Updated empanelment criteria with enhanced quality metrics and digital compliance requirements for healthcare providers
Major changes in empanelment criteria and operational requirements for healthcare providers
New quality indicators including patient satisfaction scores, clinical outcomes, and infection control measures.
Mandatory integration with ABDM, digital health records, and real-time claim processing systems.
Updated treatment package rates with performance-based incentives and quality bonus structures.
Mandatory NABH or equivalent accreditation for hospitals with 50+ beds seeking empanelment.
Automated claim processing with 7-day settlement timeline for compliant healthcare providers.
Mandatory patient feedback systems and grievance redressal mechanisms with performance tracking.
Different empanelment tiers based on facility type, capacity, and service offerings
Up to 30 beds
31-100 beds
100+ beds
Streamlined digital application process with faster approval timelines
Valid registration under Clinical Establishment Act
NABH, JCI, or equivalent quality certification
Valid medical council registration for all doctors
Fire safety, pollution control, and building approvals
Complete digital application with document upload (Day 1-7)
Automated and manual verification process (Day 8-21)
Physical verification and quality assessment (Day 22-35)
Final approval and system activation (Day 36-45)
Key performance indicators for ongoing empanelment and performance-based incentives
| Quality Metric | Target | Measurement | Incentive |
|---|---|---|---|
| Patient Satisfaction Score | ≥ 4.0/5.0 | Monthly patient feedback | 5% bonus |
| Readmission Rate | ≤ 10% | 30-day readmission tracking | 3% bonus |
| Infection Control Rate | ≤ 2% | Hospital-acquired infections | 4% bonus |
| Claim Processing Time | ≤ 24 hours | Average submission time | 2% bonus |
| Digital Compliance | 100% | ABDM integration status | 3% bonus |
Our empanelment experts can help you navigate the new PM-JAY 4.0 requirements and ensure successful empanelment