Tender Notice Dt - Department of Health , J&K

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1.11 Thereafter, once the beneficiary is discharged, the beneficiary shall again approach thehelpdesk with the discharge summary.1.12 After card & beneficiary verification, the discharge details shall be entered into the terminal.1.13 In case treatment of one family member is under way when the card is required for treatmentof another member, the software shall consider the insurance cover available after deducting theamount blocked against the package.1.14 Due to any reason if the beneficiary does not avail treatment at the hospital after the amount isblocked the RSBY helpdesk would need to unblock the amount.Case 2: In case of packages not covered under the scheme2.1 Hospital shall take Authorization from Insurance companies in case of package not coveredunder the RSBY scheme.2.2 Steps from 1.1.1 to 1.1.62.3 In case the line of treatment prescribed is not covered under RSBY, the helpdesk shall advicethe beneficiary accordingly and initiate approval from Insurer manually (authorization request).2.4 The hospital will fax to Insurer a pre-authorization request. Request for hospitalization onbehalf of the beneficiary may be made by the hospital hospital/consultant attached to the hospitalas per the prescribed format. The preauthorization form would need to give the beneficiary’sproposed admission along with the necessary medical details and the treatment planned to beadministered and the break up of the estimated cost.2.5 Insurer shall either approve or reject the request. In case Insurer approves, they will alsoprovide the AL (authorization letter) number and amount authorized to the hospital via return fax.Authorization certificate will mention the amount guaranteed class of admission, eligibility ofbeneficiary or various sub limits for rooms and board, surgical fees etc. wherever applicable, as perthe benefit plan of the insured. Hospital must take care to ensure admission accordingly.2.6 On receipt of approval the RSBY helpdesk would manually enter the amount and packagedetails (authorization ID) into the helpdesk device. The device would connect to the server on-linefor verification of the authorization ID. The server would send the confirmation (denial/approval)to the helpdesk device.Steps 1.1.8 to 1.1.1581
Case 3: In case of in-sufficient fundsIn case the amount available is less than the package cost, the hospital shall follow the norms ofdeposit / running bills.Steps from 1.1.1 to 1.1.73.1 In case of insufficient funds the balance amount could be utilized and the rest of the amountwould be paid by the beneficiary after conformance of beneficiary.3.2 The terminal would have a provision to capture the amount collected from the beneficiary.Steps from 1.1.8 to 1.1.15.82
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GOVERNMENT OF J&KDEPARTMENT OF HEAL
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GOVERNMENT OF J&KDEPARTMENT OF HEAL
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Table of ContentsPART I - INFORMATI
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4. Unit of Enrolment:4.1. The unit
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part of insured family member till
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iii) Those facilities undertaking s
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ased on basic quality criteria as g
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Insurance Act 1938.2. Premium payme
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(d)(e)(f)pre-defined fee.An enrollm
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) Beneficiary has balance in his/ h
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intermediary institutions for the p
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to as the “Call Centre Service”
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The parties shall refer such disput
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for the insurer to download.ii. Dis
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esponsibility of the Insurer to ens
Page 31 and 32: 36. Notification of Award And Signi
Page 33 and 34: details of the scheme as mentioned
Page 35 and 36: SECTION B - FINANCIAL PROPOSAL(KIND
Page 37 and 38: SECTION D -DECLARATION BY THE BIDDE
Page 39 and 40: Annexure - 3UNDERTAKING BY THE BIDD
Page 41 and 42: Annexure 5Format for Providing Addi
Page 43 and 44: O.T. Charges, Medicines and Drugs,
Page 45 and 46: 34 FP00300010 J32 Ethmoidectomy - E
Page 47 and 48: 123 FP00500048 Q43 Duplication of I
Page 49 and 50: 212 FP00500137 K51 Ileostomy 7 17,5
Page 51 and 52: 301 FP00600020 D27 Ovarectomy/Oophr
Page 53 and 54: 390 FP00900048 K25 Vagotomy with Py
Page 55 and 56: 477 FP01100044Closed Reduction and
Page 57 and 58: 12 PAEDIATRIC565 FP01200001 Q79 Abd
Page 59 and 60: 653 FP01400045 N28 Repair of Ureter
Page 61 and 62: 743 FP01800016 B53744 FP01800017 B5
Page 63 and 64: War like operations (whether war be
Page 65 and 66: Draft MoU Between Insurance Company
Page 67 and 68: 4. Insurer has on the basis of desi
Page 69 and 70: 5. The Hospital shall ensure that m
Page 71 and 72: 2.5 Within a period of 12 hours fro
Page 73 and 74: 2. The hospital undertakes to uphol
Page 75 and 76: All official correspondence, report
Page 77 and 78: 3. Notwithstanding anything to the
Page 79 and 80: each of the terms of this Agreement
Page 81: Annexure IHospital Services- Admiss
Page 85 and 86: Qualifying Criteria for Smart Card
Page 87 and 88: Annexure 14List of Public Hospitals
Page 89 and 90: 2. Smart card:2.1. OverviewA smart
Page 91 and 92: esponsible for each of these to the
Page 93 and 94: • Licensed system software• Cer
Page 95 and 96: chip personalization. It is mandato
Page 97 and 98: Annexure 17Guidelines for the RSBY
Page 99 and 100: 1.3.1. Re-issuance of a card: This
Page 101 and 102: 2. District Server1.3.4.4.1. The ca
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Tender Notice Dt - Department of Health , J&K

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