Tender Notice Dt - Department of Health , J&K

e) Pre-Authorisation function for the interventions which are not includedin the package rates.f) Paperless Claims settlement for the hospitals with electronic clearingfacility.g) Publicity for the scheme so that all the relevant information related toRSBY reaches beneficiaries, hospitals etc.h) Dispute Resolution functions as explained below in the tender.i) Hospital Empanelment of both public and private providers based onempanelment criteria. Along with criteria mentioned in this tender,separate criteria may jointly be developed by State Government/ NodalAgency and the Insurance Company.j) Feedback functions which include designing feedback formats,collecting data based on those formats, analyzing feedback data andsuggest appropriate actions.k) Coordinate with district level Offices in each selected district.l) Coordinate with State Nodal Agency and State Government.The Insurer shall set-up a district office in each of the project districts of theState. The district office will coordinate activities at the district level. Thedistrict offices in the selected districts will perform the above functions atthe district level.17. Management Information Systems (MIS) ServiceThe Insurer shall provide Management information system reports wherebyinformation regarding enrolment, health-service usage patterns, claims data,customer grievances and such other information regarding the delivery ofBenefits as required by the Government. The reports will be submitted bythe Insurer to the Government on a regular basis as agreed between theParties in the prescribed format.The Insurer shall provide facility of the District Kiosk. District Kiosk willhave a data management desk for post issuance modifications to the smartcards as described in Annexure -16. The role and function of the districtkiosk has been provided in Annexure – 17.All data generated under the scheme shall be the property of theGovernment.18. Call Center ServicesThe Insurer shall provide telephone services for the guidance and benefitof the beneficiaries whereby the Insured Persons shall receive guidanceabout various issues by dialing a State Toll free number. This serviceprovided by the Insurer as detailed in this clause-18 is collectively referred21