Insurance and TPA panels bring patients when your procedures are covered by health insurance, because many insured patients check their insurer's hospital list before choosing a doctor. They suit hospitals and surgical practices, rarely cosmetic clinics. Get registrations and accreditation in order, never accept package rates below your real cost, and run the TPA desk like a sales team.
Picture a family that has already said yes to surgery. They trust the surgeon, they have picked a date, and then someone asks one question: "Is this hospital cashless for my policy?" If the answer is no, many of them walk out and go somewhere else. Not because another surgeon is better. Because another hospital is on the list. For insured patients, being on the panel can matter more than how good you are, and many check their insurer's hospital list before they look up anything on Google.
Who should get on insurance and TPA panels?
This channel is for hospitals, day-care centres and surgical practices offering procedures that health insurance covers: joint replacement, urology, general surgery, cataract surgery and similar. It takes anywhere from one to six months depending on your accreditation and paperwork, and the cost is mostly administrative.
Be honest with yourself about fit. Purely cosmetic treatments usually are not covered, so aesthetic and hair clinics will rarely benefit. If most of your patients pay out of pocket for elective treatment, your time is better spent elsewhere.
Why does being cashless bring patients?
Because patients have already paid for their care through their premiums. When you are on their insurer's network, choosing you costs them far less out of their own pocket, and the cashless process removes the fear of a huge bill on discharge day. If you are not on their list, you are not in the running.
It also connects with corporate work. Employees on group insurance often follow their HR team's recommendations, so a hospital that is cashless for a nearby company's policy, and has given talks to its staff, has a natural advantage.
How do I get empanelled?
Here is the order I follow with hospitals, from Known Doctors Get Booked. Requirements vary by insurer and change over time, so confirm current criteria with each insurer or TPA before you apply.
- Get your registrations in order: hospital registration, a ROHINI ID, and all licences and KYC documents.
- Work towards accreditation. Many insurers look for NABH. Hospitals with at least entry-level NABH accreditation and an existing tie-up with one or more insurers can apply through the industry's Common Empanelment Process and get through faster.
- Check each insurer's criteria. Some, for example, set minimum bed counts for multispeciality hospitals, with different numbers for bigger and smaller cities.
- Prepare your documents: registration, ROHINI ID, KYC, accreditation certificates, your tariff list, and the details and registrations of your doctors and nurses.
- Apply, through the common empanelment portal or directly to individual insurers and TPAs.
Start with the insurers your patients already have. For one month, ask every patient about their insurance and note it in the CRM. Then apply to the most common ones first.
How do I make sure panel rates do not lose money?
This is where most hospitals get hurt. Before you agree to any package, know your real cost for every procedure: direct costs such as consumables and the doctor's share, plus allocated costs such as machine time, rent and operating expenses.
Here is the example from the book. Say your real cost for a procedure is ₹1,80,000 and a panel offers a package of ₹1,60,000. That is ₹20,000 lost on every case. Do 10 a month and you have lost ₹2 lakh, while feeling busy.
| Before you sign | Why it matters |
|---|---|
| Real cost per procedure, including allocated costs | So you can set a minimum package rate |
| A minimum acceptable rate for every package | So you never accept volume at a loss |
| Expected volume from that insurer's policyholders | So you know whether the panel is worth the admin |
| Payment timelines | So cash flow stays predictable |
| What is and is not included in each package | So patients are never surprised at discharge |
| A date to renegotiate at renewal | Because your salaries, rent and consumables rise every year |
For anything involving contracts, tax treatment or compliance, confirm with your chartered accountant or lawyer.
How do I run the TPA desk so it brings patients?
Your TPA desk is a sales team, not a back office. Set it up with at least one trained person who owns pre-authorisations, queries and claim documents every single day. Not "whoever is free".
- Treat pre-authorisation speed as a sales number. A patient who waits days for approval may move to another hospital. A fast, complete pre-authorisation keeps them with you.
- Get the paperwork right the first time. Complete records, clear notes, every document attached. Most claim delays and denials come from missing information.
- Use a checklist for every procedure, reviewed before each claim goes out.
- Explain coverage before admission. A patient surprised by a bill on discharge day will not remember your surgery. They will remember the bill.
- Track it monthly: time to pre-authorisation, claims queried, rejections by reason and payment delays.
How do I make being cashless visible?
Patients specifically search for it, so show it everywhere they look: list your empanelled insurers on your website, your condition pages and your Google Business Profile. Train your front desk to answer "Are you cashless for my policy?" confidently on the first call, and to collect the policy details so the TPA desk can start early.
One joint replacement unit we worked with kept losing insured patients at the last moment, as families moved to network hospitals. We went after the panels their patients held most, set up a dedicated TPA desk with a pre-authorisation checklist and added the insurer list to the website, condition pages and Google profile. Insured patients stopped leaving at the last step, and cashless became a reason to choose them.
If you run a hospital or multispeciality centre or a surgical practice such as orthopaedics, panels can change the size of the business. We help hospitals plan this as part of growth consulting, alongside the front desk work in conversion systems. Book a free growth call to talk through whether it fits your practice.
The short version
- Many insured patients check their insurer's list first; if you are not on it, you are not in the running.
- Panels suit covered procedures, rarely cosmetic, aesthetic or hair practices.
- Get registrations, ROHINI ID, KYC and accreditation in order, then start with your patients' insurers.
- Never accept a package rate below your real cost per procedure.
- Run the TPA desk like a sales team, and explain coverage before admission.
Frequently asked questions
Is NABH accreditation required to get on insurance panels?
Not always, but many insurers look for it, and entry-level NABH accreditation with an existing insurer tie-up can make the common empanelment route faster. Criteria vary by insurer and change over time, so check each insurer's current requirements before applying, and plan accreditation as part of your empanelment timeline.
How long does hospital empanelment with insurers take?
Typically anywhere from one to six months, depending on your registrations, accreditation status, documentation and each insurer's process. Having your hospital registration, ROHINI ID, KYC, tariff list and staff details ready before you apply avoids most of the back and forth that slows hospitals down.
Should a small clinic join TPA panels?
Only if you offer procedures that insurance covers and enough of your patients hold those policies. Many outpatient and cosmetic treatments are not covered. Ask every patient about insurance for a month, then decide. For purely cosmetic practices, the admin usually outweighs the benefit.
Why do insurance claims keep getting queried or delayed?
Most delays come from missing or incomplete information. Use a documentation checklist for every procedure, reviewed before each claim goes out, and give one trained person ownership of the TPA desk. Track queries and rejections by reason every month, and fix the most common cause first.
On a free growth call, my team traces your last month from enquiry to treatment and shows you your biggest leak in rupees.
