Payer networks
Insurance Empanelment & Networking in India
We plan TPA empanelment and direct insurer tie-ups around the employers and policies in your catchment, prepare empanelment documents, negotiate package tariffs and support scheme empanelment for PM-JAY, state schemes, CGHS and ECHS where they fit your services. Insurers, TPAs and scheme authorities decide who joins their networks.
The rules of the ground
Who regulates and pays in India
IRDAI regulates health insurers and the third-party administrators that process many of their claims. For a private hospital, cashless access to a patient's policy depends on empanelment with each insurer or TPA network and on agreed package tariffs, and claims are increasingly moving onto the National Health Authority's National Health Claims Exchange (NHCX). Government schemes form a second channel: Ayushman Bharat PM-JAY and the state schemes that run alongside it, plus CGHS and ECHS panels for central government and ex-servicemen beneficiaries. Each payer has different rates, documentation and payment timelines, so the right mix is a commercial decision taken at setup, not after opening.
Regulates medical education and practice nationally and maintains the national medical register, while state medical councils register the doctors who practise in each state.
A board of the Quality Council of India that accredits hospitals, clinics and small healthcare organisations, with entry-level standards that give smaller facilities a realistic first step.
Regulates health insurers and third-party administrators, including the rules on cashless treatment, claims settlement and the networks through which private hospitals receive insured patients.
Runs Ayushman Bharat PM-JAY with the State Health Agencies, leads the Ayushman Bharat Digital Mission and operates the National Health Claims Exchange used for insurance claims.
Scope
What we deliver in India
Payer mix and network strategy
An analysis of which insurers, TPAs and plan tiers cover the population in your catchment, which ones competitors accept, and the order in which to approach them for the best return.
Empanelment application packs
Complete application files for each insurer or TPA: licences, practitioner credentials, service lists, equipment, accreditation evidence, quality indicators and facility profile, prepared to each payer's format.
Tariff and contract negotiation
Price list preparation benchmarked to regulator price references where they apply, review of contract clauses on authorisation, payment terms and audits, and negotiation support through to signature.
CHI accreditation readiness (KSA)
For Saudi providers, preparation for the Council of Health Insurance accreditation that insurers rely on, covering operational, financial, information management and revenue cycle requirements before network contracting.
Contract implementation
Network terms, price lists, co-payment rules and authorisation requirements configured in your HIS and briefed to front desk and billing, so newly signed contracts do not create a wave of rejections.
Network review and renewal
Annual review of each payer relationship covering volume, rejection trends, payment speed and profitability, used to prepare renewal negotiations or decide which networks to expand or exit.
Process
How the work runs
Assess readiness
We confirm that licences, practitioner credentials, service scope and systems meet what insurers typically require, and close gaps before any application is submitted.
Target payers
Using your specialties, location and patient profile, we agree a ranked list of insurers, TPAs and plan tiers to approach first.
Apply and follow up
Applications are submitted in each payer's format and actively followed up with network teams, answering queries and site-visit requests promptly.
Negotiate terms
We support tariff discussions and contract review so that pricing, payment terms and authorisation rules remain sustainable for your facility over time.
Go live
Contracts are loaded, staff are briefed and the first claims under each new network are monitored closely to catch configuration issues early.
Frequently asked questions
What does a healthcare consultancy in India do for a new hospital or clinic?
Is NABH accreditation mandatory for private hospitals in India?
Which law governs clinic and hospital registration in India?
Where does Tulazai Health work in India?
What is insurance empanelment for a clinic or hospital?
Can you guarantee that insurers will accept our facility?
Complimentary 30-minute call
Talk it through with a senior consultant.
Tell us where your facility is today and where you want it to be. You leave the call with a clear next step.