Hospital empanelment: verification for insurers and TPAs
A cashless network is only as trustworthy as the hospitals in it. When an insurer or TPA empanels a hospital, it is promising policyholders that they will be treated there and promising itself that the bills it receives are real. A careful verification at the start prevents many disputes later.
Why empanelment checks matter
- Existence: some "hospitals" are little more than a signboard and a few beds.
- Capacity claims: the number of beds, ICU facilities and specialists may be overstated.
- Registration: a missing or expired registration is a basic red flag.
- Billing behaviour: hospitals that pad bills or admit patients unnecessarily raise claim costs for everyone.
- Ownership and conflicts: who actually runs the place?
What to verify
- Registration and licences: the hospital's registration with the relevant authority, and any required licences.
- Business details: the legal entity, its address and tax registrations.
- Facilities: wards, beds, ICU, operation theatre, pharmacy and diagnostics, as declared.
- Staff: doctors and nursing staff present, with registrations where required.
- Location: the premises match the declared address, with live location recorded.
- Rate card and billing process: how bills are raised and who approves them.
- Past complaints or claim patterns where available to you.
Why video helps
A physical audit remains the gold standard for some decisions, but it is slow and costly across many cities. A recorded live video tour lets a team see the reception, wards and equipment within a day, with location and time saved. It is also easy to repeat at intervals and to compare with the declared details.
How Praman helps
Praman by SatyaSakshi lets a TPA or insurer send the hospital's representative a WhatsApp link. They join a live video tour, show the facilities and answer your questions while the call records location, time and photos. Business details can be checked alongside, and a reviewer approves the final audit result. Reports are kept per hospital, so a later review can compare against the original. Where a physical audit is still needed, SatyaSakshi's field team can handle it within the same case.
Frequently asked questions
Why verify a hospital before empanelment?
A network hospital serves thousands of policyholders. Confirming it exists, is registered and has the facilities it claims protects customers and reduces claim disputes.
Can a hospital be audited on video?
Yes, for many checks. A staff member gives a live tour of reception, wards and equipment with location and time recorded. A physical audit can follow where your policy requires it.
How often should hospitals be re-checked?
Many insurers review at empanelment and then periodically or when claim patterns raise questions. Follow your own network policy.
Related: how Praman handles this for businesses · all instant checks
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