain common steps that must be followed.

Firstly, the provider must satisfy the minimum criteria as stipulated by CGHS in order to be considered for empanelment. This criteria generally includes factors such as infrastructure and facilities, availability of manpower and supplies, etc.

Then, the provider will need to submit either an online application or a hard copy of a form, depending on their location. This form will typically ask for some basic information about the provider, such as their name, contact details, and a list of services that they provide.

Once the application has been submitted, the provider will need to wait for an approval from the relevant CGHS authorities. Depending on the situation, the approval process can take anywhere from a few weeks to several months.

Once the provider has been approved, they will be assigned a unique ID and will be listed in the CGHS database, which will allow them to provide medical coverage to CGHS beneficiaries and also receive payments from CGHS for the services they provide.

In some cases, CGHS may require some additional documents before the provider can be empanelled, such as proof of registration with the Medical Council of India, etc. These documents must be submitted before the application can be processed.

3. CGHS Hospital Empanelment

CGHs Hospital empanelment is a process that is distinct from general empanelment and has its own set of rules and regulations. Hospital empanelment involves a more rigorous process that changes based on the type and location of the provider.

The process of CGHs hospital empanelment is similar to the empanelment of general providers but has some additional requirements such as the infrastructure must meet certain standards, and the capacity and availability of manpower.

The hospital also needs to submit additional documents such as proof of registration with the Medical Council of India, an authorization from the state government, and a service agreement that outlines the obligations of both parties. This agreement will detail the terms of service, the responsibilities of both parties, and the responsibilities of the hospital in terms of quality control, patient safety, and medical auditing.

Once the process is complete and the empanelment is approved, the hospital can start receiving patients and payments from CGHS under the terms of the service agreement.

4. CGHS Empanelment application form

To apply for CGHS empanelment, the hospital must fill up the empanelment application form. This application form requires the hospital to provide information about the hospital, its infrastructure, and its manpower. Here is a list of the items required to complete the CGHS empanelment application form.

  • 1. A valid PAN card of the hospital.
  • 2. A valid corporate identity number (CIN) of the hospital.
  • 3. Details of the lease or rental agreement, if applicable.
  • 4. Facility survey report.
  • List of the hospital infrastructure and services.
  • Details of manpower and specialized medical equipment.
  • Certification by the statutory medical bodies, such as Medical Council of India or State Medical Council.
  • Copy of the service agreement between the hospital and CGHS.
  • 9. Details of any commitments or agreement of the hospital with other CGHS networks.
  • Authorization from the state government for operating the hospital.
  • Copy of the hospital registration with the local civic body.

5. CGHS Empanelment hospital

Once you have completed and submitted the CGHS empanelment application form, the CGHS office will review it and decide whether to empanel the hospital. Here are some factors that the office takes into account when considering empanelment:

1. Infrastructural Requirements – The hospital must have necessary infrastructural facilities like adequate beds, patient wards, operation theatres, and diagnostic services.

2. Manpower Necessity – The hospital must have adequate number of doctors and paramedics to provide the required services.

3. Quality of Service – The hospital should be able to provide quality service to the CGHS beneficiaries.

4. Past Performance – The hospital must have a good record of delivering quality service to its patients.

The CGHS office may also conduct an on-site review to check the hospital’s infrastructure, services provided and manpower availability. If the CGHS office is satisfied with all the requirements, then it will empanel the hospital.

6. CGHS Empanelment Procedure

Once the CGHS office is satisfied with the hospital’s inflow requirements and past performance records, then the hospital is eligible for its empanelment. The empanelment process involves the following steps:

1. Approval of Proforma – An application proforma is provided to the hospital. It has to be approved by the CGHS office after inspection of the hospital’s infrastructure.

2. Fee Structure Verification – The CGHS office verifies the fee structure of the hospital and reserves the right to approve or reject the fees charged.

3. Quality Check – A quality assurance team will review the services, infrastructure and staff at the hospital.

4. Acknowledgement of Hospital – After passing all the required checks and inspections, the CGHS office will provide an acknowledgement letter indicating the hospital’s eligibility for empanelment.

5. Approval Letter – After receiving the acknowledgement letter, the hospital is required to send back the duly filled forms to the CGHS office for approval. The office will provide a signed copy of the approval letter to the hospital.

After the CGHS office provides the approval letter, the hospital can proceed with the billing process and provide services to the CGHS beneficiaries.

7. CGHS Empanelment for dental clinic

The CGHS office provides empanelment for dental clinics too. For dental clinics, the empanelment procedure involves the same steps listed above with some additional requirements. All the required documents need to be submitted in a prescribed form. These documents include a certificate that shows the registration granted by the dental council of India, a copy of the physical layout of the dental clinic, and proof of professional indemnity insurance.

The dental clinic must also provide a valid dental practice license, latest accreditation certificate and electricity bill to the CGHS office. The clinic should also have a minimum of two to four dental chairs and other basic dental equipment as per the guidelines of the Dental Council of India.

The quality assurance team from the CGHS office will also inspect the dental clinic for infrastructure, hygiene and staffing. The CGHS office will provide an acknowledgement letter indicating the dental clinic’s eligibility for empanelment, once all the criteria is met. The dental clinic can then start the billing process and provide services to the CGHS beneficiaries.

8. CGHS Empanelment guidelines

The CGHS office has set up a set of guidelines that dental clinics need to follow in order to get empaneled. These guidelines include:

  • – Adequate dental chairs, equipment and staff
  • – Hygiene and sterilization maintenance
  • – Compliance with all regulations prescribed by the Dental Council of India
  • – Use of quality materials and products
  • – Constant maintenance of records
  • – Use of proper protocols for diagnosis and treatment
  • – Adherence to ethical codes of conduct
  • – Timely availability of services
  • – Strict and accurate billing process

The guidelines mentioned above are strictly enforced by the CGHS office and the dental clinics that do not comply with these guidelines may be denied empanelment or may be subjected to penalties. Therefore, it is important for the dental clinics to adhere to the guidelines in order to ensure proper functioning of the clinic and benefit from the services provided to CGHS beneficiaries.

9. CGHS Empanelment form for private hospitals

In order to avail of the benefits provided by the Central Government Health Scheme (CGHS), private hospitals need to apply for cghs empanelment. The process for obtaining cghs empanelment for private hospitals is a bit different from that of dental clinics.

Private hospitals need to submit an application in the prescribed form comprising of details such as the name and address of the hospital, services available, infrastructure, number of beds, departments, doctors, staff, etc. The form also requires the hospital’s bank details and PAN as well as the details of the person/administrator responsible for the empanelment. After submitting the empanelment form and the required documents, the hospital will have to appear for an inspection and selection process conducted by the CGHS officials.

Once the hospital is selected and empanelled, the hospital is eligible to provide services to CGHS beneficiaries. The hospital has to provide quality services and maintain the necessary requirements as per the guidelines of the CGHS in order to remain valid. The hospital has to abide by the CGHS rules and regulations and must be compliant with the conditions mentioned in the contract.

10. CGHS Empanelment checklist

The Central Government Health Scheme (CGHS) empanelment checklist contains the following key details:

  • 1. A valid, self-attested PAN card of the hospital.
  • 4. Documents of facilities/services offered by the hospital, such as scanned copies of availability of laboratory, operation theatre, services provided, etc.
  • 5. A detailed report of the hospital’s capacity including number of beds, number of doctors and staff, etc.
  • 6. A list of current medical equipment and emergency response capability with contact information of emergency services.
  • 7. A properly signed, self-attested agreement between the hospital and the CGHS officials.
  • 8. Trade license/ Municipal license of the hospital.
  • 9. Any other document specified in the CGHS hospital empanelment form.

11. What are the benefits of CGHS Empanelment?

The benefits of CGHS empanelment are numerous and include:

1. Increased patient inflow: Once your hospital is listed by the CGHS, you are likely to attract more patients who are under the purview of CGHS, potentially resulting in increased revenue.

2. Standardized treatment and facilities: CGHS sets standards for the hospitals in its network, so you can rest assured that your hospital is following a set standard of care.

3. Improved Quality of Healthcare: CGHS empanelment encourages hospitals to provide high-quality healthcare, further enhancing your reputation.

4. Greater Cost Savings: By empanelling your hospital with CGHS, you can save on administrative and other costs, as CGHS brings together all the stakeholders in one location.

5. Better Access to Reimbursed Treatment: For CGHS beneficiaries, CGHS empanelled hospitals provide accessible, reimbursable treatments. Your hospital will benefit from the increased number of CGHS patients as well as the frequent visits by CGHS members.

12. To wrap things up

To wrap things up, CGHS empanelment serves as a symbol of recognition for your hospital and its services. It also ensures that your hospital is capable of providing the highest quality care in both its treatment and facilities, as set by the CGHS standards.

Empanelling your hospital with CGHS protects you from any mismanagement and enhances your reputation as a high-quality healthcare provider.

CGHS also provides cost savings to both your patients and your hospital. Last but not least, you will get increased access to CGHS-reimbursed treatments, further fulfilling your commitment to patient-oriented care.