EDM and NWH Obligations

Empanelment and Disciplinary Committee (EDC)

An Empanelment and Disciplinary Committee (EDC) of RAHCT will regulate the NWH services.

Empanelment and Disciplinary Committee (EDC) under the chairmanship of Chief Medical Auditor of the Rajiv Aarogyasri Health Care Trust is responsible for empanelment of new hospitals.

EDC ensures that a hospital possesses adequate infrastructure, man power, equipment requirements of the Rajiv Aarogyasri Health Care Trust, and conforms to the service and quality standards of various health schemes being implemented by Trust.

The empanelment process followed by the Rajiv Aarogyasri Health Care Trust includes online procedures,Disciplinary actions, and settlement of disputes regarding claims.

Medical Audit

The success of the scheme rests on ensuring that all the stakeholders adhere to the highest level of medical ethics. Chief Medical Auditor shall be performing the following medical audit functions:

• Monitoring of quality of medical care.
• Framing guidelines to prevent moral hazard.
• Monitoring the trends of utilization of listed therapies across NWHs.
• Conduct investigation into allegations of treatment lapses.
• Analyze mortality and morbidity under this scheme and recommend corrective measures
• Recommend punitive actions against a medical professional or NWH.

NWH Obligations

Reception:

NWH shall place kiosk at the reception or at the patient entry point to the NWH as decided by the Rajiv Aarogyasri Health Care Trust for the purpose of reception and registration. It shall provide 2 MBPS net connection and dedicated computer with peripherals. NWH shall identify, direct and register all the patients holding eligibility card.

Free pre-evaluation

• All the beneficiaries shall be pre-evaluated for the listed therapies till the diagnosis is established.
• Counseling for packages where facilities are unavailable.
• The patient shall be properly counselled and referred to nearby NWH for further management, if found to be suffering from diseases other than those that cannot be managed in the NWH.