How a hospital gets onto insurance panels, and what it signs away doing it

There is a rule most hospitals have never invoked. Since 29 May 2024, an insurer must decide a cashless authorisation request in no more than one hour, and grant final authorisation on discharge within three hours. If discharge approval runs late, the additional charge is meant to be borne by the insurer, from the shareholders' fund.

It is in the IRDAI Master Circular on Health Insurance Business, verbatim. Insurers were given until 31 July 2024 to put the systems in place. Almost no hospital front office tracks the clock against it.

The floor: what counts as a hospital

IRDAI's standard definition sets the minimum. At least 10 in-patient beds in towns under 10 lakh population, and at least 15 elsewhere. Qualified nursing staff round the clock. A qualified medical practitioner in charge round the clock. A fully equipped operation theatre of its own. Daily patient records accessible to the insurer.

The document pack

A typical TPA permanent-empanelment pack runs to about fifteen items: registration certificate, accreditation certificates, ROHINI ID, hospital KYC, owner details and KYC, list of specialties, infrastructure detail covering beds, ICU, OT, pharmacy, lab and fire safety, the faculty and staff lists, IT and billing details, and sample documents — your letterhead, a standard discharge summary, an itemised final bill and an OPD receipt.

Those samples matter more than they look. They are what the TPA's auditor will compare every future claim against.

Provisional onboarding is lighter: registration certificate, ROHINI ID, hospital and owner KYC, basic details. A temporary ID is issued immediately against a provisional MoU, with a full audit in the following 15 to 30 days.

What the MoU actually does

Read the tariff clauses before the indemnity ones. In the standard TPA agreements we have reviewed, three terms do most of the damage:

• A three-year lock on your rate card. One template says plainly that no revised schedule of charges will be accepted before three years have passed, and that any revision then needs insurer approval. If you sign in a year when your costs are already tight, you have fixed them until 2029.
• The agreed rate binds cash patients too. Hospitals are required to bill at the agreed rates whether the patient is cashless or paying themselves.
• A 15-day window to contest a deduction. Miss it and the deduction stands. This is the single most common piece of money hospitals leave on the table, because nobody owns the reconciliation.

Where rates come from is worth understanding too. GIPSA is not a regulator or an insurer. It is a coordination forum for the four public sector general insurers, used to negotiate preferred provider rates set per procedure, per city, per eligible room category. No official discount schedule is published anywhere, and every agreement we have read leaves the percentage blank for bilateral negotiation. Treat any specific figure you are quoted as a negotiating position, not a published rate.

What this means for your hospital

If you are small or mid-sized and shut out of cashless networks, the General Insurance Council's common empanelment platform is currently the cheapest route in. It is free, it replaces individual insurer contracts with a single tripartite agreement covering 32-plus insurers, and rates are revised on a 30-month cycle with a 30-day payment term. Roughly 2,000 hospitals had been onboarded as of May 2026 against a target of about 5,000 by the end of FY27, out of some 70,000 hospitals in the country.

The trade-off is real and worth stating. Joining early means joining before rates are standardised, and standardisation is the point of the exercise. Hospital associations have said so loudly. That is a judgement about your own cost position, not a compliance question.

Whatever route you take, do two things afterwards. Put the one-hour and three-hour clocks into your pre-authorisation log, so a pattern of delay is evidence rather than a feeling. And give one named person the deduction reconciliation, with the 15-day window in their calendar.