Tender Document for Selection of Implementation Support Agency (TPA) For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS)
In the State of Uttarakhand
August 2021
Volume II: About Health Schemes (AB-PMJAY, AAUY and SGHS) Schedule of Requirements, Specifications, Scope of work and Allied Technical Details
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Table of Contents Abbreviations ...... 5 Definitions and Interpretations ...... 6 Disclaimer...... 11 1. Name of the Scheme ...... 13 2. Objectives of the Scheme ...... 13 3. Health Scheme Beneficiaries and Beneficiary Family Unit ...... 13 4. Benefit Cover and Benefit Limit ...... 14 4.1 Benefit Cover and Benefit Limit ...... 14 4.2 Health Scheme Benefit Limit on a Family Floater Basis...... 15 5. Benefit Package: Health Scheme Cover ...... 15 5.1 Benefits under Health Scheme Benefit Cover ...... 15 5.2 Exclusions under Health Scheme Benefit Cover ...... 16 5.3 Benefits Available only through Empanelled Health Care Providers ...... 16 6. Package Rates ...... 16 7. Special Provisions for State Government Employees and Pensioneres (GEP) Beneficiaries – IPD Treatment ...... 18 8. Special Provisions for State Government Employees and Pensioneres (GEP) Beneficiaries –OPD Treatment...... 19 9.Identification of Health Scheme Beneficiary Family Units ...... ………………………………………………….20 10. Empanelment of Health Care Providers ...... 20 11. Agreement with Empanelled Health Care Providers ...... 21 12. De-empanelment of Health Care Providers ...... 21
13. General Responsibilities and obligations of the EHCP…………………………………………………………….…….....21
14. Process for beneficiary identification, issuance of AB-PMJAY, AAUYand SGHS E-Card and transaction for service delivery………………………………………………………………………………………………………………………………..23
15. Scope of Services - IPD and Day Care……………………………………………………………………………………………...27
16. Monitoring and verification of EHCPs………………………………………………………………………………………………30 17. Implementation Support Contract(Service Level Agreement /Scope of work ...... 31 17.1 Term of the Implementation Support Contract (Service Level Agreement ) with the Implementation Support Agency ...... 31 17.2 Start of Benefit Cover Period ...... 31 17.3 Commencement of Benefit Cover Period in State ...... 31 17.4 Implementation Support Period ...... 31 17.5 Renewal of Implementation SupportContract (Service Level Agreement ) ...... 32 17.5.1 Benefit Cover Period for the Health Scheme Beneficiary Family Unit in the First Benefit Cover Period...... 32 17.6 Benefit Cover Period in the Renewal……………………………………………………………………………………..32 17.7 Payment of Fee to Implementation Support Agency……………………………………………………………..32
2 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
18. Cashless Access of Services ...... 33 19. Pre-authorisation of Procedures ...... 34 20. Portability of Benefits ...... 36 21. Claims Management ...... 36 22. Project Offices of the Implementation Support Agency ...... 37 22.1 Project Office at the State Level ...... 37 22.2 Organizational Set up and Functions...... 37 23. Capacity Building Interventions ...... 39 24. Management Information System...... 40 25. Commitments of the Implementation Support Agency ...... 41 26. Plan for Provision of Services in the Absence of Internet Connectivity ...... 42 27. Monitoring and Verification ...... 42 27.1 Scope of Monitoring ...... 42 27.2 Monitoring Activities to be undertaken by the Implementation Support Agency ...... 43 27.3 Monitoring Activities to be undertaken by the State Health Authority ...... 44 27.4 Key Performance Indicators for the Implementation Support Agency ...... 46 27.5 Measuring Performance ...... 46 28. Fraud Control and Management ...... 47 29. Reporting Requirements ...... 48 30. Events of Default of the Implementation Support Agency and Penalties ...... 48 30.1 Events of Default ...... 48 30.2 Penalties ...... 49 31. Coordination Committee ...... 50 31.1 Constitution and Membership ...... 50 31.2 Roles and Responsibilities ...... 50 32. Grievance Redressal ...... 51 33. Renewal of the Implementation Support Contract(Service Level Agreement)...... 51 34. Termination of the Implementation Support Contract (Service Level Agreement) and Consequences ...... 51 35 . Force Majeure ……………………………………………………………………………………………………………………………….52
36. Confidentiality of Information and Data Protection ……………………………………………………………………….52
37. Arbitration and Dispute Resolution ..……………………………………………………………………………………………...52
38. Indemnity…………………………………………………………………………………………………………………………………… ... 53 [ 39. Exit Management Plan ………………………………………………………………………………………………………………….. 53
3 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Annexes :Volume II Annex 2.1 Health Scheme Beneficiaries ...... 55 Annex 2.2 Exclusions to the Benefir Cover ...... 56 Annex 2.3 Packages and Rates ...... 57 Annex 2.4 Guidelines for Identification of Health Scheme Beneficiary Family Units…………………………….317 Annex 2.5 Guidelines for Empanelment of Health Care Providers and Other Related Issues………………. 320 Annex 2.6 Claims Management Guidelines including Portability ...... 341 Annex 2.7 Template for Medical Audit ...... 349 Annex 2.8 Template for Hospital Audit ...... 351 Annex 2.9 Key Performance Indicators ...... 352 Annex 2.10 Indicative Fraud Triggers ...... 354 Annex 2.11 Indicators to Measure Effectiveness of Anti-Fraud Measures ...... 356 Annex 2.12 Guidelines for Hospital Transaction Process including pre-authorisation ...... 357 Annex 2.13 Guideline for Greivance Redressal…………………………………………………………………………………....363 Annex2.14 Minimum Staffing requirements of Key Personnel…………………………………………………………….371
Annex 2.15 Beneficiary Identification System …………………………………………………………………………………….373
Annex 2.16 Aarogya Mitra under AB-PMJAY, AAUY and SGHS ……………………………………………………………374
Annex 2.17 Process of Delivery of Benefits, Claim reporting and Submission……………………………………..375
Annex 2.18 Indicative list of emergency Conditions……………………………………………………………………….…..380
Annex 2.19 Format for Bank Guarantee for Performance security ……………………………………………...... ….381
4 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Abbreviations
AB-NHPM Ayushman Bharat - National Health Protection Mission AB-PMJAY Ayushman Bharat –Pradhan Mantri Jan Aarogya Yojana AAUY Atal Ayushman Uttarakhand Yojana SGHS State Government Health Scheme AL Authorisation Letter (from the ISA/TPA) BFU Beneficiary Family Unit BPL Below Poverty Line BC Benefit Cover BL Benefit Limit CCGMS Central Complaints Grievance Management System CHC Community Health Centre CRC Claims Review Committee DAL Denial of Authorisation Letter DGRC District Grievance Redressal Committee DGNO District Grievance Nodal Officer EHCP Empanelled Health Care Provider GEP Government Employees and Pensioners of Uttarakhand GRC Grievance Redressal Committee IRDAI Insurance Regulatory Development Authority of India ISA Implementation Support Agency MoHFW Ministry of Health & Family Welfare, Government of India NGRC National Grievance Redressal Committee NHA National Health Authority NOA Notice of Award PHC Primary Health Centre RAL Request for Authorisation Letter (from the EHCP) SECC Socio Economic Caste Census SGRC State Grievance Redressal Committee SGNO State Grievance Nodal Officer SHA State Health Authority TPA Third Party Administrator UCN Unique Complaint Number
5 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Definitions and Interpretations
1. AAUY shall refer to Atal Ayushman Uttarakhand Yojana managed and administered by State Health Authority on behalf of Department of Medical, Health and Family Welfare, Government of Uttarakhand. 2. AB-PMJAY shall refer to Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana managed and administered by the Ministry of Health and Family Welfare, Government of India. 3. Aspirational Districts refer to Haridwar and Udhamsingh Nagar Districts of Uttarakhand State. 4. Beneficiary (ies) shall mean member of the Beneficiary Family Units that are covered under the AB PM-JAY, AAUY (Atal Ayushman Uttarakhand Yojana), SGHS (State Government Health Scheme) and any other such scheme in the State of Uttarakhand. 5. Beneficiaries Family Unit (AB-PMJAY) refers to those families in the Socio-Economic Caste Census (SECC) 2011 database of Uttarakhand State as identified by NHA. 6. Beneficiaries Family Unit GEP (Government Employee and Pensioners) refers to those eligible families including all its members which are Government Employees and Pensioners, Employees and Pensioners of Corporations/ Autonomous Bodies, Authorities, Universities and Institutions (receiving Grants in Aid from the State Government) who have paid member contribution. GEP beneficiaries will be provided medical facilities under SGHS. 7. Beneficiaries Family Unit RP (Remaining Population) refers to those families including all its members but are not covered in above two categories (AB-PMJAY and SGHS) and also do not avail benefits from similar schemes like ECHS (Employee Contributory Health Scheme), ESIC (Employee State Insurance Corporation), Central Government Employees and Pensioners. Databases of RP are NFSA Ration cards (2014-15), MSBY families and remaining SECC families not covered under AB-PMJAY. RP will be provided medical facilities under AAUY. 8. Benefit Cover Limit for AB-PMJAY and AAUY shall mean an annual maximum benefit limit of Rs. 5,00,000/- (On cashless and family floater Basis) covering in patient care and day care surgeries for treatment of diseases and medical conditions pertaining to secondary and / or tertiary treatment through a network of Empaneled Health Care Providers (EHCP). 9. Benefit Cover Limit for GEP shall mean the annual benefit cover for in patient care and day care surgeries for treatment of diseases and medical conditions pertaining to secondary and / or tertiary treatment through a network of Empaneled Health Care Providers (EHCP) without any monetary limit. 10. Benefit Cover Period shall mean the standard period of 12 calendar months from the date of start of the Benefit Period or lesser period as stipulated by SHA from time to time. 11. Benefit Package shall refer to the package of benefits that the insured families would receive under the AB-PMJAY, AAUY and SGHS Schemes.
6 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
12. Bid refers to the qualification bid and the financial bids submitted by an eligible TPA to function as Implementation Support Agency ( ISA ) pursuant to the release of this Tender Document as per the provisions laid down in this Tender Document and all subsequent submissions made by the Bidder as requested by the State Health Authority for the purposes of evaluating the Bid. 13. Bid Validity Period shall mean the period of 180 days from the Bid Due Date (excluding the Bid Due Date) for which each bid shall remain valid. 14. Bidder shall mean any eligible TPA to function as ISA which has submitted its bids in response to this Tender Document released by the State Government. 15. Category A States includes Arunachal Pradesh, Goa, Himachal Pradesh, Jammu and Kashmir, Manipur, Meghalaya, Mizoram, Nagaland, NCT Delhi, Sikkim, Tripura, Uttarakhand and 6 Union Territories (Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu, Lakshadweep and Puducherry). 16. Category B States includes Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Uttar Pradesh, and West Bengal. 17. Claim shall mean a claim that is received by the ISA/ SHA from an Empaneled Health Care Provider, either online or through alternate mechanism in absence of internet connectivity. 18. Claim Payment shall mean the payment of eligible Claim received by an Empaneled Health Care Provider from the SHA in respect of benefits under the Benefit Cover made available to a Beneficiary. 19. Days shall be interpreted as calendar days unless otherwise specified. 20. Empanelled Diagnostics Labs and Pharmacies Stores shall mean and refer to those Diagnostic labs (All Government/ NABL Diagnostics Labs) and Pharmacies stores (to be defined by SHA) which are empanelled by the SHA for providing services to the Beneficiaries under the GEP (Government Employee and Pensioners) Beneficiary Family unit. 21. EHCP shall mean Empaneled Health Care Providers which is empaneled and has signed this agreement with SHA for the implementation of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Atal Ayushman Uttarakhand Yojana (AAUY), and State Government Health Scheme (SGHS) and Public Hospitals (both Central and State Government) which are deemed to be empaneled. 22. Emergency Conditions shall mean the conditions as mentioned in (Annex 2.16 Vol II ) to this agreement. 23. Fraud shall refer to, mean and include any intentional deception, manipulation of facts and / or documents or misrepresentation made by the EHCP or by any person or organization appointed employed / contracted by the EHCP with the knowledge that the deception could result in unauthorized financial or other benefit to herself/ himself or some other person or the organization itself. It includes any act that may constitute fraud under any applicable law in India. 24. GEP (Government Employee and Pensioners) Beneficiary Family Unit (SGHS) refers to those families including all its members which are Government Employees & Pensioners of Uttarakhand, Government Employee & pensioners of Corporations/ Authorities and 7 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
any other Government aided entity and Organizations of Uttarakhand Government those who have paid member contribution. 25. Health Schemes shall mean the ’Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)’ managed and administered by the Ministry of Health and Family Welfare, Government of India through National Health Authority and ‘Atal Ayushman Uttarakhand Yojana (AAUY)’ and ‘State Government Health Scheme (SGHS)’ managed and administered by the Department of Medical Health and Family Welfare, Government of Uttarakhand through State Health Authority in Trust Mode. 26. Health Services shall mean all services necessary or required to be rendered by the EHCP under an agreement with SHA for its Health Schemes. 27. Hilly Areas mean all blocks of District Almora, Bageshwar, Chamoli, Pithoragarh, Rudraprayag , Champawat, Tehri and Uttarkashi ; all blocks of District Pauri Garhwal except Duggada block; Block Chakrata, Kalsi and Mussoorie Nagar-Palika in District Dehradun and Block Bhimtal, Dhari, Okhalkhanda, Betalghat and Ramgarh in District Nainital. 28. Hospitalization shall mean any Medical Treatment or Surgical Procedure which requires the Beneficiary to stay at the premises of an Empaneled Health Care Provider for 24 hours or more including day care treatment as applicable. 29. ICU or Intensive Care Unit shall mean an identified section, ward or wing of an Empaneled Health Care Provider which is under the constant supervision of dedicated Medical Practitioners and which is specially equipped for the continuous monitoring and treatment of patients who are in critical condition, require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the general ward. 30. Implementing Support Agency (ISA) shall mean a Third Party Administrator means the successful bidder selected pursuant to bidding process and has agreed to the terms and conditions of the Tender Document and has signed the ISA Contract with the State Government. 31. Institution shall for all purpose mean an EHCP. 32. IEC shall mean Information Education and Communication and refer to all such efforts undertaken by the State Health Authority, the State Government that are aimed at promoting information and awareness about the Ayushman Uttarakhand and its benefits to the potential beneficiaries in particular and to the general population at large. 33. Medically Treatment shall mean any medical treatment, surgical procedure, day-care treatment or follow-up care, which: a. is required for the medical management of the illness, disease or injury suffered by the Beneficiary; b. does not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity; c. has been prescribed by a Medical Practitioner; and 8 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
d. Confirms to the professional standards widely accepted in international medical practice or by the medical community in India. 34. MoHFW shall mean the Ministry of Health and Family Welfare, Government of India. 35. Material Misrepresentation shall mean an act of intentional hiding or fabrication of a material fact which, if known to the other party, could have terminated, or significantly altered the basis of a contract, deal, or transaction. 36. NABH shall mean National Accreditation Board for Hospitals and Healthcare providers, a constituent board of Quality Council of India Certification, set up to establish and operate accreditation programme for healthcare organizations. 37. NHA shall mean the National Health Authority set up by the Ministry of Health and Family Welfare, Government of India with the primary objective of coordinating the implementation, operation and management of AB-PMJAY. It will also foster co- ordination and convergence with other similar schemes being implemented by the Government of India and State Governments. 38. Package Rate shall mean the fixed maximum charges for a Medical Treatment or Surgical Procedure or for any Follow-up Care that will be paid by the SHA under Cover, which shall be determined in accordance with the rates provided in this Contract. 39. Service Area shall refer to all State(s)/ UT(s) covered and included for the implementation of the Health Schemes. 40. SGHS shall mean State Government Health Scheme managed and administered by the Department of Medical, Health and Family Welfare, Government of Uttarakhand. 41. State Health Authority (SHA) refers to the agency/ body set up by the Department of Medical, Health and Family Welfare, Government of Uttarakhand for the purpose of coordinating and implementing the AB-PMJAY, AAUY and SGHS schemes in the State of Uttarakhand and such other Schemes that may be introduced during the tenure of Contract. 42. Successful Bidder shall mean the Bidder ( ISA ) whose bid document is responsive, which has been prequalified and whose financial bid is the lowest among all the shortlisted and with whom the State Government intends to select and sign the ISA Contract for this Scheme. 43. Selected Bidder shall mean the successful bidder who has been selected in the bid exercise and has agreed to the terms and conditions of the Tender Document and has signed the ISA Contract with the State Government. 44. Service Area refers to all the districts in the State of Uttarakhand covered and included under this Tender Document for the implementation of Ayushman Uttarakhand. 45. State Government refers to the duly elected Government in the State in which the tender is issued. 46. Turn-around Time (TAT) shall mean the time taken by the ISA in processing a Claim received from an Empaneled Health Care Provider and SHA making a Claim Payment including investigating such Claim or rejection of such Claim.
9 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
47. Tender Documents refers to this Tender Document including Volume I - “Instruction to Bidders” and Volume II - “About Health Schemes (AB-PMJAY, AAUY and SGHS)” including all amendments, modifications issued by the SHA in writing pursuant to the release of the Tender Document. 48. Third Party Administrator is an organization holding licence from Insurance Regulatory and Development Authority of India (IRDAI) to process claims and related activities for corporate, retail health insurance as well as Government Sponsored Health Insurance Schemes (GSHIS).
10 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Disclaimer
The information contained in this Tender Document or subsequently provided to the Bidders, whether verbally or in documentary or any other form, by or on behalf of the Department of Medical Health & Family Welfare, Government of Uttarakhand, hereinafter referred to as the State Government, acting through the State Health Authority (SHA), or any of its employees or advisors, is provided to the Bidders on the terms and conditions set out in this Tender Document along with all its Volumes and such other terms and conditions subject to which such information is provided.
The purpose of this Tender Document is to provide the Bidder(s) with information to assist the formulation of their Tender. This Tender Document does not purport to contain all the information each Bidder may require. This Tender Document may not be appropriate for all persons and it is not possible for the State Government or the SHA or its representatives, to consider the objectives, financial situation and particular needs of each Bidder who reads or uses this Tender Document. Each Bidder should conduct its own investigations and analysis and should check the accuracy, reliability and completeness of the information in this Tender Document, and where necessary obtain independent advice from appropriate sources. Neither the State Government nor the SHA nor their employees or their consultants make any representation or warranty as to the accuracy, reliability or completeness of the information in this Tender Document. The State Government shall incur no liability under any law including the law of contract, tort, principles of restitution or unjust enrichment, statutes, rules or regulations as to the accuracy, reliability or completeness of the Tender Document. The statements and explanations contained in this Tender Document are intended to provide an understanding to the Bidders about the subject matter of this Tender and should not be construed or interpreted as limiting in any way or manner the scope of services and obligations of the Bidders that will be set forth in the Implementation Support Agency’s Agreement or the State Government’s rights to amend, alter, change, supplement or clarify the scope of work, or the agreement to be signed pursuant to this Tender or the terms thereof or herein contained. Consequently, any omissions, conflicts or contradictions in the Bidding Documents, including this Tender Document, are to be noted, interpreted and applied appropriately to give effect to this intent, and no claims on that account shall be entertained by the State Government.
This Tender Document does not constitute an agreement and does not constitute either an offer or invitation by the State Government or the SHA to the Bidders or any other person.
Information provided in the Tender Documents to the Bidders is on a wide range of matters, some of which may depend upon interpretation of law. The information given is not intended to be an exhaustive account of statutory requirements and should not be regarded as complete or authoritative statements of law. The State Government or the SHA accepts no responsibility for the accuracy, or otherwise, of any interpretation or opinion on law expressed in this Tender Document.
The State Government may, in its absolute discretion but without being under any obligation to do so, update, amend or supplement the information, assessment or assumptions contained in this Tender Document.
The issue of this Tender Document does not imply that the State Government is bound to appoint the Successful Bidder as the Implementation Support Agency, as the case may be, and the State Government reserves the right to reject all or any of the Bidders or Bids or not to enter into a Contract for the implementation of the Health Schemes run by State Health Authority in the State of Uttarakhand in the State of Uttarakhand, without assigning any reason whatsoever.
11 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Each Bidder shall bear all its costs associated with or relating to the preparation and submission of its Bid including but not limited to preparation, copying, postage, delivery fees, expenses affiliated with any demonstration or presentation which may be required by the State Government or any other costs incurred in connection with or relating to its Bid. All such costs and expenses will be borne by the Bidders and the State Government and its employees and advisors shall not be liable, in any manner whatsoever, for the same or for any other costs or other expenses incurred by any Bidder in preparation or submission of its Bid, regardless of the conduct or outcome of the Bidding Process.
The entire Tender Document is in two volumes: Volume I – Instruction to Bidders and Volume II – About Health Schemes (AB-PMJAY, AAUY and SGHS).
This document is Volume II of the Tender Document ‘About Health Sceheme (PMJAY/ AAUY and SGHS) Uttarakhand: Schedule of Requirements, Specifications, Scope of work and Allied Technical Details’.
12 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Volume II: About Health Schemes (AB-PMJAY, AAUY and SGHS)
1. Name of the Scheme
The name of the Scheme is the “Health Scheme” and shall hereafter be referred to as “HEALTH SCHEME”. Health Schemes run by State Health Authority, Uttarakhand comprises of AB- PMJAY, AAUY and SGHS.
2. Objectives of the Scheme
The objective of Health Scheme scheme is to provide to the AB-PMJAY, AAUY and SGHS beneficiaries reduced catastrophic health expenditure, improvement in access to quality health care, reduction in unmet needs and reduce out of pocket healthcare expenditures of poor and vulnerable AB-NHPM families falling under the deprivation criteria of D1, D2, D3, D4, D5 and D7, automatically Included category and broadly 11 defined occupational un-organised workers (in Urban Sector) of the Socio-Economic Caste Census (SECC) database of the State along with the estimated existing RSBY Beneficiary Families not figuring in the SECC Database. These eligible AB-NHPM beneficiary families will be provided coverage for secondary, tertiary and day care procedures (as applicable) for treatment of diseases and medical conditions through a network of Empanelled Health Care Providers (EHCP).
In addition to this, GEP (Government Employee and Pensioners) Beneficiary Family Unit refers to those eligible families including all its members which are Government Employees & pensioners of Uttarakhand, Government Employees & Pensioners of Corporations/ Authorities and any other Government aided entity and Organizations of Uttarakhand Government those who have paid member contribution. The IPD/ DAYCARE TREATMENT/ INTERVENTION of all the Government Employees and Pensioners of the State of Uttarakhand and their dependent family members are governed by the Government Order No. 214/XXVIII-3-2020-04/2008 T.C. issued on 4th May 2020. In addition to the IPD/ Daycare Treatment/ Intervention, all Government Employees and Pensioners of Uttarakhand State and their family members shall be entitled to OPD (Outdoor Patient Department) facilities on the basis of reimbursement of incurred expenditure as per provisions contained in the Government Order No. 214/ XXVIII-3- 2020-04/ 2008 T.C. issued on 4th May 2020.
RP (Remaining Population) AAUY Beneficiary Family Unit refers to those families including all its members which are resident of Uttarakhand State but are not included in of the above two categories and also do not avail benefits from similar schemes like ECHS (Employee Contributory Health Scheme), ESIC (Employee State Insurance Corporation), Central Government Employees and Pensioners. Provision for ‘RP’ has been made and the scheme for RP shall be known as ‘Atal Ayushman Uttarakhand Yojana (AAUY)’.
3. Health Scheme Beneficiaries and Beneficiary Family Unit
a. All AB-PMJAY Beneficiary Family Units, as defined under the deprivation criteria of D1, D2, D3, D4, D5 and D7, automatically Included category (in rural areas) and broadly 13 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
defined occupational un-organised workers (in Urban Sector) of the Socio-Economic Caste Census (SECC) database of the State (as updated from time to time) along with the existing RSBY Beneficiary Families not figuring in the SECC Database which are resident in the Service Area (State or cluster of States for which this Tender Document is issued) and fall under one or more of the categories further detailed in Annex 2.1 of this Volume II of the Tender Document shall be considered as eligible for benefits under the Scheme and be automatically covered under the Scheme. b. All SGHS members of eligible beneficiary family units of Government Employees & pensioners of Uttarakhand, Government Employee & pensioners of Corporations/Authorities and any other Government aided entity and Organizations of Uttarakhand Government those who have paid member contribution, Referred to as GEP (Government Employee and Pensioners) Beneficiary henceforth in the document. c. All AAUY members of beneficiary family units which are resident of Uttarakhand State but are not included in the above two categories and also do not avail benefits from similar schemes like ECHS (Employee Contributory Health Scheme), ESIC (Employee State Insurance Corporation), Central Government Employees and Pensioners, Referred to as RP (Remaining Population) Beneficiary henceforth in the document. d. Unit of coverage under the Scheme shall be a family and each family for this Scheme shall be called a Health Scheme Beneficiary Family Unit, which will comprise all members in that family. Any addition in the family will be allowed only in case of marriage and/ or birth/ adoption.
4. Benefit Cover and Benefit Limit
4.1 Benefit Cover and Benefit Limit
a. Benefit Cover (BC) for AB-PMJAY, AAUY and SGHS benificiaries shall include hospitalization / treatment expenses coverage including in-patient and day care procedures (as applicable) for medical conditions and diseases requiring secondary and tertiary level of medical and surgical care treatment through a network of Empanelled Health Care Providers (EHCPs) and follow up care along with cost for pre and post- hospitalisation treatment as defined. In addition, for GEP (Government Employee and Pensioners) Beneficiary Family unit the annual benefit cover will include OPD (consultations/ diagnostic/ radiology) facilities on reimbursement basis and additional benefits of Diagnostic and Pharmacy services through empanelled diagnostics labs (All Government/NABL Diagnostics Labs) and Pharmacies stores (to be defined by SHA). The annual benefit cover for GEP shall be unlimited. b. Benefit Limit for AB-PMJAY and AAUY Family Unit - As on the date of commencement of the Benefit Cover Period, the Health Scheme Benefit limit in respect of the benefit cover for each Health Scheme Beneficiary Family Unit shall be Rs. 5,00,000 (Rupees Five Lakh Only) per family per annum on cashless and family floater basis. This shall be called the benefit limit, which shall be fixed irrespective of the size of the Health Scheme Beneficiary Family Unit, subject to Section 4.2. c. Benefit Limit for GEP (SGHS Family Unit) - The annual benefit limit for GEP (Government Employee and Pensioners) Beneficiary Family unit for in patient care, day care procedures and OPD treatment of diseases and medical conditions pertaining to
14 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
secondary and / or tertiary treatment through a network of Empanelled Health Care Providers (EHCP) and additional benefits of Diagnostic services and Pharmacy services through empanelled diagnostics labs (All Government/NABL Diagnostics Labs) and Pharmacies stores (to be defined by SHA) shall be unlimited.
4.2 Health Scheme Benefit limit on a Family Floater Basis
a. The ISA (TPA) shall ensure that the Scheme’s BC shall be available to each Health Scheme Beneficiary Family Unit on a family floater basis covering all the members of the Health Scheme Beneficiary Family Unit including Senior Citizens, i.e., the benefit limit shall be available to any or all members of such Beneficiary Family Unit for one or more Claims during each Benefit Cover Period. New family members may be added after due approval process as defined by the Government. b. The maximum entitlement of a AB-PMJAY/ AAUY Beneficiary Family Unit on family floater basis for one or more Claims under the BC during any Benefit Cover Period shall not exceed Rs. 5,00,000 (Rupees Five Lakh Only). However, the annual benefit limit for GEP (Government Employee and Pensioners) Beneficiary Family unit the for in-patient care, day care procedures and OPD treatment of diseases and medical conditions pertaining to secondary and / or tertiary treatment through a network of Empanelled Health Care Providers (EHCP) and additional benefits of Diagnostic services and Pharmacy services through empanelled diagnostics labs (All Government/ NABL Diagnostics Labs) and Pharmacies stores (to be defined by SHA) shall be unlimited.
5. Benefit Package Cover of Health Scheme (PM-JAY, AAUY and SGHS)
5.1 Benefits under Health Scheme (PM-JAY, AAUY and SGHS)
a. The benefits within this Health Scheme under the Benefit Cover are to be provided on a cashless basis to the Health Scheme Beneficiary Family Units up to the limit of their annual coverage and includes: (i) Hospitalization expense benefits (ii) Day care treatment benefits (as applicable) (iii) Follow-up care benefits (iv) Pre-Hospitalisation expenses for up to three days shall be inclusive of the hospitalization package. (In case of Biopsies it would be relaxed to a maximum of 10 days.) (v) Post Hospitalization expense benefits for up to fifteen days shall be inclusive of the hospitalization package and during this period the Hospital shall provide medications and provide diagnostic evaluation and necessary follow –up visits free of cost to the beneficiary. (vi) New born child/ children benefit. (vii) Diagnostic services and Pharmacy services through empanelled diagnostics labs (All Government/ NABL Diagnostics Labs) and Pharmacies stores (to be defined by SHA) only limited for GEP (Government Employee and Pensioners) Beneficiary Family units.
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b. The details of benefit package including list of exclusions are furnished in Annex 2.2: ‘Exclusions to the Benefit Cover’ and Annex 2.3: ‘Packages and Rates’. c. All packages under Health Scheme would be mandated for Pre-Authorization except in case of emergency. d. Except for exclusions listed in Annex 2.2, services for any other surgical treatment services may also be allowed after approval from the Chairman of the designated committee, provided the services are within the benefit limit available and pre- authorisation has been provided by the SHA. e. All benefits availed in the Private hospitals will only be referral based from govt hospitals except in the case of emergency conditions .The referral from Government hospital shall not be necessary in respect of medical colleges, full NABH accredited hospitals and hospitals located in hilly areas as defined in G.O No. 214/XXVIII-3-2020- 04/2008 T.C.
5.2 Exclusions under Health Scheme in Uttarakhand Benefit Cover
a. Each of the benefits specified above in Sections 5.1 shall be available for irrespective of any pre-existing conditions, diseases, illnesses or injuries affecting the Health Scheme, Uttarakhand Beneficiaries on the date of commencement of each Benefit Cover Period, subject only to the exclusions as provided in Annex 2.2.
5.3 Benefits Available only through Empanelled Health Care Providers
a. The benefits under the Health Scheme Benefit Cover shall only be available to a Health Scheme Beneficiary through an EHCP after Aadhaar based identification as far as possible. In case Aadhaar is not available then other defined Government recognised ID will be used for this purpose.
b. The benefits under the Health Scheme Cover shall, subject to the available Health Scheme benefit limit, be available to the Health Scheme Beneficiary on a cashless basis at any EHCP.
c. Specialized tertiary level services shall be available and offered only by the EHCP empanelled for that particular service. Not all EHCPs can offer all tertiary level services, unless they are specifically designated by the SHA for offering such tertiary level services.
d. Addition benefits of Diagnostic services and Pharmacy services through empanelled diagnostics labs (All Government/ NABL Diagnostics Labs) and Pharmacies stores (to be defined by SHA) only limited for GEP (Government Employee and Pensioners) Beneficiary Family units.
6. Package Rates
a. The ISA (TPA) shall process the claims of public and private health care providers under the Health Scheme based on Package Rates determined as follows: 16 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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(i) If the package rate for a medical treatment or surgical procedure requiring Hospitalization or Day Care Treatment (as applicable) is fixed in Annex 2.3, then the Package Rate so fixed shall apply for the Benefit Cover Period. (ii) If the package rate for a surgical procedure requiring Hospitalization or Day Care Treatment (as applicable) is not listed in Annex 2.3, then the ISA (TPA) may pre- authorise an amount within INR 1 Lac.Any amount more than 1 lac CEO SHA shall setup a committee of expert to review & approve the case. (iii) The flat daily package rates for medical packages specified in Annex 2.3 shall apply. (iv) If the treatment cost is more than the benefit coverage amount available with the beneficiary families then the remaining treatment cost will be borne by the Health Scheme Beneficiary family. (v) The follow up care prescription for identified packages are set out in Annex 2.3. (vi) In case of Health Scheme Beneficiary is required to undertake multiple surgical treatment, then the highest package rate shall be taken at 100%, thereupon the 2nd treatment package shall take as 50% of package rate and 3rd treatment package shall be at 25% of the package rate. (vii) Surgical and Medical packages will not be allowed to be availed at the same time. (viii) Certain packages as mentioned in Annex 2.3 will only be reserved for Public EHCPs as decided by the SHA. They can be availed in Private EHCPs only after a referral from a Public EHCP is made. (ix) Certain packages as indicated in Annex 2.3 have differential pricing for NABH and Non-NABH, for Hospitals running PG/ DNB Course, for rural and urban EHCPs and for EHCPs in aspirational districts as identified by NITI Aayog. For hospitals situated at Upper Himalaya terrain additional 10% of the package rates will be admissible. (x) All GEP Beneficiaries requiring hospitalization shall be entitled to the hospital bed category as per rates fixed from time to time by the SHA keeping in view the CGHS rates.
Note: In case the authorized wards are not vacant at the time of admission in that case the above category wards will be provided to the beneficiaries but reimbursement will be done on the basis of actual athorized wards. In case of vice-versa the reimbursement will be done on the basis of ward attained. However hospitals cannot deny the beneficiaries in case of non-availability of beds in authorized ward.
b. As part of the regular review process, the Parties (the ISA/TPA and EHCP) shall review information on incidence of common medical treatments or surgical procedures that are not listed in Annex 2.3 and that require hospitalization or day care treatments (as applicable). c. Either Party may suggest the inclusion of additional Package for determination of rates following due diligence and procedures and based on the incidence of diseases or reported medical conditions and other relevant data. The agreed package rates shall
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be deemed to have been included in Annex 2.3 with effect from the date on which the Parties have mutually agreed to the new package rates in writing. d. No claim processing of package rate for a medical treatment or surgical procedure or day care treatment (as applicable) that is determined or revised shall exceed the sum total of Benefit Cover for a Health Scheme Beneficiary Family Unit. e. However, package rates for some medical treatment or surgical procedures may exceed the available Benefit limit, which in turn would enable Health Scheme beneficiaries to avail treatment of such medical conditions or surgical procedures on their own cost / expenses at the package rate rather than on an open-ended or fee for service basis.
7. Special Provisions for State Government Employees and Pensioneres (GEP) Beneficiaries – IPD Treatment
The IPD/ DAYCARE TREATMENT/ INTERVENTION of all the Government Employees and Pensioners of the State of Uttarakhand and their dependent family members is governed by the Government Order No. 214/XXVIII-3-2020-04/2008 T.C. issued on 4th May 2020. Some special provisions contained in the said Order
a. The health scheme for employees/ pensioners shall be operated under the name of ‘STATE GOVERNMENT HEALTH SCHEME (SGHS)’. b. All Government Employees and Pensioners of Uttarakhand State and their dependent family members (GEP) shall be entitled to Indoor Patient Department (IPD) treatment in the government and private hospitals approved by SHA in the State of Uttarakhand. c. All GEP Beneficiaries of Uttarakhand State shall be provided cashless treatment on getting admitted in the EHCPs. d. The package rates towards IPD treatment of GEP beneficiaries shall be payable to the EHCPs as per package rates fixed by NHA under AB-PMJAY and there shall be no upper ceiling in the annual Benefit Cover Limit. e. Referral from Government Hospital shall not be required for the GEP Beneficiaries for availing treatment by getting admitted in Private EHCPs. f. The GEP will also be entitled for availing treatment outside Uttarakhand in any EHCP included in National Portability of NHA. In such case, referral by any empaneled public or private EHCP will be required except treatment in emergency condition. g. GEP working/ living outside Uttarakhand will not require referral for getting treatment in any EHCP in National Portability of NHA. h. If the Package Rate for any surgical procedure requiring Hospitalization or Day Care Treatment (as applicable) is not listed it will be treated as an “unspecified package” for which the EHCP shall seek pre-authorization from ISA/ SHA for an appropriate amount under SGHS wherein there shall be no upper limit for an unspecified package.
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i. All GEP Beneficiaries requiring hospitalization shall be entitled to the hospital bed category as per rates fixed from time to time by the SHA keeping in view the CGHS rates.
8. Special Provisions for State Government Employees Andpensioneres (GEP) Beneficiaries – OPD Treatment
In addition to the IPD/ Daycare Treatment/ Intervention, all Government Employees and Pensioners of Uttarakhand State and their family members shall be entitled to OPD (OUTDOOR PATIENT DEPARTMENT) facilities on the basis of reimbursement of incurred expenditure as per provisions contained in the Government Order No. 214/XXVIII-3- 2020-04/2008 T.C. issued on 4th May 2020. Some special provisions as per this order are: -
a. EHCP shall provide OPD (consultation/ diagnostic/ radiology) facilities to all GEP Beneficiaries registered under SGHS in a precise, reliable and professional manner to the satisfaction of SHA and in accordance with additional instructions issued by SHA in writing from time to time. b. The EHCP shall treat the beneficiaries according to good business practice. c. OPD treatment (consultation/ diagnostic/ radiology) shall only be applicable to GEP beneficiaries under SGHS. d. The EHCP shall provide consultation, diagnostic/ radiology facilities to GEP beneficiaries chargeable on the basis of CGHS rates as fixed from time to time by MoHFW, GOI. e. The GEP beneficiaries will make the payment to the EHCP in lieu of the OPD facilities availed as per applicable CGHS rates. f. The EHCP in lieu of the payment made by the beneficiary against the availed OPD treatment will issue Essentiality Certificate to the beneficiary duly signed by the treating doctor/ Medical Superintendent. g. There is no need of referral for GEP Beneficiaries registered under SGHS for availing the OPD facilities. h. The EHCP undertakes to uphold all the changes that may be necessary during the term of contract with respect to the revision/ amendments in OPD and Diagnostic/ Radiology as per applicable schedule of charges of CGHS. i. The EHCP shall not make Claims to SHA towards OPD treatment given to GEP beneficiaries under SGHS as the OPD services are to be provided against payment made by the beneficiaries. j. The EHCP shall not charge the beneficiary in excess of the prescribed CGHS Rates for Uttarakhand/ Dehradun towards OPD facilities rendered. k. SHA reserves the right to terminate this Agreement if the OPD/ Diagnostic/ Radiology facilities are either denied or inappropriately provided as per desired standards of treatment, to the GEP beneficiaries. 19 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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9. Identification of Health Scheme Beneficiary Family Units
a. Identification of Health Scheme Beneficiary Family Units will be based on the deprivation criteria of D1, D2, D3, D4, D5 and D7, Automatically Included category and 11 broadly defined occupational un-organised workers (in Urban Sector) of the Socio- Economic Caste Census (SECC 2011) database of the State.. In addition to that a specific database will be provided by SHA which will be based on NFSA 2014-15 Database, Voter ID database, Uttarakhand employee and Pensioners database from treasury & MSBY database. .
b. The beneficiaries will be identified using Aadhaar and/ or Ration Card and/ NFSA card/ Voter ID/ Employee code from Uttarakhand Treasury/ Family Health Survey Data and/ or any other specified identification document produced by the beneficiary at the point of contact. Once successfully identified, the beneficiary will be provided with a print of Health Scheme e-card which can be used as reference while availing benefits.
c. Detailed guidelines for beneficiary identification are provided in Annex 2.4.
10. Empanelment of Health Care Providers
a. All public hospitals with inpatient facilities (Community Health Centre and above) shall be deemed to be empanelled.
b. Private healthcare providers (both for profit and not for profit) which provide hospitalization and/or day care services (as applicable) would be eligible for empanelment under Health Scheme, subject to their meeting of certain requirements (empanelment criteria) in the areas of infrastructure, manpower, equipment (IT, help desk etc.) and services (for e.g. liaison officers to facilitate beneficiary management) offered, which can be seen at Annex 2.5 of this document.
c. At the time of empanelment, those Hospitals that have the capacity and which fulfil the minimum criteria for offering tertiary treatment services as prescribed by the SHA would be specifically designated for providing such tertiary care packages.
d. The SHA shall be responsible for empanelment and periodic renewal of empanelment of health care providers for offering services under the Health Scheme. The SHA may undertake this function either directly or through the selected ISA Implementation Support Agency. However, the final decision regarding empanelment of hospital will rest with SHA.
e. Under circumstances of any dispute, final decision related to empanelment of health care providers shall vest exclusively with the SHA.
f. Detailed guidelines regarding empanelment of health care providers are provided at Annex 2.5. 20 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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11. Agreement with Empanelled Health Care Providers
a. Once a health care provider is found to be eligible for empanelment, the SHA and the selected ISA (TPA) shall enter into a Provider Service Agreement with such health care provider substantially in the form to be provided for the medical treatments, surgical procedures, day care treatments (as applicable), and follow-up care for which such health care provider meets the infrastructure and personnel requirements.
b. This Provider Service Agreement shall be a tripartite agreement where the ISA (TPA) shall be the third party.
c. The Agreement of an EHCP shall continue for a period of at least 3 years from the date of the execution of the Provider Services Agreement, unless the EHCP is de- empanelled in accordance with the Health Scheme guidelines and its agreement terminated in accordance with its terms.
d. The ISA (TPA) will not enter into any understanding with the EHCP that are in contradiction to or that deviates from or breaches the terms of the Implementation Support Contract between the SHA and the ISA (TPA) or tripartite Provider Service Agreement with the EHCP.
e. If the ISA (TPA) or any of its representatives violates the provisions of Section 9.d. above, it shall be deemed as a material breach and the SHA shall have the right to initiate appropriate action against the Implementation Support Agency or the EHCP or both.
f. ISA shall train EHCPS both Public and Private about the required IT infrastructure /hardware/software/TMS
12. De-empanelment of Health Care Providers
a. The SHA, either on its own or through ISA (TPA), shall de-empanel an EHCP from the Health Scheme, as per the guidelines mentioned in Annex 2.5
b. Notwithstanding a suspension or de-empanelment of an EHCP, the ISA (TPA) shall ensure that it shall exercise due diligence with respect to Claims for any expenses that have been pre-authorised or are legitimately due before the effectiveness of such suspension or de-empanelment as if such de-empanelled EHCP continues to be an EHCP.
13. General Responsibilities and obligations of the EHCP a. Ensure that no confidential information is shared or made available by the EHCP or any person associated with it to any person or entity not related to the EHCP without prior written consent of SHA/ ISA.
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b. The EHCP shall provide cashless facility to the beneficiary in strict adherence to the provisions of the agreement. c. The EHCP may have their facility covered by proper indemnity policy including errors, omission and professional indemnity insurance and agrees to keep such policies in force during entire tenure of the Agreement. The cost/ premium of such policy shall be borne solely by the EHCP. d. The EHCP shall provide the best medical facilities to the beneficiary. e. The EHCP will hire dedicated person (s) called Arogya Mitra to manage the help desk and facilitate the beneficiary in accessing the benefits under Health Schemes. The cost of the Arogya Mitras will be entirely borne by the Private EHCP. f. The EHCP shall also have two contact persons nominated for all matters related to AB- PMJAY, AAUY and SGHS; one person from clinical team (a doctor who is actively engaged in the treatment of the patients) and one officer in the administration department assigned for Health Schemes. These contact persons shall eventually be required to make themselves trained with the processes described in Health Schemes. g. The EHCP shall ensure to make their team including Arogya Mitra (s) and Contact Person (s) actively participate in all trainings and workshops to be organized by SHA / ISA from time to time. SHA and/or ISA will organize trainings for Arogya Mitra (s) and Contact Persons (s) of EHCP. In addition, the EHCP may also be required to conduct trainings for its staff at their premises with the help of SHA and ISA. The cost of attending such trainings and organizing trainings shall be borne by the EHCP unless otherwise agreed with SHA. h. SHA shall pay an incentive to the EHCP as per prescribed additional percentage rate over the listed package rate if it qualifies for one or more of the following criteria as given below. o NABH accreditation certification – ENTRY LEVEL 10% o NABH accreditation certification – FULL LEVEL 15% o EHCP is located in Hilly area 10% o EHCP is located in Aspirational district of the state 10% o EHCP is a teaching hospital running PG/ DNB courses. 10%
i. For such EHCP that is not NABH accredited, it agrees to get at least NABH entry level certification within two years which may further be extended by SHA by one year. j. The EHCP agrees that it shall display their status of preferred service provider of AB- PMJAY/ AAUY/ SGHS schemes at their main gate, reception/ admission desks along with the display and other materials supplied by SHA/ NHA whenever possible for the ease of the beneficiaries. Format, design and other details related to these signages as provided by NHA/ SHA shall be used.
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k. The EHCP hereby agrees that it shall unconditionally comply with all the provisions of the Anti-Fraud Guidelines issued by the SHA / NHA including all its amendments from time to time. l. The EHCP further agrees and acknowledges that lack of compliance the Anti-Fraud Guidelines shall be deemed as a material breach of this contract and in such a situation the SHA may, at its sole discretion, initiate disciplinary proceedings as per the provisions of this contract, which may lead to termination and / or if the situation so demands seeking recourse to civil or criminal remedies available under Applicable Laws. m. The EHCP agrees to follow the guidelines issued by Department of Medical Health & Family welfare, Uttarakhand/ MoHFW/ NHA/ SHA for the implementation of the AB- PMJAY/ AAUY/ SGHS schemes from time to time. The EHCP agrees to make itself constantly updated on these guidelines and follow the same.
14. Process for beneficiary identification ,issuance of AB-PMJAY, AAUY and SGHS E-Card and transaction for service delivery A Beneficiary Verification & Authentication
a. Member may bring the following to the AB-PMJAY, AAUY and SGHS helpdesk: Letter from MoHFW/NHA/SHA or MSBY Card or NFSA Ration Card or any other defined document as prescribed by the State Government.
b. Arogya Mitra/ Operator will check if AB-PMJAY, AAUY and SGHS e-Card/ AB- PMJAY, AAUY and SGHS ID/ Aadhaar Number is available with the beneficiary.
c. In case Internet connectivity is available at hospital,
i. Operator/ Arogya Mitra identifies the beneficiary’s eligibility and verification status from AB-PMJAY, AAUY and SGHS Central Server.
ii. If beneficiary is eligible and verified under AB-PMJAY / AAUY / SGHS, server will show the details of the members of the family with photo of each verified member.
iii. If found OK, then beneficiary can be registered for getting the cashless treatment.
iv. If patient is eligible but not verified then patient will be asked to produce Aadhaar Card/ Number/ Ration Card for verification (in absence of Aadhaar).
v. Beneficiary mobile number will be captured.
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vi. If Aadhaar Card/Number is available and authenticated online, then patient will be verified under scheme (as prescribed by the software) and will be issued a AB-PMJAY/ AAUY/ SGHS e-Card for getting the cashless treatment.
vii. Beneficiary gender and year of birth will be captured with Aadhaar eKYC or Ration Card.
viii. If Aadhaar Card/ Number is not available, then beneficiary will be advised to get the Aadhaar Card/number within stipulated time.
d. In case Internet connectivity is not available at hospital i. Arogya Mitra at AB-PMJAY, AAUY and SGHS Registration Desk at Hospital will call Central Helpline and using IVRS enters AB-PMJAY/ AAUY /SGHS ID or Aadhaar number of the patient. IVRS will speak out the details of all beneficiaries in the family and hospital will choose the beneficiary who has come for treatment. It will also inform the verification status of the beneficiary. ii. If eligible and verified then beneficiary will be registered for getting treatment by sending an OTP on the mobile number of the beneficiary. iii. In case beneficiary is eligible but not verified then she/ he can be verified using Aadhaar OTP authentication and can get registered for getting cashless treatment. e. In case of emergency or in case person does not show AB-PMJAY/ AAUY/ SGHS e-Card/ ID or Aadhaar Card/ Number and claims to be AB-PMJAY/ AAU / SGHS beneficiary and show some photo ID proof issued by Government, then beneficiary may get the treatment. Government Photo ID proof need not be insisted in case of emergency. In all such cases, relevant Beneficiary proof will be supplied within specified time before discharge otherwise beneficiary will pay for the treatment to the Hospital. f. If eligibility, verification and authentication are successful, beneficiary should be allowed for treatment. g. These details captured will be available at SHA / ISA level for their approval. Once approved, the beneficiary will be considered as successfully identified and verified under AB-PMJAY / AAUY / SGHS.
B Package Selection a. The operator will check for the specialty for which the hospital is empaneled. Hospitals will only be allowed to view and apply treatment package for the specialty for which they are empanelled. b. Based on diagnosis sheet provided by doctor, operator should be able to block Surgical or Non-Surgical benefit package(s) using IT system. c. Both surgical and non-surgical packages cannot be blocked together, either of the type can only be blocked.
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d. As per the package list, the mandatory diagnostics/ documents will need to be uploaded along with blocking of packages. e. Some packages will be reserved for blocking only in public hospitals. f. The operator can block more than one package for the beneficiary. A logic will be built in for multiple package selection, such that reduced payment is made in case of multiple packages being blocked in the same hospitalisation event. g. If a registered mobile number of beneficiary family is available, an SMS alert will be sent to the beneficiary notifying him of the packages blocked for him. h. At the same time, a printable registration slip needs to be generated and handed over to the patient or patient’s attendant. i. If for any reason treatment is not availed for any package, the operator can unblock the package before discharge from hospital.
C Pre-authorisation a. There would be defined packages which will require pre-authorisation from the SHA/ ISA. In case any inpatient treatment is not available in the packages defined, then hospital will be able to provide that treatment up to Rs. 100,000 to the beneficiary only after the same gets approved by the SHA and will be reflected as an unspecified package. Under both scenarios, the operator should be able to initiate a request to the SHA/ ISA for pre-authorisation using the web application. b. The hospital operator will send all documents required for pre-authorisation to the SHA/ ISA using the Centralized AB PM-JAY transaction management application. c. The documents exchanged will not be stored on the AB PM-JAY server permanently. Only the information about pre-authorisation request and response received will be stored on the central server. It is the responsibility of the SHA to maintain the documents at their end. d. The documents needed may vary from package to package and hence a master list of all documents required for all packages will be available on the server. e. The request as well as approval of the form will be done using the AB PM-JAY IT system. f. In case of no or limited connectivity, the filled form can also be sent to SHA/ ISA either through fax/ email. However, once internet connectivity is established, the form should also be submitted using online system as described above. g. The SHA/ ISA will have to approve or reject the request latest by 6 hours. If the SHA/ ISA fails to do so, the request will be considered deemed to be approved after 6 hours by default. h. In case of an emergency or delay in getting the response for pre-authorisation request due to technical issues, provision will be there to get the pre-authorisation code over the phone from SHA/ ISA or the call center setup by it. The documents required for the processing, may be sent using the transaction system within stipulated time.
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i. In case of emergency, SHA/ ISA will provide the pre-authorisation code generated through the algorithm/ utility provided by MoHFW/ NHA-NIC. j. Pre-authorisation code provided by the SHA/ ISA will be entered by the operator and will be verified by the system. k. If pre-authorisation request is rejected, SHA/ ISA will provide the reasons for rejection. Rejection details will be captured and stored in the transaction database. l. If the beneficiary or the hospital are not satisfied by the rejection reason, they can appeal through grievance system. D Balance Check, Treatment, Discharge and Claim Request a. Based on selection of package(s), the operator will check from the Central AB PM-JAY Server if sufficient balance is available with the beneficiary to avail services. b. States using their own IT system for hospital transaction will be able to check and update balance from Central AB PM-JAY server using API c. If balance amount under available covers is not enough for treatment, then remaining amount (treatment cost - available balance), will be paid by beneficiary (OOP expense will also be captured and stored) d. The hospital will only know if there is sufficient balance to provide the selected treatment in a yes or no response. The exact amount will not be visible to the hospital. e. SMS will be sent to the beneficiary registered mobile about the transaction and available balance f. List of diagnostic reports recommended for the blocked package will be made available and upload of all such reports will be mandatory before discharge of beneficiary. g. Transaction System would have provision of implementation of Standard Treatment Guidelines for providing the treatment h. After the treatment, details will be saved and beneficiary will be discharged with a summary sheet. i. Treatment cost will be deducted from available amount and will be updated on the Central AB PM-JAY Server. j. The operator/ AM fills the online discharge summary form and the patient will be discharged. In case of mortality, a flag will be raised against the deceased member declaring him as dead or inactive. k. At the same time, a printable receipt needs to be generated and handed over to the patient or patient’s attendant. l. After discharge, beneficiary gets a confirmation and feedback call from the AB PM-JAY call centre; response from beneficiary will be stored in the database m. Data (Transaction details) should be updated to Central Server and accessible to SHA/ ISA for Claim settlement. Claim will be presumed to be raised once the discharge information is available on the Central server and is accessible to the SHA/ ISA. n. SMS will be sent to beneficiary registered mobile about the transaction and available balance
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o. After every discharge, claims would be deemed to be raised to the SHA/ ISA. An automated email alert will be sent to the ISA/ SHA specifying patient name, AB-PM- JAY/ AAUY/ SGHS ID, registration number & date and discharge date. Details like Registration ID, Beneficiary ID, date and amount of claim raised will be accessible to the SHA/ ISA on AB PM-JAY System. Also details like Registration-ID, AB-PM-JAY / AAUY / SGHS ID, Date and amount of claim raised, date and amount of claim disbursement, reasons for difference in claims raised and claims settled (if any), reasons for rejection of claims (if any) will be retrieved through APIs. p. Once the claim is processed and the hospital gets the payment, the above-mentioned information along with payment transaction ID will be updated on central AB-PMJAY system by the SHA/ ISA for each claim separately. q. Hospital Transaction Management Module would be able to generate a basic MIS report of beneficiary admitted, treated and claim settled and in process and any other report needed by Hospitals on a regular basis. r. Upon discharge, beneficiary will receive a feedback call from the Call center where he can share his feedback about his/ her hospitalisation experience.
15. SCOPE OF SERVICES – IPD AND DAY CARE
a. The EHCP undertakes to provide services in a precise, reliable and professional manner to the satisfaction of SHA / ISA and in accordance with additional instructions issued by SHA in writing from time to time. b. The EHCP will treat the beneficiaries according to good business practice. c. The EHCP will extend priority admission facilities to the beneficiaries. d. The EHCP shall provide treatment/ interventions to the beneficiaries registered under the Health Schemes as per specified packages and the rates mentioned in Annex-2.3 to this Agreement. The following is agreed among the parties regarding the packages: i. The treatment/ interventions to the Health Scheme beneficiaries shall be provided in a complete cashless manner. Cashless means that for the required treatment/interventions as per package rates and no payment shall need to be done by the Health Scheme beneficiary undergoing treatment/ intervention or any of its family member till such time there is a balance amount left in benefit c o v e r limit. ii. The various benefits under AB-PMJAY, AAUY and SGHS include Hospitalization expense benefits; Day care treatment benefits (as applicable); Pre and post hospitalization expense benefits and New born child / children care benefits (as applicable) iii. An EHCP is able to provide these benefits subject to exclusions mentioned in Annex-2.2 to this Agreement and subject to remaining available benefit cover balance and subject to pre-authorisation for selected procedures by ISA/ SHA.
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iv. The EHCP ……………………………………………………… (enter the name of the hospital) is eligible to provide treatment/ interventions to beneficiaries only for those clinical specialties for which it has been empaneled, namely
…………………………………………………………………………………………………... ……………………………………………………………………………………………………. ……………………………………………………………………………………………………. (enter the names and codes of specialties for which the hospital is empaneled)
v. The EHCP may add any clinical specialty to its services, the information regarding the same shall be provided to the SHA in accordance with necessary details as mentioned in ………………………………………………………... (name of guidelines) in writing, and SHA shall update empanelment status of the EHCP in HEM Portal if conditions of the guidelines in respect of the specialty are fulfilled.
e. The charges payable to EHCP for the treatment/ intervention provided to the beneficiary based on package rates for a medical treatment or surgical procedure requiring Hospitalization or Day Care Treatment (as applicable) based on package rates determined as below - i. If the Package Rate for a medical treatment or surgical procedure requiring Hospitalisation or Day Care Treatment (as applicable) is fixed as in Annex-2.3 to this Agreement, then it shall apply. ii. If the Package Rate for any surgical procedure requiring Hospitalisation or Day Care Treatment (as applicable) is not listed in Annex-2.3 to this Agreement, then the ISA/ SHA may pre-authorize an appropriate amount up to a limit of Rs. 1,00,000 to an eligible AB- PMJAY and AAUY beneficiary. iii. If the Package Rate for a medical treatment requiring Hospitalisation is not listed in Annex-2.3 to this Agreement, the flat daily Package Rates for medical packages specified in Annexure-2 shall apply subject to pre-authorisation from ISA/ SHA. iv. In case of Health Schemes Beneficiary is required to undertake multiple surgical treatment, then the highest Package Rate shall be taken at 100%, thereupon the 2nd treatment package shall be taken as 50% of Package Rate and 3rd treatment package shall be at 25% of the Package Rate as configured in the transaction management software. v. Surgical and Medical packages will not be allowed to be availed at the same time. vi. Certain packages as mentioned in Annex-2.3 to this Agreement will only be reserved for Public EHCPs as decided by the SHA. vii. Packages as mentioned in Annex-2.3 to this contract can only be availed by beneficiaries registered under AB-PMJAY and AAUY at Private EHCPs only after a referral from a Public EHCP has been obtained by the beneficiary. However,
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referral will not be required in cases of private medical colleges, NABH accredited hospitals and private hospitals located in hilly areas of the state. Further for GEP beneficiaries, referral from a Public EHCP will not be required for availing benefit at any Private EHCP.
f. These Package Rates (in case of surgical or defined day care benefits) will include: i. Registration Charges ii. Bed charges (General Ward in case of surgical package) iii. Nursing and Boarding charges iv. Surgeons, Anesthetists, Medical Practitioner, Consultants fees etc. v. Anesthesia, Blood Transfusion, Oxygen, O.T. Charges, Cost of Surgical Appliances etc. vi. Medicines and Drugs vii. Cost of Prosthetic Devices, implants viii. Pathology and radiology tests: radiology to include but not be limited to X-ray, MRI, CT Scan, etc. (as applicable) ix. Food to patient. x. Pre and Post Hospitalisation expenses: Pre-hospitalization (up to 3 days before admission) and Post-hospitalization (up to 15 days after discharge) expenses incurred for consultation, diagnostic tests and medicines in the same hospital shall be included in the concerned booked package. xi. Any other expenses related to the treatment of the patient in the EHCP.
g. If the treatment cost is more than available benefit cover limit then the remaining treatment cost will be borne by the AB-PMJAY and AAUY beneficiary family as per the package rates defined in this document. Beneficiary will need to be clearly communicated in advance about the additional payment. This clause shall not be applicable for GEP beneficiaries as for them, there is no upper limit of benefit coverage. h. The follow up care prescription for identified packages are set out in Annex-2.3 to this Agreement. i. The EHCP shall ensure that medical treatment/ facility under this agreement should be provided with all due care and accepted standards are extended to the beneficiary. j. The EHCP agrees to provide treatment to all eligible beneficiaries subject to the amount under benefit cover limit and as per agreed Package Rate from all over the India. The EHCP shall be paid at the Package Rates applicable in the EHCP State and not as per the package rates applicable in the beneficiary State. The EHCP agrees not to discriminate between the beneficiaries on any basis. k. The EHCP shall allow SHA and/ or ISA official to visit the beneficiary while he/ she is admitted in the EHCP. SHA and/ or ISA shall not interfere with the medical team of the EHCP, however SHA and/ or ISA reserve the right to discuss the treatment plan
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with treating doctor. Further access to medical treatment records and bills prepared in the EHCP will be allowed to SHA/ ISA on a case to case basis with prior appointment from the EHCP. l. The EHCP shall comply with future requirements of SHA and ISA to facilitate better services to beneficiaries e.g. providing for standardized billing, ICD coding or implementation of Standard Clinical and Treatment Protocols and if mandated by Statutory requirement both parties agree to revise the same. m. The EHCP agrees to have bills audited on a case to case basis as and when necessary through SHA /ISA audit team. This will be done on a pre-agreed date and time and on a regular basis. The SHA shall have the right to undertake spot checks without any prior intimation and the EHCP agrees to provide full cooperation regarding the same. n. The EHCP will convey to its medical consultants to keep the beneficiary only for the required number of days of treatment and carry only the required investigation & treatment for the ailment, for which he is admitted.
16. Monitoring and verification of EHCPs a. The SHA shall, either directly or through the ISA or any of its authorized representatives, shall have the right to conduct monitoring visits and random audits of any or all cases of hospitalisation and any or all claims submitted by the EHCP. b. Monitoring of EHCPs shall include but not be limited to: i. Overall performance and conduct of the EHCP ii. Beneficiary registration process iii. Pre-authorisation and claims submission process iv. EHCP facility and infrastructure. c. The scope of medical audit of services provided by the EHCP shall focus on ensuring comprehensiveness of medical records and shall include but not be limited to: i. Completeness of the medical records file ii. Evidence of patient history and current illness iii. Operation report (if surgery is done) iv. Patient progress notes from admission to discharge v. Pathology and radiology reports. d. If at any point in time the NHA/ SHA issues Standard Treatment Guidelines for all or some of the medical/ surgical procedures, assessing compliance to Standard Treatment Guidelines shall be within the scope of the medical audit. e. The SHA/ ISA shall conduct the medical audit through on-site visits to the EHCP facility for inspection of records, discussions with the nursing and medical staff. f. The SHA/ ISA shall conduct hospital audit of the EHCP that will focus on compliance to minimum empanelment criteria including but not limited to facilities, infrastructure, human resources, medical record keeping system and EHCP’s obligations like operational help desk, appropriate signage of the Scheme prominently displayed.
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Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
17. Implementation Support Contract
17.1 Term of the Implementation Support Contract (Service Level Agreement) with the Implementation Support Agency
a. The Implementation Support Contract that will be signed between the ISA (TPA) and the SHA pursuant to this Tender Document, shall be for a period of maximum 3 years (initial 2 years with provision of one more year of extension), subject to performance review after two years and renewal.
b. All decisions related to renewal shall be taken by the SHA based on the guidelines provided in this Tender Document and the ISA (TPA)shall not consider renewal after two years as its automatic right.
17.2 Start of Benefit Cover
a. For the purpose of start of a benefit cover, all eligible beneficiary family units in the entire State of Uttarakhand shall be covered under one benefit cover. This issue of benefit cover shall be supported by the ISA (TPA) before the commencement of the benefit cover start date.
b. The ISA (TPA) shall ensure that the Health Scheme Beneficiaries in that States with the Health Scheme are provided services from that date of start of benefit cover.
17.3 Commencement of Benefit Cover Period in State
a. The first Cover Period for a State shall commence from the date decided and announced by the SHA.
b. The ISA (TPA) shall ensure servicing of benefit cover for the State in the Service Area covering all Health Scheme beneficiaries as per the Health Scheme Beneficiary Database.
c. Upon renewal of the implementation support contract (Service Level Agreement) for a State in accordance with Section 11.5, the renewal Period for such State shall commence from 0000 hours of the day, following the day on which the immediately preceding Benefit Cover Period expires.
17.4 Implementation Support Period
In respect of each Benefit, the Benefit Cover Period shall be for a period of 12 months from the date of commencement of such Cover Period, i.e., until 2359 hours on the date of expiration of the twelfth month from the date of commencement determined in accordance with Section 11.5.1
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17.5 Renewal of Implementation Support Period (Service Level Agreement)
a. The SHA shall renew the Implementation Support Contract of the ISA (TPA) after two years for a maximum of one more year. Further, in case of emergent situations, the Benefit shall be extended as per the time frame decided by SHA and the decision of SHA shall be final and binding upon the Implementation Support Agency.
b. The Implementation Support Contract shall be renewed subject to the following conditions being fulfilled:
(i) Achievement against KPIs (Key Performance Indicators) threshold levels as mentioned in Annex 2.9 (ii) The ISA (TPA) demonstrating to the reasonable satisfaction of the SHA that it is not suffering from any Event of Default or if it has occurred, such Event of Default is not continuing. (iii) If any of the conditions for renewal in points (i) and (ii) of this Section 11.5 are not fulfilled, then the SHA may refuse renewal of the Benefit cover for a State. (iv) Provided that in each case that the Party refusing or denying renewal gives written reasons for such refusal or denial, as the case may be.
c. Upon renewal of each Benefit cover for State, the SHA shall inform along with the commencement and expiry dates of the renewal Benefit Cover Period and the Benefit Cover Period for all the Health Scheme Beneficiary Family Units in that State, EHCP in the state. Such information shall be widely publicised. d. The process of renewel will be initiated in the last quarter of the second year.
17.5.1 Benefit Cover Period for the Health Scheme Beneficiary Family Unit in the First Benefit Cover Period
a. During the first Benefit Cover Period for a State, the Benefit cover shall commence from 0000 hours on the date indicated by the SHA.
b. The end date of the Benefit cover for each State will be 12 months from the date of start of the Cover.
17.6 Cover Period in the Renewal
a. During each renewal Period following the first Cover Period :
(i) The Benefit Cover Period for each existing Health Scheme Beneficiary Family Unit shall commence from 0000 hours of the day following the day on which the immediately preceding Benefit Cover Period has expired;
17.7 Payment of Fee to Implementation Support Agency
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a. The ISA (TPA) shall be paid a fee as per the award of the Contract for servicing the Health Scheme Beneficiary Family Units. The Fee shall be payable by SHA at pre-agreed rate
b. The total Fee payable shall be paid to ISA (TPA) by SHA in instalments as per below schedule:
Instalment Payment Schedule Amount
1 Within 21 days, after establishment of project As per actual Bill subject office (one Time )at the designated space to the ceiling limit as per (Rent Free) provided by SHA ( the approved financial bid 2 Within 15 days of submission of Monthly bill As per actual Bill subject after operationalization of State Project office to the ceiling limit as per by ISA (TPA) the approved financial bid and review of performance against agreed Key Performance Indicators
c. All installments shall be payable by SHA after receiving a request / invoice from ISA (TPA). Such request /invoice should be sent to SHA by ISA (TPA) at least 15 days before the due date of payment of instalments.
d. The ISA (TPA) shall ensure that neither it nor any of its employee or representative charge any other fee from any beneficiary, beneficiary family unit, EHCP, SHA or any other functionary associated with Health Scheme in the state for Health Scheme related activities, unless otherwise specifically permitted by SHA.
e. The violation of clause 11.7.d shall be considered an event of default and a criminal breach of trust and shall invoke action from SHA.
18. Cashless Access of Services The ISA shall also ensure and facilitate the following-
a. The Health Scheme beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insured, i.e., not specifically excluded under the Scheme.
b. The EHCP shall be reimbursed as per the package cost specified in the Tender Document agreed for specified packages or as pre-authorised amount in case of unspecified packages.
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c. The ISA (TPA) shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the Health Scheme Beneficiary Database and undertake verification based on the Beneficiary Identification
d. Process laid out, using unique Health Scheme Family ID and also ascertain the balance available under the Health Scheme Cover.
e. The ISA (TPA) shall provide each EHCP with an operating manual describing in detail the verification, pre-authorisation and claims procedures.
f. The ISA (TPA) shall train Ayushman Mitras that will be deputed in each EHCP that will be responsible for the administration of the Health Scheme on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services to the Ayushman beneficiaries
g. The EHCP shall establish the identity of the member of a Health Scheme Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) Health Scheme Beneficiary has balance in her/ his Health Scheme and Cover amount. (iii) Provisional entry shall be made on the server using the Health Scheme ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of claim amount. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognised system of identification adopted by the SHA of Health Scheme Beneficairy Family Unit to complete the transaction.
19. Pre-authorisation of Procedures
a. All procedures in Annex 2.3 that are earmarked for pre-authorisation shall be subject to mandatory pre-authorisation. In addition, in case of Inter-State portability, all procedures shall be subject to mandatory pre-authorisation irrespective of the pre- authorisation status in Annex 2.3.
b. The ISA (TPA) shall ensure that no EHCP shall, under any circumstances whatsoever, undertake any such earmarked procedure without pre-authorisation unless under emergency. Process for emergency approval will be followed as per guidelines laid down under Health Scheme.
c. Request for hospitalization shall be forwarded by the EHCP after obtaining due details from the treating doctor, i.e. “request for authorisation letter” (RAL). The RAL needs to be submitted online through the Scheme portal and in the event of any IT related
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problem on the portal, then through email or fax. The medical team of Implementation Support Agency would get in touch with the treating doctor, if necessary.
d. The RAL should reach the authorisation department of the Implementation Support Agency within 6 hours of admission.
e. In cases of failure to comply with the timelines stated in above Section 13.d, the EHCP shall forward the clarification for delay with the request for authorisation.
f. The ISA (TPA) shall ensure that in all cases pre-authorisation request related decisions are communicated to the EHCP within 4 hours for all non-emergency cases and within 2 hours for emergencies. If there is no response from the ISA within 4 hours of an EHCP filing the pre-authorisation request, the request of the EHCP shall be deemed to be automatically authorised.
g. The ISA shall not be liable to honour any claims from the EHCP for procedures featuring in Annex 2.3, for which the EHCP does not have a pre-authorisation, if prescribed.
h. Reimbursement of all claims for procedures listed under Annex 2.3 shall be as per the limits prescribed for each such procedure unless stated otherwise in the pre- authorisation letter/communication.
i. The RAL form should be dully filled with clearly mentioned Yes or No. There should be no nil, or blanks, which will help in providing the outcome at the earliest.
j. The ISA approves payment only after receipt of RAL and the necessary medical details. And only after the ISA has ascertained and negotiated the package with the EHCP, shall issue the Authorisation Letter (AL). This shall be completed within 4 hours of receiving the RAL.
k. In case the ailment is not covered or the medical data provided is not sufficient for the medical team of the authorisation department to confirm the eligibility, the ISA (TPA) can deny the authorisation or seek further clarification/information.
l. The ISA (TPA) needs to file a report to the SHA explaining reasons for denial of every such pre-authorisation request.
m. Denial of authorisation (DAL)/guarantee of payment is by no means denial of treatment by the EHCP. The EHCP shall deal with such case as per their normal rules and regulations.
n. Authorisation letter (AL) will mention the authorisation number and the amount authorized as a package rate for such procedure for which package has not been fixed earlier. The EHCP must see that these rules are strictly followed.
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o. The authorisation is given only for the necessary treatment cost of the ailment covered and mentioned in the RAL for hospitalization.
p. The entry on the Health Scheme portal for claim amount blocking as well at discharge would record the authorisation number as well as package amount agreed upon by the EHCP and the ISA (TPA).
q. In case the balance sum available is less than the specified amount for the Package, the EHCP should follow its norms of deposit/running bills etc. However, the EHCP shall only charge the balance amount against the package from the Health Scheme beneficiary. The ISA (TPA) upon receipt of the bills and documents would release the authorized amount.
r. The ISA (TPA) will not be liable for payments in case the information provided in the RAL and subsequent documents during the course of authorisation is found to be incorrect or not fully disclosed.
s. In cases where the Health Scheme beneficiary is admitted in the EHCP during the current Benefit Cover Period but is discharged after the end of the Benefit Cover Period, the claim has to be processed by the ISA (TPA) from the Benefit which was operating during the period in which the Health Scheme beneficiary was admitted.
20. Portability of Benefits
a. The benefits of Health Scheme will be portable across the country and a beneficiary covered under the scheme will be able to get benefits under the scheme across the country at any EHCP.
b. Package rates of the hospital where benefits are being provided will be applicable .Claims will be approved/denied and recommended for payment by the ISA (TPA) that is covering the beneficiary under Benefit.
c. The ISA (TPA) undertakes that it will exercise due diligence to service any claim from any empanelled hospital under the scheme within India and will settle claims within 30 days of receiving them. d. To ensure true portability of Health Scheme, State Governments shall enter into Memorandum of Understanding with Government of India/NHA under AB-PMJAYfor allowing sharing of network hospitals, transfer of claim & transaction data arising in areas beyond the service area.Detailed guidelines of portability are provided at Annex 2.6 21. Claims Management
a. All EHCPs shall be obliged to submit their claims within Seven Days (7 Days) of discharge of patient in the format prescribed by the ISA (TPA). However, in case of Public EHCPs this time may be relaxed upto Fifteen Days (15 Days). However, if claim
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documents are not uploaded by EHCP within Thirty Days (30 days) of the discharge of the patient then the claim shall be deemed to be rejected.
b. The ISA (TPA) shall be responsible for processing all claims within 15 days after receiving all the required information/ documents.
c. Guidelines for submission of claims, claims processing, handling of claim queries, dealing with fraudulent claims and all other related details are furnished in Annex 2.10.
22. Project Offices of the Implementation Support Agency
22.1 Project Office at the State Level
The Implementation Support Agency shall establish a Project Office in Dehradun for coordination with the State Health Authority on a regular basis, whereas only rent free premises will be provided by State Health Authority. However the logistics support, maintenance and staff will be the responsibility of the ISA .Every employee of ISA at the state project office will be provided with workstation(table,chair,computer hardware with MS Office software and internet connectivity )The office on the whole should have adequate telephone infrastructure, fax machines, printers, photocopy machines, scanners and other IT equipments necessary for effective office functioning .At the district the district coordinator should be provided with computer hardware with internet connectivity . Note: It is important to note that all the project office and district level assets for which the SHA has reimbursed the cost to the ISA shall remain the property of SHA (On built ,operate and transfer basis )and should be returned to SHA as and when the agreement comes to an end .
22.2 Organizational Set up and Functions
a. In addition to the support staff for other duties, the ISA (TPA) shall recruit or employ experienced and qualified personnel exclusively for the purpose of implementation of the Health Scheme and for the performance of its obligations and discharge of its liabilities under the Implementation Support Contract:
(i) One State Coordinator who shall be responsible for implementation of the Scheme and performance of the Implementation Support Contract in the State. (ii) One Full Time District coordinator for each District, and additional One District Coordinator for Dehradun, Haridwar, Udham Singh Nagar and Nainital Districts (13+4). Job responsibilities would include monitoring, supervision of Ayushman Mitra, training of field workers, claim management, medical audits, claim audit, fraud control and handling grievances in the district. (iii) The State Coordinator shall be located in the Project Office and each District Coordinator shall be located in the relevant District Office. (iv) Role of State Coordinator
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Liase with the state officials of the SHA to addressing operational issues as and when they arise . Coordinate and ensure smooth implementation of the scheme in the state Monitor and supervise all the District coordinators Monitoring ,supervision of Ayushman Mitra Claim management, Medical audit ,claim audit ,fraud control Handling grivenaces in the State To follow up with the EHCP to ensure that the IT infrastructure installed is fully functional at all times To coordinate and carry out relevant trainings in the State .
(v) Role of District Coordinator
Monitoiring supervision of Ayushman Mitra Handling grievances in the district To coordinate and ensure smooth implementation of the Scheme in the district. To follow up with the EHCP to ensure that the IT infrastructure installed is fully functional at all times. Liaise with the district officials of the SHA to addressing operational issues as and when they arise. To coordinate and carry out relevant trainings in the district.
b. In addition to the personnel mentioned above, the Implementation Support Agency shall recruit or employ experienced and qualified personnel for each of the following roles within its organisation exclusively for the purpose of the implementation of the Health Scheme To undertake Information Technology related functions which will include, among other things, collating and sharing claims related data with the SHA and running of the website, if any other than central web-portal, at the State level and updating data at regular intervals on the website. The website shall have information on Health Scheme in the local language and English with functionality for claims settlement and account information access for the Health Scheme Beneficiaries and the EHCP. (i) To implement the grievance redressal mechanism and to participate in the grievance redressal proceedings provided that such persons shall not carry out any other functions simultaneously if such functioning will affect their independence as members of the grievance redressal committees at different levels. (ii) To coordinate the ISA’s (TPA) State level obligations with the State level administration of the SHA.
c. In addition to the personnel mentioned above, the Implementation Support Agency shall recruit or employ experienced and qualified personnel for each of the following roles within its organisation at the State/ district level, exclusively for the purpose of the implementation of the Health Scheme:
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(i) To undertake the Management Information System (MIS) functions, which include creating the MIS dashboard and collecting, collating and reporting data. (ii) To generate reports in formats prescribed by the SHA from time to time or as specified in the Scheme Guidelines, at monthly intervals. (iii) Processing and approval of beneficiary identity verification requests, received from Ayushman Mitras at the hospitals, as per the process defined in the scheme. Scrutiny and approval of beneficiary identity verification requests if all the conditions are fulfilled, within 30 minutes of receiving the requests from Ayushman Mitras at the network hospital. (iv) To undertake the Pre-authorisation functions under Health Scheme To undertake paperless claims settlement for the Empanelled Health Care Providers including the provision of necessary Medical Practitioners to undertake investigation of claims made. (v) To undertake internal monitoring and control functions including fraud detection along with providing a team with adequate manpower to analyse data for analyzing patterns, frauds, abuse and taking actions against the hospitals. (vi) To undertake feedback functions which include designing feedback formats, collecting data based on those formats from different stakeholders like Health Scheme beneficiaries, the EHCPs etc., analysing the feedback data and recommending appropriate actions. (vii) To undertake training and capacity building of various stakeholders involved in providing benefits under Health Scheme, such as officials from EHCP, Ayushman Mitras etc (viii) Training of Ayushman Mitras at each of the Sub District Hospitals/District Hospitals/ Medical College & Hospitals and Network Hospitals to facilitate the access to care for the scheme beneficiaries. (ix) To coordinate the ISA’s (TPA) district level obligations with the district level administration of the SHA.
d. The ISA (TPA) shall not outsource any roles or functions as mentioned above.
e. The ISA (TPA) shall provide a list of all such appointments and replacement of such personnel to the SHA within 15days of all such appointments and replacements. The ISA (TPA) shall ensure that its employees coordinate and consult with the SHA’s corresponding personnel for the successful implementation of Health Scheme and the due performance of the ISA's obligations and discharge of the ISA's liabilities under the Implementation Support Contract and the Policies issued hereunder.
f. The ISA (TPA) shall complete the recruitment of such employees within 15 days of the signing of the Implementation Support Contract and in any event, prior to commencement of the Benefit Cover Period.
23. Capacity Building Interventions
The Implementation Support Agency shall, at a minimum, conduct the Empanelled Health Care Provider Training as follows: -
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a. The ISA (TPA) shall provide training to the Ayushman Mitras for all EHCPs in a State at least once every 6 months, that is, at least twice during each Benefit Cover Period for such State. Such training shall minimum include: list of covered procedures and prices, pre-authorisation procedures and requirements, IT training for making online Claims and ensuring proper installation and functioning of the Hospital IT Infrastructure for each Empanelled Health Care Provider.
b. The ISA (TPA) shall organize training workshops for each public EHCP (including Community Health Centres- CHCs and Primary Health Centres- PHCs) at the hospital premises at least once every 6 months, that is, at least twice during each Benefit Cover Period for a State and at any other time requested by the EHCP, to increase knowledge levels and awareness of the hospital staff.
c. If a particular EHCP frequently submits incomplete documents or incorrect information in Claims or in its request for authorisation as part of the pre-authorisation procedure, then the Implementation Support Agency shall undertake a follow-up training for such EHCP.
24. Management Information System
a. All Management Information System (MIS) shall be on a centralised web-based architecture designed by the MoHFW, GoI for the purposes of the Scheme.
b. The ISA (TPA) shall maintain a MIS dashboard that will act as a visual interface to provide at-a-glance views on key ratios and measures of data regarding the implementation of the Scheme.
c. The ISA (TPA) shall update the information on the MIS dashboard real time and shall provide the SHA and any number of authorized representatives of the SHA or its advisors/ consultants with access to the various modules on the MIS dashboard. The SHA and the MoHFW, GoI shall have the right to download, print or store the data available on the MIS dashboard.
d. In addition, the ISA (TPA) shall submit reports to the SHA regarding health-service usage patterns, claims data and such other information regarding the delivery of benefits as may be required by the SHA on a monthly basis.
e. In addition, the ISA (TPA) shall be responsible for submitting such other data and information as may be requested by the SHA and/ or to the MoHFW, GoI and to submit such reports in formats as required by and specified by the SHA from time to time.
f. All data generated by the ISA (TPA) in relation to the implementation and management of the Scheme and/or in performing its obligations under the Implementation Support Contract shall be the property of the SHA and MoHFW, GoI. ISA (TPA) undertakes to
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handover all such information and data to the SHA within 10 days of the expiration of the Benefit for that State and on the expiration or early termination of the Implementation Support Contract.
25. Commitments of the Implementation Support Agency (TPA)
The Implementation Support Agency shall undertake the following tasks which are necessary for successful implementation of the Scheme. These are indicative but not exhaustive.
a. Set up a fully operational Project and district office within 15 days of signing the Implementation Support Contract with the SHA.
b. Carry out hospital empanelment related activities including field verification of the hospitals, signing contract with the hospitals, their training and related activities.
c. Oversee IT infrastructure in EHCPs including training of EHCP staff on the same.
d. Service Health Scheme Covers as per the provisions of this Scheme for all Health Scheme Beneficiaries on the database provided to it by the SHA.
e. Provide training for Ayushman mitras including organising workshops.
f. Processing and approval of beneficiary identity verification requests, received from Ayushman Mitras at the hospitals, as per the process defined in the scheme. Scrutiny and approval of beneficiary identity verification requests if all the conditions are fulfilled, within 30 minutes of receiving the requests from Ayushman Mitras at the network hospital.
g. Process legitimate and due claims of the EHCPs within the allocated timeframe of 15 days.
h. Participate in and coordinate timely redressal of grievances in close coordination with the concerned Grievance Redressal Committee.
i. Comply with the orders of the concerned Grievance Redressal Committee should an order be issued against the ISA (TPA) itself.
j. To undertake feedback functions which include designing feedback formats, collecting data based on those formats from different stakeholders like Health Scheme beneficiaries, the EHCPs etc., analysing the feedback data and recommending appropriate actions.
k. Abide by the terms and conditions of the Implementation Support Contract throughout the tenure of the Contract.
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l. Ensuring that the contact details of the State Coordinator of the Implementation Support Agency and the nodal officer of the EHCP (as the case may be) are updated on the Health Scheme (ayushmanuttarakhand.org) website.
m. To ensure provision of services in absence of internet connectivity as provided in Section 26.
n. Any future advisory or guidelines issued by NHA, MoH&FW, SHA and State Governement regarding the Health Scheme shall be binding on ISA.
26. Plan for Provision of Services in the Absence of Internet Connectivity
The ISA (TPA) agrees that if, in the implementation of the Scheme and use of the prescribed technology and systems, there is an issue causing interruption in the provision of Cashless Access Services, the ISA (TPA) shall:
a. make all efforts to put in place an alternate mechanism to ensure continued provision of Cashless Access Services to the Health Scheme Beneficiaries in accordance with the methodology prescribed in the Health Scheme Guidelines;
b. take all necessary measures to fix the technology or related issues to bring the Cashless Access Services back onto the online platform within the earliest possible time in close coordination with the SHA; and
c. furnish all data/information in relation to the cause of interruptions, the delay or other consequences of interruptions, the mitigating measures taken by ISA (TPA) and any other related issues to the SHA in the format prescribed by the SHA at that point in time.
27. Monitoring and Verification
27.1 Scope of Monitoring
a. Monitoring under Health Scheme shall include supervision and monitoring of all the activities under the Health Scheme undertaken by the ISA (TPA) and ensuring that the ISA (TPA) complies with all the provisions of the Implementation Support Contract signed with the State Health Authority (SHA) for implementation of the Scheme.
b. Monitoring shall include but not be limited to: i. Overall performance and conduct of the ISA (TPA). ii. Claims management process. iii. Grievance redressal process. iv. Any other aspect/ activity of the ISA (TPA) related to the implementation of the Scheme.
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27.2 Monitoring Activities to be undertaken by the Implementation Support Agency
27.2.1 General Monitoring Obligations
Under the Health Scheme, the ISA (TPA) shall cooperate with SHA in effective monitoring of the entire process of implementation of the Scheme on an ongoing basis to ensure that it meets its obligations under its Implementation Support Contract with the SHA. Towards this obligation the Implementation Support Agency shall undertake, but not be limited to, the following tasks:
a. Ensure compliance to all the terms, conditions and provisions of the Scheme.
b. Ensure monitoring of processes for seamless access to cashless health care services by the Health Scheme beneficiaries under the provisions of the Scheme.
c. Ensure monitoring of processes for timely processing and management of all claims of the EHCPs.
d. Ensure fulfilment of obligations as per the agreed Key Performance Indicators (KPIs).
27.2.2 Medical Audit a. Scope of medical audit i. The scope of medical audit under the Scheme shall focus on ensuring comprehensiveness of medical records and shall include but not be limited to: Completeness of the medical records file. Evidence of patient history and current illness. Operation report (if surgery is done). Patient progress notes from admission to discharge. Pathology and radiology reports. ii. If at any point in time the SHA issues Standard Treatment Guidelines for all or some of the medical/ surgical procedures, assessing compliance to Standard Treatment Guidelines shall be within the scope of the medical audit. b. Methodology i. The Implementation Support Agency shall conduct the medical audit through on- site visits to the concerned EHCPs for inspection of records, discussions with the nursing and medical staff. ii. The indicative process of conducting medical audits is set out below and based on this the ISA(TPA) shall submit its detailed audit methodology to the SHA for approval: The auditor shall check the data before meeting the EHCP authorities. The audit should preferably be conducted in the presence of the EHCP’s physician/ treating doctor. iii. The medical audit will include a review of medical records in the format specified in Annex 2.7. iv. All medical audits should compulsorily be done by MBBS doctors or Specialists as required who are a part of the Implementation Support Agency. The 43 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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Implementation support agency shall share the profiles of all such auditors hired/empanelled by it for medical audit purposes under the Scheme. v. Frequency and Sample of medical audit - The number of medical audits to be conducted by the ISA (TPA) will be a five percent of the total cases hospitalized in each of the EHCP in the current quarter.
27.2.3 Hospital Audit
a. The ISA (TPA) will assist SHA in hospital audit for every single EHCP visited by it as a part of the medical audit as described in Section 21.2.2 above. b. Hospital audit shall be conducted as per the format prescribed in Annex 2.8. c. Hospital audit will focus on compliance to EHCP’s obligations like operational help desk, appropriate signage of the Scheme prominently displayed, etc. details of which are captured in Annex 2.8. d. Quick factsheets of EHCPs to be shared by ISA with SHA whenever required
27.3 Monitoring Activities to be undertaken by the State Health Authority
27.3.1 Audits by the State Health Authority
a. Audit of the audits undertaken by the Implementation Support Agency: The SHA shall have the right to undertake sampled audits of all audits (Medical Audit and Hospital Audit) undertaken by the ISA (TPA).
b. Direct audits: In addition to the audit of the audits undertaken by the Implementation Support Agency referred in Section 23.3.1.a, the SHA shall have the right to undertake direct audits on a regular basis conducted either directly by it or through its authorized representatives/ agencies including appointed third parties. Direct audits shall include:
(i) Claims audit: For the purpose of claims audit, the SHA shall constitute a Claims Review Committee (CRC) that shall look into 100 percent of the pre-authorisation claims rejected or partially settled by the ISA (TPA) to assure itself of the legitimacy of the ISA’s decisions. Claims settlement decisions of the ISA (TPA) that are disputed by the concerned EHCP shall be examined in depth by the CRC after such grievance of the EHCP is forwarded by the concerned Grievance Redressal Committee (GRC) to the CRC. CRC meeting shall be scheduled every month or as decided by SHA. Penalty equal to amount involved in claim may be imposed on ISA by Claim Review Committee (CRC) on wrong approval or denial of pre authorisation request of EHCP. CRC shall examine the merits of the case within 30 working days and recommend its decision to the concerned GRC. The GRC shall then communicate the decision to the aggrieved party (the EHCP) as per the provisions specified in the Section of Grievance Redressal Mechanism.
During the claims audit the SHA shall look into the following aspects (indicative, not exhaustive):
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Evidence of rigorous review of claims. Comprehensiveness of claims submissions (documentation) by the EHCPs. Number of type of queries raised by the Implementation Support Agency during review of claims – appropriateness of queries. Accuracy of claims settlement amount.
(ii) Beneficiary identification Audit: SHA will undertake direct audits to review beneficiary identification decisions/ recommendation made by the ISA: a. 100 percent of the beneficiary rejected by the ISA to assure itself of the legitimacy of the ISA’s recommendation. b. 10 percent of accepted beneficiary identification to assure itself of the legitimacy of ISA’s decisions. c. 100 percent of the beneficiary identification decisions of the ISA that are disputed by the concern beneficiary shall be examined in depth by the SHA after such grievance of the beneficiary is forwarded by the concern Grievance Redressal Committe(GRC) to the SHA. SHA shall examine the merits of the case within 30 working days and recommend its decisions to the concern GRC. The GRC shall then communicate the decisions to the aggrieved party (the beneficiary) as per provisions specified in the clause of Grievance Redressal Mechanism.
During the beneficiary identification audit the SHA shall look into the following aspect (Indicative not exhaustive): Evidence of regress of review of identification request. Comprehensiveness of the beneficiary identification submissions (Documentation) by EHCPs / CHCs or any other contact point. No. Of type of queries raised by ISA during review of beneficiary identification - Appropriateness of queries. Accuracy of beneficiary identification decisions/ recommendations.
(iii) Concurrent Audits: The SHA shall have the right to set up mechanisms for concurrent audit of the implementation of the Scheme and monitoring of Implementation Support Agency’s performance under this Implementation Support Contract.
27.3.2 Spot Checks by the State Health Authority
a. The SHA shall have the right to undertake spot checks of district offices of the Implementation Support Agency and the premises of the EHCP without any prior intimation.
b. The spot checks shall be random and will be at the sole discretion of the SHA.
27.3.3 Performance Review and Monitoring Meetings
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a. The SHA shall organize fortnightly meetings for the first three months and monthly review meetings thereafter with the Implementation Support Agency. The SHA shall have the right to call for additional review meetings as required to ensure smooth functioning of the Scheme.
b. Whereas the SHA shall issue the Agenda for the review meeting prior to the meeting while communicating the date of the review meeting, as a general rule the Agenda shall have the following items: (i) Review of action taken from the previous review meeting. (ii) Review of performance and progress in the last quarter: utilization pattern, claims pattern, etc. This will be done based on the review of reports submitted by the ISA (TPA) in the quarter under review. (iii) KPI Results review – with discussions on variance from prescribed threshold limits, if any. (iv) Contracts management issue(s), if any. (v) Risk review, fraud alerts, action taken of fraud alerts. (vi) Any other item.
c. All meetings shall be documented and minutes shared with all concerned parties.
d. Apart from the regularly quarterly review meetings, the SHA shall have the right to call for interim review meetings as and when required on specific issues.
27.4 Key Performance Indicators for the Implementation Support Agency
a. A set of critical indicators where the performance level obligations have been set, shall attract financial penalties and shall be called Key Performance Indicators (KPI). For list of KPIs, see Annex 2.9.
b. At the end of every 12 months, the SHA shall have the right to amend the KPIs, which if amended, shall be applicable prospectively on the Implementation Support Agency and the Implementation Support Agency shall be obliged to abide by the same.
27.5 Measuring Performance
a. Performance shall be measured quarterly against meeting the obligations for the KPIs for each indicator.
b. Indicator performance results shall be reviewed in the quarterly review meetings and reasons for variances, if any, shall be presented by the Implementation Support Agency.
c. All penalties imposed by the SHA on the ISA (TPA) shall have to be paid by the ISA (TPA) within 60 days of such demand.
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d. Based on the review the SHA shall have the right to issue rectification orders demanding the performance to be brought up to the levels desired as per the Health Scheme Guidelines.
e. All such rectifications shall be undertaken by the ISA (TPA) within 30 days of the date of issue of such Rectification Order unless stated otherwise in such Order(s).
f. At the end of the rectification period, the ISA (TPA) shall submit an Action Taken Report with evidences of rectifications done to the SHA.
g. If the SHA is not satisfied with the Action Taken Report, it shall call for a follow up meeting with the ISA (TPA) and shall have the right to take appropriate actions within the overall provisions of the Implementation Support Contract between the SHA and the ISA (TPA).
28. Fraud Control and Management
a. The Scheme shall use an integrated centralized IT platform for detecting outlier behaviour and predictive modelling to identify fraud.
b. The MIS software will be designed to generate automatic reports and present trends including outlier behaviours against the list of trigger alerts.
c. For an indicative (not exhaustive) list of fraud triggers that may be automatically and on a real-time basis be tracked by the centralised Health Scheme IT platform, refer to Annex 2.10. The ISA (TPA) shall have capactities and track the indicative (not exhaustive) triggers and it can add more triggers to the list.
d. Seamless integration of the centralised AB-PMJAY IT platform with State level servers shall ensure real time alerts to the SHAs for immediate intimation to the ISA (TPA) and for detailed investigations.
e. For all trigger alerts related to possible fraud at the level of EHCPs, the ISA (TPA) shall take the lead in immediate investigation of the case in close coordination and under constant supervision of the SHA.
f. Investigations pursuant to any such alert shall be concluded within 15 days and all final decision related to outcome of the Investigation and consequent penal action, if the fraud is proven, shall vest solely with the SHA.
g. The SHA shall take all such decision within the provisions of the Implementation Support Contract and be founded on the Principles of Natural Justice.
h. The SHA shall on an ongoing basis measure the effectiveness of anti-fraud measures in the Scheme through a set of indicators. For a list of such indicative (not exhaustive) indicators, refer to Annex 2.11.
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29. Reporting Requirements
a. The Implementation Support Agency shall submit the following reports as per the schedule provided in the table below:
No. Report Frequency Deadline
(i) Medical & Hospital Audit For each audit Within 24 hours of completing the Reports audit (ii) Medical & Hospital Audit Weekly On Saturday of each week Summary Reports (iii) Claims/ Utilization Daily Online updation every day at the Summary Reports end of the day. (iv) Report for greivances/ Weekly Within 5th day of the month complaints and following the end of the month resolutions (v) Overall Scheme Progress Monthly Within 10th day of the month Reports following the end of the quarter
b. All reports shall be uploaded by the ISA (TPA) online on the NHA/SHA/ISA(TPA) web portal.
c. The ISA (TPA) shall receive auto-acknowledgement immediately on submission of the report.
d. The SHA shall review all progress reports and provide feedback, if any, to the ISA(TPA) .
e. All Audits reports shall be reviewed by the SHA and based on the audit observations, determine remedial actions, wherever required.
30. Events of Default of the Implementation Support Agency and Penalties
30.1 Events of Default
a. Following instances would constitute Events of Default for ISA (TPA) which may lead to termination of the Implementation Support Contract with the SHA:
(i) Performance against KPI is not being adhered as specified in Annex 2.9 for two consecutive quarters. (ii) Intentional or unintentional act of undisputedly proven fraud committed by the ISA or its employee or representative.
b. Further each of the following events or circumstances, to the extent not caused by a default of the SHA or Force Majeure, shall be considered for the purposes of the Implementation Support Contract as Events of Default of the ISA which, if not rectified
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within the time period permitted, may lead to Termination of the Implementation Support Contract/Service Level Agreement :
(i) The ISA has failed to perform or discharge any of its obligations in accordance with the provisions of the Implementation Support Contract /SLAwith SHA unless such event has occurred because of a Force Majeure Event, or due to reasons solely attributable to the SHA without any contributory factor of the ISA (TPA). (ii) The ISA (TPA) has successively infringed the terms and conditions of the Implementation Support Contract and/or has failed to rectify the same even after the expiry of the notice period for rectification of such infringement then it would amount to material breach of the terms of the Service Level Agreement/ Implementation Support Contract by the ISA. (iii) If at any time any payment, assessment, charge, lien, penalty or damage herein specified to be paid by the ISA to the SHA, or any part thereof, shall be in arrears and unpaid; (iv) Any representation made or warranties given by the ISA under the Implementation Support Contract/SLA is found to be false or misleading; (v) The ISA engaging or knowingly has allowed any of its employees, agents, tenants, contractor or representative to engage in any activity prohibited by law or which constitutes a breach of or an offence under any law, in the course of any activity undertaken pursuant to the Implementation Support Contract; (vi) The ISA has been adjudged as bankrupt or become insolvent: (vii) Any petition for winding up of the ISA has been admitted and liquidator or provisional liquidator has been appointed or the ISA has been ordered to be wound up by Court of competent jurisdiction, except for the purpose of amalgamation or reconstruction with the prior consent of the SHA, provided that, as part of such or reconstruction and the amalgamated or reconstructed entity has unconditionally assumed all surviving obligations of the ISA under the Implementation Support Contract/SLA; (viii) The ISA (TPA) has abandoned the Project Office(s) of the Health Scheme and is non-contactable.
30.2 Penalties
a. KPI performance related penalties are provided in the KPI table in Annex 2.9
b. Apart from the KPI related penalties, the SHA shall impose the following penalties on the Implementation Support Agency which have been referred to in the other sections of this Tender Document:
No. Additional Defaults Penalty (i) If State office and State coordinator is not being Rs. 1 lakh for every week of made available as per tender conditions delay
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(ii) If all district offices are not operational for more Rs. 5 lakh for each week of than 15 days during a Benefit period. delay
(iii) If pre-authorisation to hospital is delayed Automatic approval post 2 and beyond defined period. 4 hours for emergency and non- emergency cases respectively. ISA (TPA) would be penalised at the rate of Rs 100 per hour per delay beyond prescribed time limit of pre-authorisation (iv) If any Claim raised by EHCP is not processed by 1 % of the total claims amount ISA (TPA)within defined period of 15 days. per 15 Days which are delayed by ISA
31. Coordination Committee
31.1 Constitution and Membership
a. The SHA shall, within 15 days of the date of execution of this Implementation Support Contract, establish a coordination committee (the Coordination Committee) which shall meet quarterly to perform its functions.
b. The Coordination Committee shall be constituted as follows: (i) Principal Secretary (Health and Family Welfare) or any other representative designated by her/ him (Chairperson). (ii) Mission Director NHM. (iii) Chief Executive Officer, SHA (iv) Director Health Services. (v) The State Nodal Officer and one other member nominated by the SHA. (vi) The State Coordinator (s) of the Implementation Support Agency and one other member from the Corporate/ regional office of the Implementation Support Agency. State may add additional members, if required.
31.2 Roles and Responsibilities
The key functions and role of the Coordination Committee shall include but not be limited to: a. Ensuring smooth interaction and process flow between the SHA and the Implementation Support Agency. b. Reviewing the implementation and functioning of the Scheme and initiating discussions between the Parties to ensure efficient management and implementation of the Scheme. c. Reviewing the performance of the ISA (TPA) under the Implementation Support Contract/ SLA . d. Any other matter that the Parties may mutually agree upon.
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32. Grievance Redressal
A robust and strong grievance redressal mechanism has been designed for Health Scheme. The District /Block authorities shall act as a frontline for the redressal of Beneficiaries’ / Providers / other Stakeholder’s grievances. The District / Block authorities shall also attempt to solve the grievance at their end. The grievances so recorded shall be numbered consecutively and the Beneficiaries/ Providers or any other aggrieved party shall be provided with the number assigned to the grievance. The District authorities shall provide the Beneficiaries/ Provider or any other aggrieved party with details of the follow-up action taken as regards the grievance as per the process laid down. The District authorities shall also record the information in pre-agreed format of any complaint / grievance received by oral, written or any other form of communication. Under the Grievance Redressal Mechanism of Health Scheme, set of three tier Grievance Redressal Committees have been set up to attend to the grievances of various stakeholders at different levels. Details of Grievance Redressal mechanisms and guidelines for this purpose are provided at Annex 2.13. 33. Renewal of the Implementation Support Contract (Service Level Agreement) a. The 3-year Term of this ISA (TPA) Contract is subject to renewal after two years for one more year. b. All decisions related to renewal shall vest with the SHA. c. The SHA shall take the decision regarding the Implementation Support Contract (SLA) renewal based on the parameters specified in Section 11.5 of this Volume II of the Tender Document. d. The ISA (TPA) hereby acknowledges and accepts that the decision related to renewal is at the discretion of the SHA and this shall not be deemed as a right of the ISA (TPA) under this Implementation Support Contract/Service Level Agreement. 34. Termination of the Implementation Support Contract (SLA) and Consequences 34.1 Grounds for Termination a. If the SHA does not renew the Implementation Support Contract (SLA) of the Implementation Support Agency as per Section 28 above, it shall be terminated prematurely. b. The Implementation Support Contract (SLA)may be terminated also on the occurrence of one or more of the following events: (i) the ISA fails to duly obtain a renewal of its registration with the IRDAI or the IRDAI revokes or suspends the ISA (TPA) registration for the ISA (TPA) failure to comply with applicable Laws or the ISA(TPA) failure to conduct the general or health insurance business in accordance with applicable Insurance Laws or the code of conduct issued by the IRDAI; or (ii) the ISA’s average Turn-around Time over a period of 90 days is in excess of 15 days per Claim provided all fees due is paid by the SHA in time to the Implementation Support Agency; or (iii) the ISA (TPA) has failed to pay any of the Liquidated Damages/ penalties within 60 days of receipt of a written notice from the SHA requesting payment thereof; or (iv) the ISA (TPA) amends or modifies or seeks to amend or modify the Fees or the 51 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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terms and conditions of the Health Scheme (v) Cover for any renewal Benefit Cover Period; or (vi) the ISA (TPA) is otherwise in material breach of this Implementation Support Contract (SLA)that remains uncured despite receipt of a 60-day cure notice from the SHA; or (vii) any representation, warranty or undertaking given by the ISA (TPA) proves to be incorrect in a material respect or is breached; or (viii) Non-performance on KPIs. (ix) Fraudulent practices c. Termination shall take place following the legal protocols specified in the Implementation Support Contract. d. Premature termination of Implementation Support Contract shall give the following rights to the SHA: (i) Quantify pending dues of the Implementation Support Agency to the SHA and pending claims of the EHCP and ensure recovery from the SHA. (ii) SHA will provide pro data fees for the period for which ISA has provided the support services within 30 days of end of contract. 35. Force Majeure 35.1 Definition of Force Majeure Event A Force Majeure Event shall mean the occurrence in th e state of Uttarakhand of any of the following events after the date of execution of this Service Level Agreement, which was not reasonably foreseeable at the time of execution of this Service Level Agreement and which is nbeyond the reasonable control and influence of a party(the Affected Party) and whcihc causes a delay and/or inability for that party to fulfil its obligations under this Service level Agreement: a. fire,flood,atmoshpheric disturbance, lightning,strom,typhoon,tornado,earthquake.washout or other Acts of God; b. war,riotr,blockase,insurrection,acts of public enemies,civil disturbance,terrorism,sabotage or threats of such actions : and c. strikes ,lock-out or other disturbances or labour disputes ,not involving the employees of such party or nay internediaries appointed by it 36. Confidentiality of Information and Data Protection ISA will treat all non-public, especially health ,treatment and payment related information as confidential ,and such party shall not disclose or use such information ina manner contratry to the purposes of this agreement .
37. Arbitration and Dispute Resolution a. The Purchaser and the Bidder shall make every effort to resolve amicably by direct informal negotiations, any disagreement or disputes, arising between them under or in connection with the Contract. If, after Thirty (30) days from the commencement of such direct informal negotiations, the Purchaser and the Bidder have been unable to resolve amicably a Contract dispute, either party may require that the dispute be referred for resolution to the formal mechanism specified in as mentioned in RFP. b. That in case of any dispute arising between the parties with reference to the contract, interpretation of the terms or any claim whatsoever, the Secretary (Health) or any 52 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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person appointed by him on mutual consent shall be the sole Arbitrator to decide the matter and the provisions of Arbitration and Conciliation Act 1996 shall be applicable. The firm shall have no objection to the Designated Arbitrator or other appointed person as Arbitrator by him. The place of Arbitration proceedings shall be at Dehradun. c. The Arbitration and Conciliation Act 1996, the rules hereunder and any statutory modification or reenactments thereof, shall apply to the arbitration proceedings. d. The Arbitration proceedings shall be held in Dehradun, India. e. The Arbitration proceeding shall be governed by the substantive laws of India. f. The proceedings of Arbitration shall be in English language. g. If any of the Arbitrators so appointed dies, resigns, incapacitated or withdraws for any reason from the proceedings, it shall be lawful for the concerned party/ arbitrator to appoint another person in his place in the same manner as aforesaid. Such person shall proceed with the reference from the stage where his predecessor had left if both parties consent for the same; otherwise, he shall proceed de novo. h. The Arbitral Tribunal shall give reasonable award and the same shall be final, conclusive and binding on the parties. i. The fees of the arbitrator shall be borne by the parties nominating them and the fee of the Presiding Arbitrator, costs and other expenses incidental to the arbitration proceedings shall be borne equally by the parties.
38. Indemnity The agency shall, subject to the provisions of the Agreement, indemnify the department for an amount equal to the value of the Agreement for any direct loss or damage that is caused due to any deficiency in services.
39. Exit Management Plan An Exit Management plan shall be furnished by Bidder in writing to the Purchaser within 60days from the date of signing the Contract, which shall deal with at least the following aspects of exit management in relation to the contract as a whole and in relation to the Project Implementation, and Service Level monitoring.A detailed program of the transfer process that could be used in conjunction with a Replacement including details of the means to be used to ensure continuing provision of the services throughout the transfer process or until the cessation of the services and of the management structure to be used during thetransfer Exit Management plan in case of normal termination of Contract period and also an Exit Management plan in case of any eventuality due to which Project is terminated before the contract period.Exit Management plan in case of termination of the Bidder shall include Complete handover of the Planning documents, bill of materials, functional requirements specification .In the event of termination or expiry of the contract, Project 53 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
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Implementation, orService Level monitoring, both Bidder and Purchaser shall comply with the Exit Management Plan During the exit management period, the Bidder shall use its best efforts to deliver the services. The ISA shall handover of all Software, emails, plans and achievements in writing to SHA.
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Annexes: Volume II
Annex 2.1 Health Scheme Beneficiaries Total Ayushman Cards created -43.92 lacs Beneficiaries Profile of the identified families is given below: Eligible Beneficiary Family Units SN Beneficiary Family Unit Name to be covered under the Scheme
1 AB-PMJAY Beneficiary Family Units 5,24,000 GEP (Government Employee and Pensioners) 2 2,54,000 Beneficiary Family families RP (Remaining Population) Beneficiary Family 3 Unit. 10,46,000 Grand Total 18,24,000
55 Tender Document Volume II: About AB-PMJAY, AAUYand SGHS State Health Authority , Government of Uttarakhand
Tender for Selection of Implementation Support Agency For providing support services for the implementation of Health Scheme (PM-JAY, AAUY and SGHS) In the State of Uttarakhand
Annex 2.2 Exclusions to the Benefit Cover
The Implementation Support Agencyshall not be liable to make any payment under this Benefit cover in respect of any expenses whatsoever incurred by any covered Person in connection with or in respect of:
1. Conditions that do not require hospitalization: Condition that do not require hospitalization and can be treated under Out Patient Care. Out patient Diagnostic, Medical and Surgical procedures or treatments unless necessary for treatment of a disease covered under day care procedures (as applicable) will not be covered.
2. Except those expenses covered under pre and post hospitalisation expenses, further expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes only during the hospitalized period and expenses on vitamins and tonics etc unless forming part of treatment for injury or disease as certified by the attending physician.
3. Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc. unless arising from disease or injury and which requires hospitalisation for treatment.
4. Congenital external diseases: Congenital external diseases or defects or anomalies, Convalescence, general debility, “run down” condition or rest cure.
5. Hormone replacement therapy for Sex change or treatment which results from or is in any way related to sex change.
6. Vaccination: Vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness. Circumcision (unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to any accident),
7. Suicide: Intentional self-injury/suicide
8. Persistent Vegetative State
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*Packages are dynamic and subject to changes by National Health Authority
Annex 2.3 Packages and Rates (All packages under Health Scheme would be mandated for Pre-Authorization except in case of emergency)
Health Benefit Packages 2.0 HBP 2.0
HBP 2.0 S. No. Specialty Code Packages Procedures 1 Burns Management BM 6 20 2 Cardiology MC 20 26 3 Cardio-thoracic & Vascular surgery SV 34 118 4 Diagnostic Laboratory DL 2 2 5 Emergency Room Packages ER 3 4 6 General Medicine MG 76 99 7 General Surgery SG 98 152 8 Infectious Disease ID 1 1 9 Interventional Neuroradiology IN 10 15 10 Medical Oncology MO 71 263 11 Mental Disorders Packages MM 10 10 12 Neo-natal care Packages MN 10 10
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13 Obstetrics & Gynecology SO 59 77 14 Ophthalmology SE 40 53 15 Orthopedics SB 71 132 16 Otorhinolaryngology SL 35 78 17 Pediatric Medical management MP 46 65 18 Radiation Oncology MR 14 35 19 Surgical Oncology SC 76 120 20 Urology SU 93 142 21 Neurosurgery SN 54 82 22 Oral and Maxillofacial Surgery SM 7 9 23 Pediatric surgery SS 19 35 24 Plastic & reconstructive Surgery SP 8 12 25 Polytrauma ST 10 21 26 Unspecified Surgical Package US 1 1 Total 874 1,582
1. Burns Management
• Total number of packages: 6 • Total number of procedures: 20 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 5 (BM006 needs pre-auth to initiate treatment, for the rest documentation could be retrospectively sent)
• Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Specific Pre and Post-op Investigations such as clinical photograph and diagram with Rule of 9 / L & B Chart for extent of burns at the time of admission and follow up clinical photographs on days 5, 10, 15, 20 as per requirements on the basis of preauthorization would need to be submitted during claims.
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• Admission Criteria to be followed for selecting packages for burn injured patients
a. Second- and third-degree burns greater than 10% of the total body surface area in patients under 10 or over 60 years of age
b. Second- and third-degree burns greater than 20% of the total body surface area in other age groups
c. Significant burns of face, hands, feet, genitalia, or perineum and those that involve skin overlying major joints
d. Third-degree burns greater than 5% of the total body surface area in any age group
e. Inhalation injury
f. Significant electric injury including lightning injury
g. Significant chemical injury
h. Burns with significant pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality (e.g. diabetes mellitus, cardiopulmonary disease)
i. Burns with significant concomitant trauma
j. Burn injury in patients who will require special social and emotional or long-term rehabilitative support, including cases of suspected child abuse and neglect.
S. Package AB PM - JAY Procedure AB PM - JAY Package Mandatory Documents - Pre Mandatory Documents - Claim No. Code Package Name Code Procedure Name Price Authorization Processing HBP 2.0 HBP 2.0 1 BM001 Thermal burns BM001A % Total Body Surface Area Burns (TBSA) - any 7,000 Clinical Notes, MLC copy with Post Treatment clinical % number, Extent of burns visible photograph, lab tests or other (not requiring admission). on photograph (with rule of 9 diagnostic procedures done as Needs at least 5-6 dressing chart) a part of treatment. Detailed clinical notes. 2 BM001 Thermal burns BM001B % Total Body Surface Area Burns (TBSA): Upto 40,000 Clinical Notes, MLC copy with Post Treatment clinical 40 %; Includes % TBSA skin grafted, flap number, Extent of upto 40% photograph, lab tests, X-rays or cover, follow-up dressings etc. as deemed burns visible on photograph other diagnostic procedures necessary; Surgical procedures are required (with rule of 9 chart) done as a part of treatment. for deep burns that are not amenable to heal Detailed discharge summary. with dressings alone. 3 BM001 Thermal burns BM001C % Total Body Surface Area Burns (TBSA): 40% 50,000 Clinical Notes, MLC copy with Post Treatment clinical - 60 %; Includes % TBSA skin grafted, flap number, Extent of upto 40% - photograph, lab tests, X-rays or cover, follow-up dressings etc. as deemed 60% burns visible on other diagnostic procedures necessary; Surgical procedures are required photograph (with rule of 9 done as a part of treatment. 59 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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for deep burns that are not amenable to heal chart) Detailed discharge summary. with dressings alone. 4 BM001 Thermal burns BM001D % Total Body Surface Area Burns (TBSA): > 60 80,000 Clinical Notes, MLC copy with Post Treatment clinical %; Includes % TBSA skin grafted, flap cover, number, Extent > 60% burns photograph, lab tests, X-rays or follow-up dressings etc. as deemed visible on photograph (with other diagnostic procedures necessary; Surgical procedures are required rule of 9 chart) done as a part of treatment. for deep burns that are not amenable to heal Detailed discharge summary. with dressings alone. 5 BM002 Scald burns BM002A % Total Body Surface Area Burns (TBSA) - any 7,000 Clinical Notes, MLC copy with Post Treatment clinical % number, Extent of burns visible photograph, lab tests or other (not requiring admission). on photograph (with rule of 9 diagnostic procedures done as Needs at least 5-6 dressing chart) a part of treatment. Detailed clinical notes. 6 BM002 Scald burns BM002B % Total Body Surface Area Burns (TBSA): Upto 40,000 Clinical Notes, MLC copy with Post Treatment clinical 40 %; Includes % TBSA skin grafted, flap number, Extent of upto 40% photograph, lab tests, X-rays or cover, follow-up dressings etc. as deemed burns visible on photograph other diagnostic procedures necessary; Surgical procedures are required (with rule of 9 chart) done as a part of treatment. for deep burns that are not amenable to heal Detailed discharge summary. with dressings alone. 7 BM002 Scald burns BM002C % Total Body Surface Area Burns (TBSA): 40% 50,000 Clinical Notes, MLC copy with Post Treatment clinical - 60 %; Includes % TBSA skin grafted, flap number, Extent of upto 40% - photograph, lab tests, X-rays or cover, follow-up dressings etc. as deemed 60% burns visible on other diagnostic procedures necessary; Surgical procedures are required photograph (with rule of 9 done as a part of treatment. for deep burns that are not amenable to heal chart) Detailed discharge summary. with dressings alone. 8 BM002 Scald burns BM002D % Total Body Surface Area Burns (TBSA): > 60 80,000 Clinical Notes, MLC copy with Post Treatment clinical %; Includes % TBSA skin grafted, flap cover, number, Extent > 60% burns photograph, lab tests, X-rays or follow-up dressings etc. as deemed visible on photograph (with other diagnostic procedures necessary; Surgical procedures are required rule of 9 chart) done as a part of treatment. for deep burns that are not amenable to heal Detailed discharge summary. with dressings alone. 9 BM003 Flame burns BM003A % Total Body Surface Area Burns (TBSA) - any 7,000 Clinical Notes, MLC copy with Post Treatment clinical % number, Extent of burns visible photograph, lab tests, X-rays or (not requiring admission). on photograph (with rule of 9 other diagnostic procedures Needs at least 5-6 dressing chart) done as a part of treatment. Detailed discharge summary. 10 BM003 Flame burns BM003B % Total Body Surface Area Burns (TBSA): Upto 40,000 Clinical Notes, MLC copy with Post Treatment clinical 40 %; Includes % TBSA skin grafted, flap number, Extent of upto 40% photograph, lab tests, X-rays or cover, follow-up dressings etc. as deemed burns visible on photograph other diagnostic procedures necessary; Surgical procedures are required (with rule of 9 chart) done as a part of treatment. for deep burns that are not amenable to heal Detailed discharge summary. 60 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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with dressings alone. 11 BM003 Flame burns BM003C % Total Body Surface Area Burns (TBSA): 40 % 50,000 Clinical Notes, MLC copy with Post Treatment clinical - 60 %; Includes % TBSA skin grafted, flap number, Extent of upto 40% - photograph, lab tests, X-rays or cover, follow-up dressings etc. as deemed 60% burns visible on other diagnostic procedures necessary; Surgical procedures are required photograph (with rule of 9 done as a part of treatment. for deep burns that are not amenable to heal chart) Detailed discharge summary. with dressings alone. 12 BM003 Flame burns BM003D % Total Body Surface Area Burns (TBSA): > 60 80,000 Clinical Notes, MLC copy with Post Treatment clinical %; Includes % TBSA skin grafted, flap cover, number, Extent > 60% burns photograph, lab tests, X-rays or follow-up dressings etc. as deemed visible on photograph (with other diagnostic procedures necessary; Surgical procedures are required rule of 9 chart) done as a part of treatment. for deep burns that are not amenable to heal Detailed discharge summary. with dressings alone. 13 BM004 Electrical BM004A Electrical contact burns: Low voltage - 30,000 Circumstances that led to low Post Treatment clinical contact burns without part of limb / limb loss; Includes % voltage electrical contact photograph, lab tests, X-rays or TBSA skin grafted, flap cover, follow-up burns, MLC copy with number. other diagnostic procedures dressings etc. as deemed necessary; Surgical % burns visible on clinical done as a part of treatment. procedures are required for deep burns that photograph (with rule of 9 Detailed discharge summary. are not amenable to heal with dressings chart) Detailed Procedure / Operative alone. Notes if surgery done. 14 BM004 Electrical BM004B Electrical contact burns: Low voltage - with 40,000 Circumstances that led to low Post Treatment clinical contact burns part of limb / limb loss; Includes % TBSA skin voltage electrical contact photograph, lab tests, X-rays or grafted, flap cover, follow-up dressings etc. as burns, MLC copy with number. other diagnostic procedures deemed necessary; Surgical procedures are % burns visible on clinical done as a part of treatment. required for deep burns that are not photograph (with rule of 9 Detailed discharge summary. amenable to heal with dressings alone. chart) Detailed Procedure / Operative Notes if surgery done. 15 BM004 Electrical BM004C Electrical contact burns: High voltage - with 60,000 Circumstances that led to High Post Treatment clinical contact burns part of limb / limb loss; Includes % TBSA skin voltage electrical contact photograph, lab tests, X-rays or grafted, flap cover, follow-up dressings etc. as burns, MLC copy with number. other diagnostic procedures deemed necessary; Surgical procedures are % burns visible on clinical done as a part of treatment. required for deep burns that are not photograph (with rule of 9 Detailed discharge summary. amenable to heal with dressings alone. chart) Detailed Procedure / Operative Notes if surgery done. 16 BM004 Electrical BM004D Electrical contact burns: High voltage - 50,000 Circumstances that led to High Post Treatment clinical contact burns without part of limb / limb loss; Includes % voltage electrical contact photograph, lab tests, X-rays or TBSA skin grafted, flap cover, follow-up burns, MLC copy with number. other diagnostic procedures dressings etc. as deemed necessary; Surgical % burns visible on clinical done as a part of treatment. procedures are required for deep burns that photograph (with rule of 9 Detailed discharge summary. are not amenable to heal with dressings chart) Detailed Procedure / Operative alone. Notes if surgery done. 61 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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17 BM005 Chemical BM005A Chemical burns: Without significant facial 40,000 Circumstances that led to Post Treatment clinical burns scarring and/or loss of function; Includes % chemical burns, MLC copy with photograph showing treated TBSA skin grafted, flap cover, follow-up number, % and area burnt burns, lab tests, X-rays or other dressings etc. as deemed necessary; Surgical visible on clinical photograph diagnostic procedures done as procedures are required for deep burns that (with rule of 9 chart) a part of treatment.Detailed are not amenable to heal with dressings discharge summary. Detailed alone. Procedure / Operative Notes if surgery done. 18 BM005 Chemical BM005B Chemical burns: With significant facial 60,000 Circumstances that led to Post Treatment clinical burns scarring and/or loss of function; Includes % chemical burns, MLC copy with photograph showing treated TBSA skin grafted, flap cover, follow-up number, % and area burnt burns, lab tests, X-rays or other dressings etc. as deemed necessary; Surgical visible on clinical photograph diagnostic procedures done as procedures are required for deep burns that (with rule of 9 chart) a part of treatment.Detailed are not amenable to heal with dressings discharge summary. Detailed alone. Procedure / Operative Notes if surgery done. 19 BM006 Post Burn BM006A Post Burn Contracture surgeries for 50,000 Clinical history detailing the Post Treatment clinical Contracture Functional Improvement (Package including burns - etiology, treatment photograph, Detailed discharge surgeries for splints, pressure garments, silicone - gel sheet given and resultant summary. Detailed Procedure / Functional and physiotherapy): Excluding Neck contractures left. Functional Operative Notes. Improvement contracture; Contracture release with - Split disability to be detailed and thickness Skin Graft (STSG) / Full Thickness expected functional Skin Graft (FTSG) / Flap cover is done for each improvement to be shared. joint with post - operative regular dressings Pre-op clinical photograph. for STSG / FTSG / Flap cover. 20 BM006 Post Burn BM006B Post Burn Contracture surgeries for 50,000 Clinical history detailing the Post Treatment clinical Contracture Functional Improvement (Package including burns - etiology, treatment photograph, Detailed discharge surgeries for splints, pressure garments, silicone - gel sheet given and resultant summary. Detailed Procedure / Functional and physiotherapy): Neck contracture; contractures left. Functional Operative Notes. Improvement Contracture release with - Split thickness Skin disability to be detailed and Graft (STSG) / expected functional Full Thickness Skin Graft (FTSG) / Flap cover is improvement to be shared. done for each joint with post-operative Pre-op clinical photograph. regular dressings for STSG / FTSG / Flap cover.
2. Cardiology
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• Total number of packages: 20 • Total number of procedures: 26 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Specific Pre and Post-op Investigations such as ECHO, ECG, pre / post-op X-ray, label / carton of stents used, pre and post-op blood tests (USG, clotting time, prothrombin time, international normalized ratio, Hb, Serum Creatinine), angioplasty stills showing stents & post stent flow, CAG report showing blocks (pre) and balloon and stills showing flow (post) etc. will need to be submitted/ uploaded for pre-authorization/ claims settlement purposes. The costs for such investigations will form part of the approved package cost. • It is prescribed as standard practice to use medicated stents (approved by FDA/DCGI) where necessary • The carton / sticker detailing the stent particulars needs to be submitted as part of claims filing by providers • It is advised to perform cardiac catheterization as part of the treatment package for congenital heart defects
S. Packa AB PM - Proce AB PM - JAY Package Stratification Implant Mandatory Mandatory Documents - Claim N ge JAY dure Procedure Price Documents - Pre Processing o Code Package Code Name Authorization HBP Name HBP 2.0 2.0 1 MC00 Right / MC00 Right Heart 5,000 Clinical notes with Discharge summary, Procedure / 1 Left Heart 1A Catheterization planned line of Operative Notes. Invoices of Catheteri treatment, ECG, ECHO catherter and other accesories zation used. 2 MC00 Right / MC00 Left Heart 5,000 Clinical notes with Discharge summary, Procedure / 1 Left Heart 1B Catheterization planned line of Operative Notes. Invoices of Catheteri treatment, ECG, ECHO catherter and other accesories zation used. 3 MC00 Catheter MC00 For Deep vein 30,800 Clinical notes and Post procedure Colour Doppler of 2 directed 2A thrombosis doppler establishing affected limb/part, invoice of Thrombol (DVT) presence of DVT catheter used, invoice of the ysis thrombolytic drug (tPA) used, Detailed Discharge Summary. 4 MC00 Catheter MC00 For Mesenteric 30,800 Clinical notes and Post procedure Colour Doppler of 2 directed 2B Thrombosis doppler establishing affected limb/part, invoice of Thrombol presence of mesentric catheter used, invoice of the 63 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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ysis thrombosis thrombolytic drug (tPA) used, Detailed Discharge Summary. 5 MC00 Catheter MC00 For Peripheral 30,800 Clinical notes and Post procedure Colour Doppler of 2 directed 2C vessels doppler establishing affected limb/part, invoice of Thrombol presence of catheter used, invoice of the ysis peripheral vessel thrombolytic drug (tPA) used, thrombosis Detailed Discharge Summary. 6 MC00 Balloon MC00 Coartication of 38,600 Cardiac Balloon - ECHO & CT angiogram Procedure / Operative Notes with 3 Dilatation 3A Aorta Adult/Cardiac Balloon report & stills images, Post Procedure images / – Pediatric (Max 1) Angiogram, barcode of balloon 14,000/33,000 used, Detailed Discharge Summary
7 MC00 Balloon MC00 Pulmonary 38,600 Cardiac Balloon - ECHO & CT angiogram Procedure / Operative Notes with 3 Dilatation 3B Artrey Stenosis Adult/Cardiac Balloon report & stills images, Post Procedure images / – Pediatric (Max 1) Angiogram, barcode of balloon 14,000/33,000 used, Detailed Discharge Summary 8 MC00 Balloon MC00 Balloon 23,400 Cardiac Balloon - Clinical notes with Procedure / Operative notes with 4 Pulmonar 4A Pulmonary Adult/Cardiac Balloon planned line of still images, Post procedure stills of y / Aortic Valvotomy – Pediatric (Max 1) treatment and ECHO Echo with report; Invoice of blade / Valvotom 14,000/33,000 report with stills. balloon used, Detailed Discharge y Summary . 9 MC00 Balloon MC00 Balloon Aortic 23,400 Cardiac Balloon - Clinical notes with Procedure / Operative notes with 4 Pulmonar 4B Valvotomy Adult/Cardiac Balloon planned line of still images, Post procedure stills of y / Aortic – Pediatric (Max 1) treatment and ECHO Echo with report; Invoice of blade / Valvotom 14,000/33,000 report with stills. balloon used, Detailed Discharge y Summary . 10 MC00 Balloon MC00 Balloon Mitral 35,700 Balloon & Accessories Clinical notes with Procedure / Operative notes with 5 Mitral 5A Valvotomy (Max 1) planned line of still images, Post procedure stills of Valvotom 55,000 treatment and ECHO Echo with report; Invoice of blade / y report with stills. balloon used, Detailed Discharge Summary . 11 MC00 Balloon MC00 Balloon Atrial 24,400 Clinical notes and Procedure / Operative notes with 6 Atrial 6A Septostomy ECHO / and doppler still images, Post procedure stills of Septosto stills + reports ECHO with report; Invoice of blade my showing the / balloon used, Detailed Discharge transposition of the Summary . great arteries (TGA) & need of septostomy 12 MC00 ASD MC00 ASD Device 36,900 ASD Device Clinical notes and Procedure / Operative notes with 7 Device 7A Closure (Max 1) ECHO report showing still images, Post procedure stills of Closure 62,000 ASD ECHO with report; Invoice of blade 64 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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/ device used, Detailed Discharge Summary . 13 MC00 VSD MC00 VSD Device 37,900 VSD Device (Max 1) Clinical notes and Procedure / Operative notes with 8 Device 8A Closure 72,000 ECHO report showing still images, Post procedure stills of Closure VSD ECHO with report; Invoice of blade / device used, Detailed Discharge Summary . 14 MC00 PDA MC00 PDA Device 25,000 PDA Device (Max 1) Clinical notes and Procedure / Operative notes with 9 Device 9A Closure 30,000 ECHO report showing still images, Post procedure stills of Closure PDA ECHO with report; Invoice of blade / device used, Detailed Discharge Summary . 15 MC01 PDA MC01 PDA stenting 40,260 Coronary Stent for Clinical notes and Procedure / Operative notes with 0 stenting 0A PDA stenting - Bare ECHO report / Angio still images, Post procedure stills of Metal/Coronary Stent showing PDA ECHO with report; Invoice of blade for PDA stenting - / barcode of stent used, barcode of Drug Eluting (Max 1) the stent used, Detailed Discharge 8,700/31,600 Summary . 16 MC01 PTCA, MC01 PTCA, inclusive 40,600 Coronary Stent for ECG, ECHO, CAG stills Procedure / Operative notes with 1 inclusive 1A of diagnostic PTCA - Bare showing blocks & still images, Angiogram report, of angiogram Metal/Coronary Stent Reports showing stent & post Stent flow + diagnostic for PTCA - Drug barcode of the stents used, angiogra Eluting (Max 3) Detailed Discharge Summary m 8,700/31,600 17 MC01 Electroph MC01 Electrophysiolo 20,000 Implant for Clinical notes with Discharge summary, EP study 2 ysiologica 2A gical Study "Electrophysiological planned line of report l Study Study" includes - treatment, ECG, Steerable decapolar ECHO, Serum catheter, Quadripolar Elctrolytes Catheter (Max 1) 46,000 18 MC01 Electroph MC01 Electrophysiolo 20,000 Implant for Clinical notes with Discharge summary, EP study 2 ysiologica 2B gical Study "Electrophysiological planned line of report, Procedure / Operative l Study with Radio Study (Max 1) treatment, ECG, Notes Frequency 76,000 ECHO, Serum Ablation Elctrolytes 19 MC01 Percutan MC01 Percutaneous 34,000 Clinical notes and Angiogram report with stills, 3 eous 3A Transluminal ECG, ECHO, CAG stills showing stent & post Stent flow + Translumi Septal showing blaocks barcode / Invoice of the stent used nal Septal Myocardial justifying the Myocardi Ablation procedure 65 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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al Ablation 20 MC01 Temporar MC01 Temporary 19,200 Clinical notes and ECG X Ray showing the pacemaker in 4 y 4A Pacemaker + Report by situ; detailed discharge summary, Pacemak implantation cardiologist Detailed Procedure / Operative er necessitating Notes; Invoice / barcode of implantat procedure pacemaker ion 21 MC01 Single MC01 Permanent 24,500 Single Chamber Clinical notes and ECG X Ray showing the pacemaker in 5 Chamber 5A Pacemaker Pacemaker - Rate + Report by situ, Invoice / Barcode of Permane Implantation - Responsive (Max 1) cardiologist designated pacemaker. Detailed nt Single Chamber 45,000 necessitating Procedure / Operative Notes, Pacemak procedure; Angiogram detailed discharge summary er if done Implantat ion 22 MC01 Double MC01 Permanent 33,000 Double Chamber Clinical notes and ECG X Ray showing the pacemaker in 6 Chamber 6A Pacemaker Pacemaker - Rate + Report by situ, Invoice / Barcode of Permane Implantation - Responsive (Max 1) cardiologist designated pacemaker. Detailed nt Double 75,000 necessitating Procedure / Operative Notes, Pacemak Chamber procedure; Angiogram detailed discharge summary er if done Implantat ion 23 MC01 Periphera MC01 Peripheral 34,500 Peripheral Stent - ECHO, Doppler, Angio Post op. Angiogram report/ stills, 7 l 7A Angioplasty Bare Metal (Max 1) stills showing blocks & showing stent; Implant / barcode of Angioplas 21,000 Reports stent used ty 24 MC01 Bronchial MC01 Bronchial artery 32,800 Clinical notes and Check Angiography of same 8 artery 8A Embolisation Chest X-Ray / HRCT bronchial artery after the Embolisat (for chest with CT procedure. Detailed discharge ion Haemoptysis) Pulmonary Angiogram summary; Detailed Procedure / (for & other investigations Operative Notes, Hb, Serum Haemopt Creatinine ysis) 25 MC01 Pericardio MC01 Pericardiocente 12,100 Clinical notes and Intra procedure clinical 9 centesis 9A sis ECHO report justifying photograph, post procedure ECHO need of procedure report; Analysis of fluid removed. 26 MC02 Systemic MC02 Systemic 17,900 Serial ECGs showing ECHO, ECG, Lab Investigation (TROP 0 Thrombol 0A Thrombolysis MI, Cardiac markers - - T report); invoice / barcode of ysis (for (for MI) CPK-MB, TROP I or thrombolytic agent used 66 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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MI) TROP T
3. Cardio-thoracic & Vascular Surgery
• Total number of packages: 34 • Total number of procedures: 118 • Number of procedures recommended for auto-approval: 0
• Pre-authorization: Mandatory for all packages
• Pre-authorization remarks: Specific Pre and Post-op Investigations such as ECHO, ECG, post-op scar photo, clinical photos of graft / filter / balloon & post flow, Angiography / CT / MRI / Doppler / CT angiogram reports etc. will need to be submitted / uploaded for pre-authorization / claims settlement purposes S. Pac AB PM - JAY Procedure AB PM - JAY Packag Stratification Implant Mandatory Mandatory No kag Package Name Code Procedure e Price Documents - Pre Documents - Claim e HBP 2.0 Name Authorization Processing Cod e HBP 2.0 1 SV0 Surgical Correction SV001A Unifocalization 1,00,00 Clinical notes and Detailed discharge 01 of Category - I of MAPCA 0 ECHO and / or summary, Detailed Congenital Heart doppler reports Operative notes, Disease barcode of Implant, if used. 2 SV0 Surgical Correction SV001B Isolated 1,00,00 Clinical notes and Detailed discharge 01 of Category - I Secundum 0 ECHO and / or summary, Detailed Congenital Heart Atrial Septal doppler reports Operative notes, Disease Defect (ASD) barcode of Implant, Repair if used. 3 SV0 Surgical Correction SV001C Glenn 1,00,00 Clinical notes and Detailed discharge 01 of Category - I procedure 0 ECHO and / or summary, Detailed Congenital Heart doppler reports Operative notes, Disease barcode of Implant, if used.
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4 SV0 Surgical Correction SV001D Pulmonary 1,00,00 Clinical notes and Detailed discharge 01 of Category - I Artery Banding 0 ECHO and / or summary, Detailed Congenital Heart doppler reports Operative notes, Disease barcode of Implant, if used. 5 SV0 Surgical Correction SV001E Systemic - 1,00,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 01 of Category - I Pulmonary 0 1) ECHO and / or summary, Detailed Congenital Heart shunt 30,000 doppler reports Operative notes, Disease barcode of Implant, if used. 6 SV0 Surgical Correction SV001F Vascular Ring 1,00,00 Clinical notes and Detailed discharge 01 of Category - I division 0 ECHO and / or summary, Detailed Congenital Heart doppler reports Operative notes, Disease barcode of Implant, if used. 7 SV0 Surgical Correction SV001G Coarctation 1,00,00 Dacron Graft – Straight Clinical notes and Detailed discharge 01 of Category - I repair 0 (Max 1) ECHO and / or summary, Detailed Congenital Heart 30,000 doppler reports Operative notes, Disease barcode of Implant, if used. 8 SV0 Surgical Correction SV002A ASD closure + 1,20,00 Mechanical Valve – Clinical notes and Detailed discharge 02 of Category - II Partial 0 Bileaflet (Max 1) ECHO report summary, Detailed Congenital Heart Anomalous 40,000 Operative notes, Disease Venous barcode of Implant, Drainage Repair if used. 9 SV0 Surgical Correction SV002B ASD Closure + 1,20,00 Mechanical Valve – Clinical notes and Detailed discharge 02 of Category - II Mitral 0 Bileaflet (Max 1) ECHO report summary, Detailed Congenital Heart procedure 40,000 Operative notes, Disease barcode of Implant, if used. 10 SV0 Surgical Correction SV002C ASD Closure + 1,20,00 Mechanical Valve – Clinical notes and Detailed discharge 02 of Category - II Tricuspid 0 Bileaflet (Max 1) ECHO report summary, Detailed Congenital Heart procedure 40,000 Operative notes, Disease barcode of Implant, if used. 11 SV0 Surgical Correction SV002D ASD Closure + 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II Pulmonary 0 1) ECHO report summary, Detailed Congenital Heart procedure 30,000 Operative notes, Disease barcode of Implant, if used.
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12 SV0 Surgical Correction SV002E ASD Closure + 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II Infundibular 0 1) ECHO report summary, Detailed Congenital Heart procedure 30,000 Operative notes, Disease barcode of Implant, if used. 13 SV0 Surgical Correction SV002F VSD closure 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II 0 1) ECHO report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 14 SV0 Surgical Correction SV002G Infundibular PS 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II repair 0 1) ECHO report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 15 SV0 Surgical Correction SV002H Valvular PS 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II repair 0 1) ECHO report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 16 SV0 Surgical Correction SV002I Partial AV canal 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II repair 0 1) ECHO report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 17 SV0 Surgical Correction SV002J Intermediate 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II AV canal repair 0 1) ECHO report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 18 SV0 Surgical Correction SV002K Atrial 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II septectomy + 0 1) ECHO report summary, Detailed Congenital Heart Glenn 30,000 Operative notes, Disease barcode of Implant, if used. 19 SV0 Surgical Correction SV002L Atrial 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II septectomy + 0 1) ECHO report summary, Detailed Congenital Heart PA Band 30,000 Operative notes, Disease barcode of Implant, if used.
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20 SV0 Surgical Correction SV002M Sinus of 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II Valsalva 0 1) ECHO report summary, Detailed Congenital Heart aneurysm 30,000 Operative notes, Disease repair with barcode of Implant, aortic valve if used. procedure 21 SV0 Surgical Correction SV002N Sinus of 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II Valsalva 0 1) ECHO report summary, Detailed Congenital Heart aneurysm 30,000 Operative notes, Disease repair without barcode of Implant, aortic valve if used. procedure 22 SV0 Surgical Correction SV002O Sub-aortic 1,20,00 PTFE Patch – Thin (Max Clinical notes and Detailed discharge 02 of Category - II membrane 0 1) ECHO report summary, Detailed Congenital Heart resection 30,000 Operative notes, Disease barcode of Implant, if used. 23 SV0 Surgical Correction SV003A Ebstien repair 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 24 SV0 Surgical Correction SV003B Double switch 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III operation 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 25 SV0 Surgical Correction SV003C Rastelli 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 26 SV0 Surgical Correction SV003D Fontan 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 27 SV0 Surgical Correction SV003E AP window 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III repair 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, 70 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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if used.
28 SV0 Surgical Correction SV003F Arch 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III interruption 0 1) Report summary, Detailed Congenital Heart Repair without 30,000 Operative notes, Disease VSD closure barcode of Implant, if used. 29 SV0 Surgical Correction SV003G Arch 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III interruption 0 1) Report summary, Detailed Congenital Heart Repair with VSD 30,000 Operative notes, Disease closure barcode of Implant, if used. 30 SV0 Surgical Correction SV003H DORV Repair 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 31 SV0 Surgical Correction SV003I Supravalvular 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III AS repair 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 32 SV0 Surgical Correction SV003J Konno 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 33 SV0 Surgical Correction SV003K Norwood 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 34 SV0 Surgical Correction SV003L VSD closure + 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III RV - PA conduit 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 35 SV0 Surgical Correction SV003M VSD + Aortic 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes,
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Disease barcode of Implant, if used. 36 SV0 Surgical Correction SV003N VSD + Mitral 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 37 SV0 Surgical Correction SV003O VSD + Tricuspid 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III procedure 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 38 SV0 Surgical Correction SV003P VSD + 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Pulmonary 0 1) Report summary, Detailed Congenital Heart procedure 30,000 Operative notes, Disease barcode of Implant, if used. 39 SV0 Surgical Correction SV003Q VSD + 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Infundibular 0 1) Report summary, Detailed Congenital Heart procedure 30,000 Operative notes, Disease barcode of Implant, if used. 40 SV0 Surgical Correction SV003R VSD + 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Coarctation 0 1) Report summary, Detailed Congenital Heart repair 30,000 Operative notes, Disease barcode of Implant, if used. 41 SV0 Surgical Correction SV003S TAPVC Repair 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 42 SV0 Surgical Correction SV003T Truncus 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III arteriosus 0 1) Report summary, Detailed Congenital Heart repair 30,000 Operative notes, Disease barcode of Implant, if used. 43 SV0 Surgical Correction SV003U Tetralogy of 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Fallot Repair 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes,
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Disease barcode of Implant, if used. 44 SV0 Surgical Correction SV003V Complete AV 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III canal repair 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 45 SV0 Surgical Correction SV003W Arterial switch 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III operation 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 46 SV0 Surgical Correction SV003X Senning 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Operation 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 47 SV0 Surgical Correction SV003Y Mustard 1,50,00 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 03 of Category - III Operation 0 1) Report summary, Detailed Congenital Heart 30,000 Operative notes, Disease barcode of Implant, if used. 48 SV0 Coronary artery SV004A Coronary artery 1,18,10 ECHO + CAG Detailed Operation 04 bypass grafting bypass grafting 0 report stills notes, detailed (CABG), (CABG), showing significant discharge summary including intra including intra multiple blocks & operative balloon operative LVEF pump (if required) balloon pump (if required) 49 SV0 Single Valve SV005A Aortic Valve 1,19,00 Mechanical Valve – Clinical notes and Post op ECHO , 05 Procedure 0 Bileaflet (Max 1) ECHO / Doppler Detailed procedure 40,000 report notes, detailed discharge summary, Barcode of implant, if used. 50 SV0 Single Valve SV005B Mitral Valve 1,19,00 Mechanical Valve – Clinical notes and Post op ECHO , 05 Procedure 0 Bileaflet (Max 1) ECHO / Doppler Detailed procedure 40,000 report notes, detailed discharge summary, Barcode of implant,
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if used.
51 SV0 Single Valve SV005C Tricuspid Valve 1,19,00 Mechanical Valve – Clinical notes and Post op ECHO , 05 Procedure 0 Bileaflet (Max 1) ECHO / Doppler Detailed procedure 40,000 report notes, detailed discharge summary, Barcode of implant, if used. 52 SV0 Double Valve SV006A Double Valve 1,42,00 Repair/Replace Mechanical Valve – Clinical notes and Detailed discharge 06 Procedure Procedure 0 None/None Bileaflet (Max 1) ECHO and doppler summary, Detailed 40,000 reports showing Operative notes, two cardiac valves barcode of diseased valves/rings used 53 SV0 Triple valve SV007A Triple valve 1,70,00 Repair/Replace Mechanical Valve – Clinical notes and Detailed discharge 07 procedure procedure 0 None/None Bileaflet (Max 1) ECHO and doppler summary, Detailed 40,000 reports showing Operative notes, three cardiac barcode of valves diseased valves/rings used 54 SV0 Closed Mitral SV008A Closed Mitral 57,000 Clinical notes and Detailed discharge 08 Valvotomy including Valvotomy ECHO and / or summary, Detailed thoracotomy including doppler reports Operative notes. thoracotomy 55 SV0 Ross Procedure SV009A Ross Procedure 1,50,00 RV - PA Conduit (Max Clinical notes and Detailed procedure 09 0 1) ECHO report notes, detailed 120,000 discharge summary, Barcode of RV-PA conduit 56 SV0 Surgery for SV010A Surgery for 1,11,00 Clinical notes and Detailed discharge 10 Hypertrophic Hypertrophic 0 ECHO report summary, Detailed Obstructive Obstructive Operation notes, Cardiomyopathy Cardiomyopath (HOCM) y (HOCM) 57 SV0 Pericardial window SV011A Pericardial 30,000 Clinical notes and Detailed Operation 11 (via thoracotomy) window (via CT Chest notes, detailed thoracotomy) establishing the discharge summary. aetiology for which surgery is done 58 SV0 Pericardiectomy SV012A Pericardiectomy 67,000 Clinical notes an Detailed Operation 12 ECHO report notes, Discharge
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summary
59 SV0 Patent Ductus SV013A Patent Ductus 57,000 Clinical notes and Detailed Operation 13 Arteriosus (PDA) Arteriosus ECHO report notes, Discharge Closure via (PDA) Closure summary thoracotomy via thoracotomy 60 SV0 Aortic Root SV014A Bental 1,50,00 Composite Aortic Clinical notes and Detailed discharge 14 Replacement Procedure 0 Valved conduit – ECHO report, CT summary, Detailed Surgery Mechanical (Max 1) angio / Angio / Operation notes. 100,000 MRI report 61 SV0 Aortic Root SV014B Aortic 1,50,00 Composite Aortic Clinical notes and Detailed discharge 14 Replacement Dissection 0 Valved conduit – ECHO report, CT summary, Detailed Surgery Mechanical (Max 1) angio / Angio / Operation notes. 100,000 MRI report 62 SV0 Aortic Root SV014C Aortic 1,50,00 Composite Aortic Clinical notes and Detailed discharge 14 Replacement Aneurysm 0 Valved conduit – ECHO report, CT summary, Detailed Surgery Mechanical (Max 1) angio / Angio / Operation notes. 100,000 MRI report 63 SV0 Aortic Root SV014D Valve sparing 1,50,00 Composite Aortic Clinical notes and Detailed discharge 14 Replacement root 0 Valved conduit – ECHO report, CT summary, Detailed Surgery replacement Mechanical (Max 1) angio / Angio / Operation notes. 100,000 MRI report 64 SV0 Aortic Root SV014E AVR + Root 1,50,00 Composite Aortic Clinical notes and Detailed discharge 14 Replacement enlargement 0 Valved conduit – ECHO report, CT summary, Detailed Surgery Mechanical (Max 1) angio / Angio / Operation notes. 100,000 MRI report 65 SV0 Aortic Arch SV015A Aortic Arch 1,50,00 Arch Graft (Max 1) Clinical notes and Detailed procedure 15 Replacement / Replacement 0 85,000 angio / CT angio / notes, detailed Thoracoabdominal using bypass MRI reports discharge summary. aneurysm Repair using bypass 66 SV0 Aortic Arch SV015B Thoracoabdomi 1,50,00 Arch Graft (Max 1) Clinical notes and Detailed procedure 15 Replacement / nal aneurysm 0 85,000 angio / CT angio / notes, detailed Thoracoabdominal Repair using MRI reports discharge summary. aneurysm Repair bypass using bypass 67 SV0 Aortic Aneurysm SV016A Aortic 1,20,00 Dacron Graft – Straight Clinical notes and Detailed procedure 16 Repair Aneurysm 0 (Max 1) ECHO / Angio / CT notes, detailed Repair using 30,000 angio / MRI discharge summary. Cardiopulmonar reports showing
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y bypass (CPB) aneurysm
68 SV0 Aortic Aneurysm SV016B Aortic 1,20,00 Dacron Graft – Straight Clinical notes and Detailed procedure 16 Repair Aneurysm 0 (Max 1) ECHO / Angio / CT notes, detailed Repair using 30,000 angio / MRI discharge summary. Left Heart reports showing Bypass aneurysm 69 SV0 Aortic Aneurysm SV016C Aortic 65,500 Dacron Graft – Straight Clinical notes Detailed procedure 16 Repair Aneurysm (Max 1) angio / CT angio / notes, detailed Repair without 30,000 MRI reports discharge summary. using Cardiopulmonar y bypass (CPB) 70 SV0 Aortic Aneurysm SV016D Aortic 65,500 Dacron Graft – Straight Clinical notes Detailed procedure 16 Repair Aneurysm (Max 1) angio / CT angio / notes, detailed Repair without 30,000 MRI reports discharge summary. using Left Heart Bypass 71 SV0 Aorto Iliac / Aorto SV017A Aorto Iliac 64,500 Dacron Graft – Clinical notes and Detailed discharge 17 femoral bypass (Uni bypass - U/L Bifurcated (Max 1) MRA / CT angio / summary, Detailed and Bi) 35,000 Angio reports Operative notes,, barcode of synthetic graft 72 SV0 Aorto Iliac / Aorto SV017B Aorto femoral 64,500 Dacron Graft – Clinical notes and Detailed discharge 17 femoral bypass (Uni bypass - U/L Bifurcated (Max 1) MRA / CT angio / summary, Detailed and Bi) 35,000 Angio reports Operative notes,, barcode of synthetic graft 73 SV0 Aorto Iliac / Aorto SV017C Aorto Iliac 64,500 Dacron Graft – Clinical notes and Detailed discharge 17 femoral bypass (Uni bypass - B/L Bifurcated (Max 1) MRA / CT angio / summary, Detailed and Bi) 35,000 Angio reports Operative notes,, barcode of synthetic graft 74 SV0 Aorto Iliac / Aorto SV017D Aorto femoral 64,500 Dacron Graft – Clinical notes and Detailed discharge 17 femoral bypass (Uni bypass - B/L Bifurcated (Max 1) MRA / CT angio / summary, Detailed and Bi) 35,000 Angio reports Operative notes,, barcode of synthetic graft 75 SV0 Pulmonary SV018A Pulmonary 1,41,00 Clinical notes and Detailed Operation 18 Embolectomy / Embolectomy 0 ECHO report + CT notes, Discharge
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Thromboendarterec Chest report summary tomy 76 SV0 Pulmonary SV018B Thromboendart 1,41,00 Clinical notes and Detailed Operation 18 Embolectomy / erectomy 0 ECHO report + CT notes, Discharge Thromboendarterec Chest report summary tomy 77 SV0 Peripheral Arterial SV019A Femoro - 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries Femoral Bypass (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 78 SV0 Peripheral Arterial SV019B Carotid - 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries endearterectom (Max 1) Angiogram / CT notes, Discharge y 30,000 Angiogram / MRI summary; barcode reports of graft used. 79 SV0 Peripheral Arterial SV019C Carotid Body 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries Tumor Excision (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 80 SV0 Peripheral Arterial SV019D Thoracic Outlet 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries syndrome (Max 1) Angiogram / CT notes, Discharge Repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 81 SV0 Peripheral Arterial SV019E Carotid 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries aneurysm (Max 1) Angiogram / CT notes, Discharge repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 82 SV0 Peripheral Arterial SV019F Subclavian 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries aneurysm (Max 1) Angiogram / CT notes, Discharge repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 83 SV0 Peripheral Arterial SV019G Axillary 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries aneurysm (Max 1) Angiogram / CT notes, Discharge repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 84 SV0 Peripheral Arterial SV019H Brachial 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries aneurysm (Max 1) Angiogram / CT notes, Discharge repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 85 SV0 Peripheral Arterial SV019I Femoral 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries aneurysm (Max 1) Angiogram / CT notes, Discharge
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repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 86 SV0 Peripheral Arterial SV019J Popliteal 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries aneurysm (Max 1) Angiogram / CT notes, Discharge repair 30,000 Angiogram / MRI summary; barcode reports of graft used. 87 SV0 Peripheral Arterial SV019K Femoral - 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries popliteal Bypass (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 88 SV0 Peripheral Arterial SV019L Axillo - Brachial 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries Bypass (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 89 SV0 Peripheral Arterial SV019M Carotio - carotid 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries Bypass (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 90 SV0 Peripheral Arterial SV019N Carotido - 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries subclavian (Max 1) Angiogram / CT notes, Discharge bypass 30,000 Angiogram / MRI summary; barcode reports of graft used. 91 SV0 Peripheral Arterial SV019O Carotido - 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries axillary bypass (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 92 SV0 Peripheral Arterial SV019P Axillo - femoral 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries bypass - U/L (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 93 SV0 Peripheral Arterial SV019Q Axillo - femoral 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries bypass - B/L (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 94 SV0 Peripheral Arterial SV019R Aorto - carotid 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries bypass (Max 1) Angiogram / CT notes, Discharge 30,000 Angiogram / MRI summary; barcode reports of graft used. 95 SV0 Peripheral Arterial SV019S Aorto - 50,000 Dacron Graft – Straight Clinical notes and Detailed operative 19 Surgeries subclavian (Max 1) Angiogram / CT notes, Discharge
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bypass 30,000 Angiogram / MRI summary; barcode reports of graft used. 96 SV0 Thromboembolecto SV020A Thromboembol 28,000 Soon as Detailed discharge 20 my ectomy documents are summary and uploaded, confirm operative notes evidence of embolus/ Thrombus in duples USG/ Angio 97 SV0 Peripheral arterial SV021A Peripheral 30,000 Clinical notes with Detailed discharge 21 injury repair arterial injury planned line of summary and (without bypass) repair (without treatment, operative notes bypass) Doppler 98 SV0 Thoracotomy, SV022A Thoracotomy, 30,000 Clinical notes and Detailed Operation 22 Thoraco Abdominal Thoraco CT Chest notes, detailed Approach Abdominal establishing the discharge summary. Approach aetiology for which surgery is done 99 SV0 Lung surgery SV023A Lung cyst 45,000 Clinical notes and Detailed Operation 23 including exision CT Chest notes, Discharge Thoracotomy summary 100 SV0 Lung surgery SV023B Decortication 45,000 Clinical notes and Detailed Operation 23 including CT Chest notes, Discharge Thoracotomy summary 101 SV0 Lung surgery SV023C Hydatid cyst 45,000 Clinical notes and Detailed Operation 23 including CT Chest notes, Discharge Thoracotomy summary 102 SV0 Lung surgery SV023D Other simple 45,000 Clinical notes and Detailed Operation 23 including lung procedure CT Chest notes, Discharge Thoracotomy excluding lung summary resection 103 SV0 Pulmonary SV024A Pulmonary 70,000 Non - Clinical notes and HPE of resected 24 Resection Resection Infective/Infective Pre-Op X-ray / CT tissue detailed None/"+20000" Scan operation notes, discharge summary. 104 SV0 Foreign Body SV025A Foreign Body 20,000 Clinical notes and Detailed Operative 25 Removal with scope Removal with Radiological notes, Detailed scope evidence of discharge summary, foreign body Photograph of
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Removed Foreign body 105 SV0 Surgical Correction SV026A Surgical 65,000 Clinical notes and Detailed operative 26 of Bronchopleural Correction of CT Chest notes and discharge Fistula Bronchopleural summary Fistula 106 SV0 Space - Occupying SV027A Space - 65,500 Clinical notes and Detailed discharge 27 Lesion (SOL) Occupying CT Chest summary, Detailed mediastinum Lesion (SOL) Operation notes, mediastinum HPE of SOL 107 SV0 Isolated Intercostal SV028A Isolated 10,000 Cl notes detailing Detailed procedure 28 Drainage and Intercostal need of ICD; X-ray notes. Detailed Management of ICD, Drainage and chest discharge summary Intercostal Block, Management of Antibiotics & ICD, Intercostal Physiotherapy Block, Antibiotics & Physiotherapy 108 SV0 Diaphragmatic SV029A Diaphragmatic 30,000 Mesh - 6 X 3 – Clinical notes and Detailed procedure 29 Repair Repair Polypropylene (Max 1) Chest XRAY, CT notes, detailed 2,000 Chest discharge summary. 109 SV0 Surgery for Cardiac SV030A Surgery for 95,000 Clinical notes and Detailed Operation 30 Tumour Cardiac Tumour ECHO report notes, Discharge summary, HPE report of tumor. 110 SV0 Immediate SV031A Tetralogy of 75,000 PTFE Patch – Thin (Max ECHO / Doppler Detailed discharge 31 reoperation (within Fallot Repair 1) Report, Detailed summary, Detailed 5 days) 30,000 Operative notes Operative notes, indicating need for barcode of Implant, Reoperation if used. Ascertain the need for reoperation. 111 SV0 Immediate SV031B Aortic Valve 59,500 Mechanical Valve – Clinical notes and Post op ECHO , 31 reoperation (within Bileaflet (Max 1) ECHO / Doppler Detailed procedure 5 days) 40,000 report, Detailed notes, detailed Operative notes discharge summary, indicating need for Barcode of implant, Reoperation if used. Ascertain the need for reoperation.
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112 SV0 Immediate SV031C Mitral Valve 59,500 Mechanical Valve – Clinical notes and Post op ECHO , 31 reoperation (within Bileaflet (Max 1) ECHO / Doppler Detailed procedure 5 days) 40,000 report, Detailed notes, detailed Operative notes discharge summary, indicating need for Barcode of implant, Reoperation if used. Ascertain the need for reoperation. 113 SV0 Immediate SV031D Tricuspid Valve 59,500 Mechanical Valve – Clinical notes and Post op ECHO , 31 reoperation (within Bileaflet (Max 1) ECHO / Doppler Detailed procedure 5 days) 40,000 report, Detailed notes, detailed Operative notes discharge summary, indicating need for Barcode of implant, Reoperation if used. Ascertain the need for reoperation. 114 SV0 Immediate SV031E Double Valve 71,000 Repair/Replaceme Mechanical Valve – Clinical notes and Detailed discharge 31 reoperation (within Procedure nt Bileaflet (Max 1) ECHO and doppler summary, Detailed 5 days) None/None 40,000 reports, Detailed Operative notes, Operative notes barcode of indicating need for valves/rings used. Reoperation Ascertain the need for reoperation. 115 SV0 Immediate SV031F Triple valve 85,000 Repair/Replaceme Mechanical Valve – Clinical notes and Detailed discharge 31 reoperation (within procedure nt Bileaflet (Max 1) ECHO and doppler summary, Detailed 5 days) None/None 40,000 reports, Detailed Operative notes, Operative notes barcode of indicating need for valves/rings used. Reoperation Ascertain the need for reoperation. 116 SV0 Low Cardiac Output SV032A Low Cardiac 50,000 Clinical notes with Procedure / 32 syndrome requiring Output planned line of Operative Notes, IABP insertion post - syndrome treatment Detailed Discharge operatively requiring IABP (including Summary insertion post - indication for need operatively of required Procedure ) 117 SV0 Re-do sternotomy SV033A Re-do 20,000 Clinical notes with Procedure / 33 sternotomy planned line of Operative Notes, treatment Detailed Discharge (including Summary 81 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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indication for need of required Procedure )
• It is advised to perform cardiac catheterization as part of the treatment package for congenital heart defects
4. Diagnostic Laboratoty
Packa ge Code AB PM - JAY Procedure Code AB PM - JAY Mandatory Mandatory S. HBP Documents - Pre Documents - Claim No. 2.0 Package Name HBP 2.0 Procedure Name Package Price Authorization Processing Clinical Notes,Receipt of Clinical Payment from Lab Notes,Positive (optional),Testing DL00 Diagnostic Confirmatory COVID-19 Single report for COVID- report for COVID- 1 1 Laboratory DL001UKA Step Test 2,000 19 Test 19
DL00 Diagnostic Collection of sample for testing of 2 3 Laboratory DL003UKA COVID-19 850
5. Emergency Room Packages
• Total number of packages: 3 • Total number of procedures: 4 • Additional cross specialty procedures: 2 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Nil 82 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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• Paper trail is to be maintained by the hospital treating the patient to be submitted during closure of claim • In case hospitalization of more than 12 hours is required, the patient will be admitted and treated accordingly in the related specialty • For the package Animal bites (Excluding Snake Bite) (ER003A), payment to be made after the completion of 5th dose Package Procedure S. AB PM - JAY AB PM - JAY Package Mandatory Documents Mandatory Documents - Claim Code Code No. Package Name Procedure Name Price - Pre Authorization Processing HBP 2.0 HBP 2.0 Clinical notes with Clinical notes / discharge Laceration - Laceration - planned line of summary with planned line of 1 ER001 ER001A 2,000 Suturing / Dressing Suturing / Dressing treatment with pre- treatment & post clinical clinical photograph photograph Emergency with Clinical notes with Clinical notes / discharge Cardiopulmonary stable 2 ER002 ER002A 2,000 planned line of summary with planned line of emergency cardiopulmonary treatment, ECG treatment status Emergency with unstable Clinical notes with Clinical notes / discharge Cardiopulmonary 3 ER002 ER002B cardiopulmonary 10,000 planned line of summary with planned line of emergency status with treatment, ECG treatment resuccitation Beneficiary signature / thumb Animal bites Animal bites Classification of bites impession; invoice / bar code 4 ER003 (Excluding Snake ER003A (Excluding Snake 1,700 with pre-clinical sticker of the vaccine, Clinical Bite) Bite) photograph Notes with complete treatment details given
6. General Medicine
• Total number of packages: 76 • Total number of procedures: 99 • Additional cross specialty procedures: 34 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages for progressive extension of treatment/ hospital stay • Pre-authorization remarks: Prior approval must be taken for all medical conditions/ packages under this domain for progressive extension of therapeutic treatments (i.e. for extending stay at 1,5,10 days stay and beyond)
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• Separate package for high end radiologic diagnostic (CT, MRI, Imaging including nuclear imaging,) relevant to the illness only (no standalone diagnostics allowed) - subject to pre-authorization with a cap of Rs 5000 per family per annum within overall sum insured
• Separate package for high end histopathology (Biopsies) and advanced serology investigations relevant to the illness only (no standalone diagnostics allowed) - after pre-authorization with a cap of Rs 5000 per family per annum within overall sum insured • Blood or Blood components transfusion if required, payable separately subject to pre- authorization. Blood can be procured only through licensed blood banks as per National Blood Transfusion Council Guidelines •All clinical test reports, diagnosis, TPR charting, case sheet / clinical notes and discharge summary need to be submitted for extension of packages and during claims submission S. No. Package AB PM - JAY Procedure AB PM - JAY Package Mandatory Documents - Pre Mandatory Documents - Claim Code Package Name Code Procedure Name Price Authorization Processing HBP 2.0 HBP 2.0 1 MG001 Acute febrile MG001A Acute febrile 1,800 Clinical notes detailing history and Detailed ICPs, Treatment illness illness Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 2 MG002 Severe sepsis MG002A Severe sepsis 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 3 MG002 Severe sepsis MG002B Septic shock 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 4 MG003 Malaria MG003A Malaria 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 5 MG003 Malaria MG003B Complicated 1,800 Clinical notes detailing history and Detailed ICPs, Treatment malaria Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management
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6 MG004 Dengue fever MG004A Dengue fever 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 7 MG004 Dengue fever MG004B Dengue 1,800 Clinical notes detailing history and Detailed ICPs, Treatment hemorrhagic fever Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 8 MG004 Dengue fever MG004C Dengue shock 1,800 Clinical notes detailing history and Detailed ICPs, Treatment syndrome Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 9 MG005 Chikungunya MG005A Chikungunya fever 1,800 Clinical notes detailing history and Detailed ICPs, Treatment fever Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 10 MG006 Enteric fever MG006A Enteric fever 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 11 MG007 HIV with MG007A HIV with 1,800 Clinical notes detailing history and Detailed ICPs, Treatment complications complications Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 12 MG008 Leptospirosis MG008A Leptospirosis 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 13 MG009 Acute MG009A Acute 1,800 Clinical notes detailing history and Detailed ICPs, Treatment gastroenteritis gastroenteritis Admission notes showing vitals and details, detailed discharge with with moderate examination findings; any summary, All investigations dehydration dehydration investigations done; planned line of reports. management 14 MG009 Acute MG009B Acute 1,800 Clinical notes detailing history and Detailed ICPs, Treatment 85 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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gastroenteritis gastroenteritis Admission notes showing vitals and details, detailed discharge with with severe examination findings; any summary, All investigations dehydration dehydration investigations done; planned line of reports. management 15 MG010 Diarrohea MG010A Chronic diarrohea 1,800 Clinical notes with planned line of Detailed Discharge Summary, treatment any other investigations done 16 MG010 Diarrohea MG010B Persistent 1,800 Clinical notes with planned line of Detailed Discharge Summary diarrohea treatment; stool examintaion summary, any other investigations done 17 MG011 Dysentery MG011A Dysentery 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 18 MG012 Acute viral MG012A Acute viral 1,800 Clinical notes with planned line of Detailed ICPs, Treatment hepatitis hepatitis treatment, LFT, USG - Whole details, detailed discharge Abdomen summary, All investigations reports. 19 MG013 Chronic MG013A Chronic Hepatitis 1,800 Clinical notes with planned line of Detailed ICPs, Treatment Hepatitis treatment, LFT, USG - Whole details, detailed discharge Abdomen summary, All investigations reports. 20 MG014 Liver abscess MG014A Liver abscess 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 21 MG015 Visceral MG015A Visceral 1,800 Clinical notes detailing history and Detailed ICPs, Treatment leishmaniasis leishmaniasis Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 22 MG016 Pneumonia MG016A Pneumonia 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 23 MG017 Severe MG017A Severe pneumonia 1,800 Clinical notes detailing history and Detailed ICPs, Treatment pneumonia Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. 86 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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management 24 MG018 Empyema MG018A Empyema 1,800 Clinical notes with planned line of Post Treatment X-ray chest, treatment, CBC, X ray chest Detailed Discharge Summary 25 MG019 Lung abscess MG019A Lung abscess 1,800 Clinical notes with planned line of Post Treatment X-ray chest, treatment , X-ray chest, CBC and any CBC, Detailed Discharge other investigations done, planned summary. line of management 26 MG020 Pericardial / MG020A Pericardial 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Pleural tuberculosis Admission notes showing vitals and details, detailed discharge tuberculosis examination findings; investigations summary, All investigations done reports. 27 MG020 Pericardial / MG020B Pleural 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Pleural tuberculosis Admission notes showing vitals and details, detailed discharge tuberculosis examination findings; investigations summary, All investigations done reports. 28 MG021 Urinary Tract MG021A Urinary Tract 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Infection Infection Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 29 MG022 Viral MG022A Viral encephalitis 1,800 Clinical notes detailing history and Detailed ICPs, Treatment encephalitis Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 30 MG023 Septic Arthritis MG023A Septic Arthritis 1,800 Clinical notes with planned line of Post treatment X-ray / treatment, CBC, X-ray of the affected Radiological evidence, CBC, joint Detailed Discharge Summary 31 MG024 Skin and soft MG024A Skin and soft 1,800 Clinical notes with planned line of Detailed ICPs, Treatment tissue tissue infections treatment, CBC details, detailed discharge infections summary, All investigations reports including CBC 32 MG025 Recurrent MG025A Recurrent 1,800 Clinical notes detailing history and Detailed ICPs, Treatment vomiting with vomiting with Admission notes showing vitals and details, detailed discharge dehydration dehydration examination findings; any summary, All investigations investigations done; planned line of reports. management 33 MG026 Pyrexia of MG026A Pyrexia of 1,800 Clinical notes detailing history and Detailed ICPs, Treatment unknown unknown origin Admission notes showing vitals and details, detailed discharge origin examination findings; any summary, All investigations
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investigations done; planned line of reports. management 34 MG027 Bronchiectasis MG027A Bronchiectasis 1,800 X ray-Chest, Clinical notes with Post treatment X-ray / planned line of treatment Radiological evidence, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 35 MG028 Acute MG028A Acute bronchitis 1,800 Clinical notes detailing history and Detailed ICPs, Treatment bronchitis Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 36 MG029 Acute MG029A Acute 1,800 Clinical notes detailing history and Detailed ICPs, Treatment excaberation excaberation of Admission notes showing vitals and details, detailed discharge of COPD COPD examination findings; any summary, All investigations investigations done; planned line of reports. management 37 MG030 Acute MG030A Acute 1,800 Clinical notes detailing history and Detailed ICPs, Treatment excaberation excaberation of Admission notes showing vitals and details, detailed discharge of Interstitial Interstitial Lung examination findings; any summary, All investigations Lung Disease Disease investigations done; planned line of reports. management 38 MG031 Endocarditis MG031A Bacterial 1,800 Clinical notes with planned line of Blood culture reports, Post Endocarditis treatment, ECHO, CBC treatment ECHO, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 39 MG031 Endocarditis MG031B Fungal 1,800 Clinical notes with planned line of Blood culture reports, Post Endocarditis treatment, ECHO, CBC treatment ECHO, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 40 MG032 Vasculitis MG032A Vasculitis 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 41 MG033 Pancreatitis MG033A Acute pancreatitis 1,800 Cliical notes, Sr Amylase, Lipase, LFT, Post treatment Sr Amylase, CBC, USG- abdomen Lipase, LFT, USG- abdomen Detailed Discharge Summary 42 MG033 Pancreatitis MG033B Chronic 1,800 Cliical notes, Sr Amylase, Lipase, LFT, Post treatment Sr Amylase, 88 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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pancreatitis CBC, USG- abdomen Lipase, LFT, USG- abdomen Detailed Discharge Summary 43 MG034 Ascites MG034A Ascites 1,800 Clinial notes, LFT, CBC, USG- Ascitic Fluid Analysis and abdomen Culture Report, Detailed Discharge Summary, 44 MG035 Acute MG035A Acute transverse 1,800 Clinical notes detailing history and Detailed ICPs, Treatment transverse myelitis Admission notes showing vitals and details, detailed discharge myelitis examination findings; any summary, All investigations investigations done; planned line of reports. management 45 MG036 Atrial MG036A Atrial Fibrillation 1,800 Clinical notes with planned line of Post treatment ECG, Detailed Fibrillation treatment, ECG, Sr Electrolytes Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 46 MG037 Cardiac MG037A Cardiac 1,800 Clincal notes, 2D echo Post treatment 2D echo, Fluid Tamponade Tamponade Aspirated report, Procedure notes, Detailed Discharge Summary 47 MG038 Congestive MG038A Congestive heart 1,800 Clinical notes detailing history and Detailed ICPs, Treatment heart failure failure Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 48 MG039 Asthma MG039A Acute asthmatic 1,800 Clinical notes detailing history and Detailed ICPs, Treatment attack Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 49 MG039 Asthma MG039B Status 1,800 Clinical notes detailing history and Detailed ICPs, Treatment asthmaticus Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 50 MG040 Respiratory MG040A Type 1 respiratory 1,800 Clinical notes detailing history and Detailed ICPs, Treatment failure failure Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 51 MG040 Respiratory MG040B Type 2 respiratory 1,800 Clinical notes detailing history and Detailed ICPs, Treatment failure failure Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations 89 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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investigations done; planned line of reports. management 52 MG040 Respiratory MG040C Due to any cause 1,800 Clinical notes detailing history and Detailed ICPs, Treatment failure (pneumonia, Admission notes showing vitals and details, detailed discharge asthma, COPD, examination findings; any summary, All investigations ARDS, foreign investigations done; planned line of reports. body, poisoning, management, Copy of MLC / FIR (if head injury etc.) required) 53 MG041 Upper GI MG041A Upper GI bleeding 1,800 Clinical notes detailing history and Detailed ICPs, Treatment bleeding (conservative) Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 54 MG041 Upper GI MG041B Upper GI bleeding 1,800 Clinical notes detailing history and Detailed ICPs, Treatment bleeding (endoscopic) Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 55 MG042 Lower GI MG042A Lower GI 1,800 Clinical notes detailing history and Detailed ICPs, Treatment hemorrhage hemorrhage Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 56 MG043 Addison’s MG043A Addison’s disease 1,800 Clincal notes, Sr. Cortisol levels, USG- Post treatment cortisol levels, disease abdomen Detailed Discharge Summary 57 MG044 Renal colic MG044A Renal colic 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 58 MG045 AKI / Renal MG045A AKI / Renal failure 1,800 Clinical notes detailing history and Detailed ICPs, Treatment failure Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 59 MG046 Seizures MG046A Seizures 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 60 MG047 Status MG047A Status epilepticus 1,800 Clinical notes detailing history and Detailed ICPs, Treatment 90 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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epilepticus Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 61 MG048 Cerebrovascul MG048A Cerebrovascular 1,800 Clinical notes detailing history and Detailed ICPs, Treatment ar accident accident Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 62 MG049 Cerebral sino- MG049A Cerebral sino- 1,800 Clinical notes detailing history and Detailed ICPs, Treatment venous venous Admission notes showing vitals and details, detailed discharge thrombosis / thrombosis examination findings; any summary, All investigations Stroke investigations done; planned line of reports. management 63 MG049 Cerebral sino- MG049B Acute stroke 1,800 Clinical notes detailing history and Detailed ICPs, Treatment venous Admission notes showing vitals and details, detailed discharge thrombosis / examination findings; any summary, All investigations Stroke investigations done; planned line of reports. management 64 MG049 Cerebral sino- MG049C Acute ischemic 1,800 Clinical notes detailing history and Detailed ICPs, Treatment venous stroke Admission notes showing vitals and details, detailed discharge thrombosis / examination findings; any summary, All investigations Stroke investigations done; planned line of reports. management 65 MG049 Cerebral sino- MG049D Acute 1,800 Clinical notes detailing history and Detailed ICPs, Treatment venous heamorrhagic Admission notes showing vitals and details, detailed discharge thrombosis / stroke examination findings; any summary, All investigations Stroke investigations done; planned line of reports. management 66 MG050 Immune MG050A Immune mediated 1,800 Clinical notes detailing history and Detailed ICPs, Treatment mediated CNS CNS disorders Admission notes showing vitals and details, detailed discharge disorders examination findings; any summary, All investigations investigations done; planned line of reports. management 67 MG051 Hydrocephalus MG051A Hydrocephalus 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 68 MG052 Myxedema MG052A Myxedema coma 1,800 Clinical notes with planned line of Post treatment Thyroid Profile, coma treatment, Throid profile, USG- Detailed Discharge Summary 91 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Thyroid Gland 69 MG053 Thyrotoxic MG053A Thyrotoxic crisis 1,800 Clinical notes with planned line of Radionuclide Iodine uptake crisis treatment, Throid profile, USG- study, Post treatment Thyroid Thyroid Gland Profile, Detailed Discharge Summary 70 MG054 Gout MG054A Gout 1,800 Clinical notes with planned line of Detailed Discharge Summary treatment, Sr.Uric acid 71 MG055 Pneumothroax MG055A Pneumothroax 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 72 MG056 Neuromuscula MG056A Neuromuscular 1,800 Clinical notes detailing history and Detailed ICPs, Treatment r disorders disorders Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 73 MG057 Hypoglycemia MG057A Hypoglycemia 1,800 Clincal notes, Blood sugar level Post treatment Blood sugar levels, Hba1C, Detailed Discharge Summary 74 MG058 Diabetic Foot MG058A Diabetic Foot 1,800 Clincal profile, Blood sugar level,CBC, Post treatment Blood sugar Photograph of the affected foot levels, Hba1C, Photograph of the affected foot, Detailed Discharge Summary 75 MG059 Diabetic MG059A Diabetic 1,800 Clinical notes detailing history and Detailed ICPs, Treatment ketoacidosis ketoacidosis Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 76 MG060 Electrolyte MG060A Hypercalcemia 1,800 Clinical notes with planned line of Post treatment Serum Imbalance treatment, Serum Calcium Calcium, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 77 MG060 Electrolyte MG060B Hypocalcemia 1,800 Clinical notes with planned line of Post treatment Serum Imbalance treatment, Serum Calcium Calcium, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 78 MG060 Electrolyte MG060C Hyponatremia 1,800 Clinical notes with planned line of Post treatment Serum
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Imbalance treatment, Serum Electrolytes Electrolytes, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 79 MG060 Electrolyte MG060D Hypernatremia 1,800 Clinical notes with planned line of Post treatment Serum Imbalance treatment, Serum Electrolytes Electrolytes, Detailed Discharge Summary, Detailed ICPs, Treatment details, All investigations reports. 80 MG061 Hyperosmolar MG061A Hyperosmolar 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Non-Ketotic Non-Ketotic coma Admission notes showing vitals and details, detailed discharge coma examination findings; any summary, All investigations investigations done; planned line of reports. management 81 MG062 Accelerated MG062A Accelerated 1,800 Clinical notes detailing history and Detailed ICPs, Treatment hypertension hypertension Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 82 MG063 Hypertensive MG063A Hypertensive 1,800 Clinical notes detailing history and Detailed ICPs, Treatment emergencies emergencies Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 83 MG064 Severe anemia MG064A Severe anemia 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 84 MG065 Sickle cell MG065A Sickle cell Anemia 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Anemia Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 85 MG066 Anaphylaxis MG066A Anaphylaxis 1,800 Clinical notes with planned line of Detailed ICPs, Treatment treatment, CBC details, detailed discharge summary, All investigations reports. 86 MG067 Heat stroke MG067A Heat stroke 1,800 Clinical notes detailing history Detailed ICPs, Treatment leading to this hospitalization and details, detailed discharge Admission notes showing vitals and summary, All investigations 93 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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examination findings; any reports. investigations done; planned line of management 87 MG068 Systematic MG068A Systematic lupus 1,800 Clinical notes detailing history and Detailed ICPs, Treatment lupus erythematosus Admission notes showing vitals and details, detailed discharge erythematosus examination findings; any summary, All investigations investigations done; planned line of reports. management 88 MG069 Guillian Barre MG069A Guillian Barre 1,800 Clinical notes and Admission notes Report of test blocked. Syndrome Syndrome detailed the need for High end histopathology (Biopsies) and advanced serology investigations 89 MG070 Snake bite MG070A Snake bite 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge neurological examination findings; summary, All investigations any investigations done; planned line reports. of management 90 MG071 Poisoning MG071A Acute 1,800 Clinical notes detailing history and Detailed ICPs, Treatment organophosphoru Admission notes showing vitals and details, detailed discharge s poisoning neurological examination findings; summary, All investigations any investigations done; planned line reports. of management, Copy of MLC / FIR 91 MG071 Poisoning MG071B Other poisonings 1,800 Clinical notes detailing history and Detailed ICPs, Treatment Admission notes showing vitals and details, detailed discharge neurological examination findings; summary, All investigations any investigations done; planned line reports. of management, Copy of MLC / FIR 92 MG072 Haemodialysis MG072B Peritoneal Dialysis 13,500 Clinical notes with planned line of All investigation / Peritoneal management,Pathological reports,Clinical notes/ Indoor Dialysis Examination (Complete Blood count, case papers,Detail discharge Blood urea, Serum Creatinine, GFR, Summary & dialysis chart (Only serum electrolytes). In chronic renal dialysis chart in chronic dialysis failure/ chronic dialysis patients pts) investigations need to be done and submitted only on 93 MG072 Haemodialysis MG072C Acute 13,500 Clinical notes with planned line of All investigation / Peritoneal Haemodialysis management,Pathological reports,Clinical notes/ Indoor Dialysis Examination (Complete Blood count, case papers,Detail discharge Blood urea, Serum Creatinine, GFR, Summary & dialysis chart (Only serum electrolytes). In chronic renal dialysis chart in chronic dialysis failure/ chronic dialysis patients pts) 94 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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investigations need to be done and submitted only on 94 MG072 Haemodialysis MG072D Chronic 13,500 Clinical notes with planned line of All investigation / Peritoneal Haemodialysis management,Pathological reports,Clinical notes/ Indoor Dialysis Examination (Complete Blood count, case papers,Detail discharge Blood urea, Serum Creatinine, GFR, Summary & dialysis chart (Only serum electrolytes). In chronic renal dialysis chart in chronic dialysis failure/ chronic dialysis patients pts) investigations need to be done and submitted only on 95 MG073 Plasmapheresi MG073A Plasmapheresis 2,000 Clinical notes detailing history and Detailed ICPs, Treatment s Admission notes showing vitals and details, detailed discharge examination findings; any summary, All investigations investigations done; planned line of reports. management 96 MG074 Blood MG074A Whole Blood 2,000 Clinical notes with planned line of Detailed ICPs, Post treatment transfusion transfusion treatment, Complete Hemogram, Complete hemogram, Detailed Blood Group, Planned line of Discharge Summary treatment 97 MG074 Blood MG074B Blood component 2,000 Clinical notes with planned line of Detailed ICPs, Post treatment transfusion including platelet treatment, Complete Hemogram, Complete hemogram, Detailed transfusion (RDP, Blood Group, Planned line of Discharge Summary PC, SDP) treatment 98 MG075 High end MG075A High end 5,000 Clinical notes detailing history and Detailed ICPs, Treatment radiological radiological Admission notes showing vitals and details, detailed discharge diagnostic diagnostic examination findings; any summary, All investigations (CT, MRI, (CT, MRI, Imaging investigations done; planned line of reports. Imaging including nuclear management including imaging) nuclear imaging) 99 MG076 High end MG076A High end 5,000 Clinical notes detailing history and Detailed ICPs, Treatment histopathology histopathology Admission notes showing vitals and details, detailed discharge (Biopsies) and (Biopsies) and examination findings; any summary, All investigations advanced advanced serology investigations done; planned line of reports. serology investigations management investigations
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7. General Surgery
• Total number of packages: 98 • Total number of procedures: 152 • Additional cross specialty procedures: 41 • Number of procedures recommended for auto-approval: 0
• Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Nil • Spinal / other regional anaesthesia are included under General Anaesthesia and need to be claimed accordingly S. Pac AB PM - JAY Proced AB PM - JAY Package Stratification Implant Mandatory Documents Mandatory Documents No. kag Package ure Procedure Price - Pre Authorization - Claim Processing e Name Code Name Cod HBP e 2.0 HBP 2.0 1 SG0 Oesophagec SG001 Oesophagecto 28,300 Clinical notes and Histopath, Intra 01 tomy A my USG/CT/MRI/ Biopsy procedure clinical report confirming the photograph, detailed diagnosis for which the discharge summary, surgery is done Detailed Operative notes 2 SG0 Operations SG002 Operations for 30,500 Clinical notes and X-ray, Picture of removed 02 for A Replacement of CT/MRI/ UGIE findings esopahgus (Intra Replacemen Oesophagus by confirming the diagnosis procedure clinical t of Colon for which the surgery is photograph), Scar Oesophagus done, Biospy, photo (should be two by Colon scars or one huge thoracolumbar scar coverin both colon removal & esopagus replacement) Detailed discharge summary, Detailed Operative notes 3 SG0 Gastrectom SG003 Bleeding Ulcer - 25,000 Clinical notes, UGI Intra Operative 96 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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03 y A Partial Endoscopy confirming Photograph, Gastrectomy the diagnosis Histopathology report, without Detailed Operative Vagotomy notes & detailed discharge summary. 4 SG0 Gastrectom SG003B Bleeding Ulcer - 25,000 Clinical notes, UGI Intra Operative 03 y Partial Endoscopy confirming Photograph, Gastrectomy the diagnosis Histopathology report, with Vagotomy Detailed Operative notes & detailed discharge summary. 5 SG0 Gastrectom SG003C Partial 27,800 Clinical notes and Intra procedure clinical 03 y Gastrectomy mandatory Biopsy + photograph, for Carcinoma Endoscopy/ CT Scan Histopathology report, confirming the post procedure clinical diagnosis, Clinical photograph, Detailed photograph Operative notes, Detailed discharge summary 6 SG0 Gastrectom SG003 Subtotal 27,800 Clinical notes and Intra procedure clinical 03 y D Gastrectomy mandatory Biopsy + photograph, for Carcinoma Endoscopy/ CT Scan Histopathology report, confirming the post procedure clinical diagnosis, Clinical photograph, Detailed photograph Operative notes, Detailed discharge summary 7 SG0 Gastrectom SG003E Total 51,600 Clinical notes and Intra procedure clinical 03 y Gastrectomy - Endoscopy report +/- photograph, Lap. Video /Biopsy/ CT Scan Histopathology report, confirming the diagnosis post procedure clinical for which this surgery is photograph, Detailed done Operative notes, Detailed discharge summary 8 SG0 Gastrectom SG003F Total 51,600 Clinical notes and Intra procedure clinical 03 y Gastrectomy - Endoscopy report +/- photograph, Open Video /Biopsy/ CT Scan Histopathology report, confirming the diagnosis post procedure clinical for which this surgery is photograph, Detailed done Operative notes, 97 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Detailed discharge summary 9 SG0 Operative SG004 Operative 15,000 Clinical notes and Intra procedure clinical 04 Gastrostom A Gastrostomy Endoscopy report +/- photograph, y Video /Biopsy/ CT Scan Histopathology report, confirming the diagnosis post procedure clinical for which this surgery is photograph, Detailed done Operative notes, Detailed discharge summary 10 SG0 Vagotomy SG005 G J Vagotomy 23,500 Clinical notes and Endoscopic intra 05 A Endoscopy report with operative confirming the diagnosis Photograph,Histopatho for which this surgery is logy report, Detailed done Operative notes, detailed discharge summary 11 SG0 Vagotomy SG005B Vagotomy + 23,500 Clinical notes and Endoscopic intra 05 Pyloroplasty Endoscopy report with operative confirming the diagnosis Photograph,Histopatho for which this surgery is logy report, Detailed done Operative notes, detailed discharge summary 12 SG0 Operation SG006 Operation for 22,500 Clinical notes and Intra procedure clinical 06 for Bleeding A Bleeding Peptic Endoscopy confirming Photograph, Detailed Peptic Ulcer Ulcer the diagnosis, discharge summary, Detailed Operative notes 13 SG0 Operation SG007 Gastric 18,500 Clinical notes and X Ray Intra procedure clinical 07 for Gastric / A Perforation Erect/USG/ CT Abdomen photograph, Detailed Duodenal confirming the Operative notes, Perforation diagnosis, FIR/MLC in detailed discharge case of traumatic summary aetiology 14 SG0 Operation SG007B Duodenal 18,500 Clinical notes and X Ray Intra procedure clinical 07 for Gastric / Perforation Erect/USG/ CT Abdomen photograph, Detailed Duodenal confirming the Operative notes, Perforation diagnosis, FIR/MLC in detailed discharge case of traumatic summary aetiology 98 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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15 SG0 Pyloroplasty SG008 Pyloroplasty 14,000 Clinical notes and Intra procedure clinical 08 A Endoscopy confirming photograph, detailed the diagnosis for which discharge summary, the surgery is done Detailed Operative notes 16 SG0 Pyloromyot SG009 Pyloromyotom 15,000 Clinical notes and Endoscopic still 09 omy A y Endoscopy report Photograph, Detailed confirming the diagnosis discharge summary, of nfantile hypertrophic Detailed Operative pyloric stenosis notes 17 SG0 Gastrojejun SG010 Gastrojejunost 18,500 Clinical notes and intra operative 10 ostomy A omy Endoscopy report OR photograph Detailed Biopsy OR CT Scan Operative notes, confirming the diagnosis detailed discharge for which this surgery is summary done 18 SG0 CystoJejuno SG011 CystoJejunosto 20,000 Clinical notes and USG / Detailed discharge 11 stomy / A my - Open CT confirming the summary, post Cystogastros diagnosis for which procedure clinical tomy procedure is needed photograph, Detailed Operative notes, scar photo 19 SG0 CystoJejuno SG011B CystoJejunosto 20,000 Clinical notes and USG / Detailed discharge 11 stomy / my - Lap. CT confirming the summary, post Cystogastros diagnosis for which procedure clinical tomy procedure is needed photograph, Detailed Operative notes, scar photo 20 SG0 CystoJejuno SG011C Cystogastrosto 20,000 Clinical notes and USG / Detailed discharge 11 stomy / my - Open CT confirming the summary, post Cystogastros diagnosis for which procedure clinical tomy procedure is needed photograph, Detailed Operative notes, scar photo 21 SG0 CystoJejuno SG011 Cystogastrosto 20,000 Clinical notes and USG / Detailed discharge 11 stomy / D my - Lap. CT confirming the summary, post Cystogastros diagnosis for which procedure clinical tomy procedure is needed photograph, Detailed Operative notes, scar photo 22 SG0 Feeding SG012 Feeding 10,000 Clinical notes and Intra procedure clinical 99 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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12 Jejunostomy A Jejunostomy Endoscopy report +/- photograph detailed Video /Biopsy/ CT Scan discharge summary, confirming the diagnosis Detailed Operative for which this surgery is notes done 23 SG0 Ileostomy SG013 Ileostomy 14,000 Clinical notes and Histopath, Post 13 A Endoscopy / Biopsy/ CT procedure clinical Scan confirming the photograph, Detailed diagnosis for which this Operative notes, surgery is done detailed discharge summary 24 SG0 Congenital SG014 Congenital 23,000 Clinical notes and X ray, Intra procedure clinical 14 Atresia & A Atresia & CT/MRI Abd confirming stills, Detailed Stenosis of Stenosis of the diagnosis Operative notes, Small Small Intestine Detailed discharge Intestine summary 25 SG0 Operation SG015 Operation for 18,000 Clinical notes and USG USG, Intra operative 15 for A Duplication of Abd/ CT/MRI clinical photograph, Duplication Intestine /Endoscopic Ultrasound Detailed Operative of Intestine - any one test notes, Detailed confirming the discharge summary, diagnosis. histopath of removed part. 26 SG0 Diverticulect SG016 Excision 20,000 Clinical notes and CT Intra operative clinical 16 omy A Duodenal Scan/Endoscopy/Double photograph, Detailed Diverticulum balloon enteroscopy Operative notes, scar confirming the diagnosis photo Detailed discharge summary 27 SG0 Diverticulect SG016B Excision 15,000 Clinical notes and Histopath, Intra 16 omy Meckel's USG/CT/MRI report operative clinical Diverticulum confirming the diagnosis photograph, Detailed Operative notes; detailed discharge summary 28 SG0 Appendicect SG017 Open 11,000 Clinical notes and USG Histopathology report, 17 omy A confirming the diagnosis Intra procedure clinical photograph of removed appendix, post procedure clinical photograph, Detailed Operative notes, 100 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Detailed discharge summary 29 SG0 Appendicect SG017B Lap. 11,000 Clinical notes and USG Histopathology report, 17 omy confirming the diagnosis Intra procedure clinical photograph of removed appendix, post procedure clinical photograph, Detailed Operative notes, Detailed discharge summary 30 SG0 Appendicula SG018 Appendicular 17,500 Clinical notes and X Ray Histopath, Intra 18 r A Perforation Abdomen Erect/USG procedure clinical Perforation confirming the diagnosis photograph, detailed discharge summary and Detailed Operative notes 31 SG0 Operative SG019 Operative 12,000 Clinical notes, USG Intra Operative clinical 19 drainage of A drainage of photograph, Detailed Appendicula Appendicular Operative notes & r Abscess Abscess discharge summary. 32 SG0 Total SG020 Open 23,000 Clinical notes and CT Histopathology, Intra 20 Colectomy A Scan/ Colonoscopy procedure clinical confirming the diagnosis photograph, detailed and need of surgery; discharge summary, Biopsy of the lsoion Detailed Operative notes 33 SG0 Total SG020B Lap. 23,000 Clinical notes and CT Histopathology, Intra 20 Colectomy Scan/ Colonoscopy procedure clinical confirming the diagnosis photograph, detailed and need of surgery; discharge summary, Biopsy of the lsoion Detailed Operative notes 34 SG0 Hemi SG021 Right - Open 25,000 Clinical notes and CT Histopathology report 21 colectomy A Scan/Colonoscopy and Intra procedure confirming the diagnosis Clinical photograp of for which the surgery is removed colon, done, Biopsy Detailed discharge summary, Detailed Operative notes 35 SG0 Hemi SG021B Right - Lap. 25,000 Clinical notes and CT Histopathology report 101 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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21 colectomy Scan/Colonoscopy and Intra procedure confirming the diagnosis Clinical photograp of for which the surgery is removed colon, done, Biopsy Detailed discharge summary, Detailed Operative notes 36 SG0 Hemi SG021C Left - Open 25,000 Clinical notes and CT Histopathology report 21 colectomy Scan/Colonoscopy and Intra procedure confirming the diagnosis Clinical photograp of for which the surgery is removed colon, done, Biopsy Detailed discharge summary, Detailed Operative notes 37 SG0 Hemi SG021 Left - Lap. 25,000 Clinical notes and CT Histopathology report 21 colectomy D Scan/Colonoscopy and Intra procedure confirming the diagnosis Clinical photograp of for which the surgery is removed colon, done, Biopsy Detailed discharge summary, Detailed Operative notes 38 SG0 Operative SG022 Operative 25,000 Clinical notes and X Ray Detailed discharge 22 Managemen A Management Abdomen / CT Contrast summary, X Ray t of Volvulus of Volvulus of confirming the Abdomen, Detailed of Large Large Bowel diagnosis, Operative notes. Bowel 39 SG0 Colostomy SG023 Colostomy 14,000 Clinical notes and CT/ Post procedure clinical 23 A MRI/ Colonoscopy photograph, Detailed evidence of need of Operative notes & surgery. detailed surgery notes. 40 SG0 Closure of SG024 Closure of 14,500 Clinical notes detailing Post procedure clinical 24 stoma A stoma why colostomy was photograph, Detailed done? Clinical Operative notes, photograph Detailed discharge summary 41 SG0 Sigmoid SG025 Sigmoid 21,500 Clinical notes and Histopathology, Intra 25 Resection A Resection Barium X-rays / CT scan/ procedure clinical sigmoidoscopy, photograph, Detailed confirming the diagnosis Operative notes, detailed discharge summary 42 SG0 Perineal SG026 Perineal 14,000 Clinical notes +/- Histopath, Intra 102 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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26 Procedure A Procedure for Colonoscopy / CT procedure clinical for Rectal Rectal Prolapse confirming the photograph, detailed Prolapse diagnosis, discharge summary, Detailed Operative notes 43 SG0 Abdominal SG027 Open 19,000 Clinical notes +/- Intra procedure clinical 27 Procedure A Colonoscopy confirming photograph, detailed for Rectal the diagnosis of discharge summary, Prolapse prolapse Detailed Operative notes, 44 SG0 Abdominal SG027B Lap. 19,000 Clinical notes +/- Intra procedure clinical 27 Procedure Colonoscopy confirming photograph, detailed for Rectal the diagnosis of discharge summary, Prolapse prolapse Detailed Operative notes, 45 SG0 Rectal Polyp SG028 Rectal Polyp 9,600 Clinical notes and Histopath, Intra 28 Excision A Excision Colonoscopy +/- Biopsy procedure clinical justifying surgery, photograph, Detailed Operative notes, detailed discharge summary 46 SG0 Anterior SG029 Open 28,500 Clinical notes, Biopsy, Histopathology report, 29 Resection of A Colonoscopy post procedure clinical rectum photograph, Detailed Operative notes & detailed discharge summary 47 SG0 Anterior SG029B Lap. 28,500 Clinical notes, Biopsy, Histopathology report, 29 Resection of Colonoscopy post procedure clinical rectum photograph, Detailed Operative notes & detailed discharge summary 48 SG0 Resection SG030 Open 25,000 Clinical notes and X Ray Histopath of resected 30 Anastomosis A Abdomen Erect/USG / part, Intra procedure CT confirming the clinical photograph, diagnosis detailed discharge summary and Detailed Operative notes 49 SG0 Resection SG030B Lap. 25,000 Clinical notes and X Ray Histopath of resected 30 Anastomosis Abdomen Erect/USG / part, Intra procedure 103 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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CT confirming the clinical photograph, diagnosis detailed discharge summary and Detailed Operative notes 50 SG0 Procedure SG031 Procedure for 8,000 Clinical notes and Detailed Operative 31 for Fissure A Fissure in Ano proctoscpic findings notes; detailed in Ano confirming the diagnosis discharge summary for which this surgery is done, 51 SG0 Haemorroid SG032 without Stapler 15,000 Clinical notes and Post procedure clinical 32 ectomy A proctoscopy notes photograph, Detailed confirming the diagnosis Operative notes, detailed discharge summary 52 SG0 Haemorroid SG032B with Stapler 32,000 Haemorroid Stapler Clinical notes and Post procedure clinical 32 ectomy (Max 1) proctoscopy notes photograph, Detailed 17,000 confirming the diagnosis Operative notes, detailed discharge summary 53 SG0 Managemen SG033 Management 5,000 Local Clinical notes and Histopath, Intra- 33 t of Pilonidal A of Pilonidal Anesthesia/General confirmation of Pilonidal operative clinical Sinus Sinus Anesthesia sinus on examination photograph, Detailed None/"+8500" Operative notes 54 SG0 Exicision of SG034 Exicision of 5,000 Clinical notes and some post procedure clinical 34 Sinus and A Sinus and imaging to show tract of photograph, Detailed Curettage Curettage sinus, confirming the Operative notes; diagnosis, Clinical detailed discharge Photograph summary. +/- Histopath of surreted material 55 SG0 Exploratory SG035 Exploratory 10,000 Clinical notes detailing Intra procedure clinical 35 Laparotomy A Laparotomy original pathology that photograph, Analysis of led to peritonitis; fluid removed, Detailed supported by X discharge summary, Ray/USG/CT Scan Detailed Operative Abdomen notes describing management done of pathology that led to peritonitis; cautious about OT time; this should take 2-3 hours. 56 SG0 Closure of SG036 Closure of 15,000 Clinical notes describing Intra procedure clinical 104 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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36 Burst A Burst Abdomen the original surgery that photograph, Detailed Abdomen led to burst abdomen Operative notes, and X Ray/USG/ CT detailed discharge Abdomen confirming summary the diagnosis for which the surgery is done 57 SG0 Hepatic SG037 Open 20,000 Clinical notes and Histopath, Intra 37 Resection A USG/CT/MRI / Biopsy procedure clinical report confirming the photograph, detailed justification of surgery. discharge summary, Detailed Operative notes 58 SG0 Hepatic SG037B Lap. 20,000 Clinical notes and Histopath, Intra 37 Resection USG/CT/MRI / Biopsy procedure clinical report confirming the photograph, detailed justification of surgery. discharge summary, Detailed Operative notes 59 SG0 Abdominal SG038 Abdominal 15,800 Clinical notes and Histopath, Intra 38 Hydatid Cyst A Hydatid Cyst USG/CT/MRI report procedure clinical (Single (Single Organ) confirming the photograph, Detailed Organ) diagnosis. Operative notes and detailed discharge summary 60 SG0 Cholecystect SG039 Without 22,800 Clinical notes and USG Intra procedure clinical 39 omy A Exploration of confirming the diagnosis photograph, Detailed CBD - Open discharge summary, Detailed Operative notes 61 SG0 Cholecystect SG039B With 22,800 Clinical notes and USG Intra procedure clinical 39 omy Exploration of confirming the diagnosis photograph, Detailed CBD - Open discharge summary, Detailed Operative notes 62 SG0 Cholecystect SG039C Without 22,800 Clinical notes and USG Intra procedure clinical 39 omy Exploration of confirming the diagnosis photograph, Detailed CBD - Lap. discharge summary, Detailed Operative notes 63 SG0 Cholecystect SG039 With 22,800 Clinical notes and USG Intra procedure clinical 39 omy D Exploration of confirming the diagnosis photograph, Detailed 105 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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CBD - Lap. discharge summary, Detailed Operative notes 64 SG0 Operative SG040 Open 10,000 Clinical notes and Intra procedure clinical 40 Cholecystost A USG/CT Scan confirming photograph, Detailed omy the diagnosis for which discharge summary, the surgery is done, Detailed Operative notes 65 SG0 Operative SG040B Lap. 10,000 Clinical notes and Intra procedure clinical 40 Cholecystost USG/CT Scan confirming photograph, Detailed omy the diagnosis for which discharge summary, the surgery is done, Detailed Operative notes 66 SG0 Operation of SG041 Operation of 24,500 Clinical notes and Histopath, Detailed 41 Choledochal A Choledochal USG/CT Abdomen discharge summary, Cyst Cyst Scar photo, Detailed Operative notes 67 SG0 Splenectom SG042 Open 25,000 Clinical notes and Detailed Operative 42 y A USG/CT Scan and Lab notes, histopath, investigations detailed discharge confirming the diagnosis summary, and justifying the surgery. 68 SG0 Splenectom SG042B Lap. 25,000 Clinical notes and Detailed Operative 42 y USG/CT Scan and Lab notes, histopath, investigations detailed discharge confirming the diagnosis summary, and justifying the surgery. 69 SG0 Bypass - SG043 Bypass - 23,500 Clinical and radiological Histopathology report, 43 Inoperable A Inoperable evidence of inoperability Intra operative clinical Pancreas Pancreas (biopsy, ERCP, MRCP) photograph, Detailed Operative notes and discharge summary. 70 SG0 Distal SG044 Distal 25,000 Clinical notes and Sr Histopath, Intra 44 Pancreatect A Pancreatectom Amylase, CT/ USG, ERCP procedure clinical omy with y with justifying the surgery, photograph, detailed Pancreatico Pancreatico discharge summary, Jejunostomy Jejunostomy Detailed Operative notes 71 SG0 Pancreatico SG045 PancreaticoDuo 30,000 Clinical notes and CT/ Histopath, Intra 106 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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45 Duodenecto A denectomy USG, ERCP confirming procedure clinical my (Whipple's) the diagnosis, photograph, detailed (Whipple's) discharge summary and Detailed Operative notes 72 SG0 Porto Caval SG046 Porto Caval 31,500 Clinical notes and USG- Intra procedure clinical 46 Anastomosis A Anastomosis doppler /CT/MRI report photograph, detailed confirming the diagnosis discharge summary, for which the surgery is Detailed Operative done notes 73 SG0 Mesenteric SG047 Mesenteric 28,500 Clinical notes and Intra procedure clinical 47 Caval A Caval USG/CT/MRI/ photograph, detailed Anastomosis Anastomosis Endoscopy report discharge summary and confirming the diagnosis Detailed Operative for which the notes anastomosis is done 74 SG0 Mesenteric SG048 Mesenteric 15,000 Clinical notes and Histopath, Intra 48 Cyst – A Cyst – Excision USG/CT/MRI report procedure clinical Excision confirming the diagnosis photograph, detailed discharge summary and Detailed Operative notes 75 SG0 Retroperito SG049 Retroperitoneal 23,000 Clinical notes and X Histopath, Intra 49 neal Tumor A Tumor – Ray/USG/CT Abdomen procedure clinical – Excision Excision confirming the diagnosis photograph, detailed discharge summary, Detailed Operative notes 76 SG0 Groin Hernia SG050 Inguinal - Open 14,200 Mesh - 6 X 3 – Clinical notes and USG Post procedure clinical 50 Repair A Polypropylene (Max (specifying size of photograph, detailed 1) defect), Clinical discharge summary 2,000 photograph Detailed Operative notes, Invoice of Mesh used 77 SG0 Groin Hernia SG050B Inguinal - Lap. 14,200 Mesh - 6 X 3 – Clinical notes and USG Post procedure clinical 50 Repair Polypropylene (Max (specifying size of photograph, detailed 1) defect), Clinical discharge summary 2,000 photograph Detailed Operative notes, Invoice of Mesh used 78 SG0 Groin Hernia SG050C Femoral - Open 14,200 Mesh - 6 X 3 – Clinical notes and USG Post procedure clinical 107 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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50 Repair Polypropylene (Max (specifying size of photograph, detailed 1) defect), Clinical discharge summary 2,000 photograph Detailed Operative notes, Invoice of Mesh used 79 SG0 Groin Hernia SG050 Femoral - Lap 14,200 Mesh - 6 X 3 – Clinical notes and USG Post procedure clinical 50 Repair D Polypropylene (Max (specifying size of photograph, detailed 1) defect), Clinical discharge summary 2,000 photograph Detailed Operative notes, Invoice of Mesh used 80 SG0 Groin Hernia SG050E Obturator - 20,000 Mesh - 15 X 15 Clinical notes and USG Post procedure clinical 50 Repair Lap. (Max 1) (specifying size of photograph, detailed 5,000 defect), Clinical discharge summary photograph Detailed Operative notes, Invoice of Mesh used 81 SG0 Hernia - SG051 Epigastric 17,400 Mesh - 15 X 15 Clinical notes and USG Post procedure clinical 51 Ventral A (Max 1) (specifying size of photograph, detailed 5,000 defect), Clinical discharge summary photograph Detailed Operative notes +/- Invoice of Mesh used 82 SG0 Hernia - SG051B Umbilical 17,400 Mesh - 15 X 15 Clinical notes and USG Post procedure clinical 51 Ventral (Max 1) (specifying size of photograph, detailed 5,000 defect), Clinical discharge summary photograph Detailed Operative notes +/- Invoice of Mesh used 83 SG0 Hernia - SG051C Paraumbilical 17,400 Mesh - 15 X 15 Clinical notes and USG Post procedure clinical 51 Ventral (Max 1) (specifying size of photograph, detailed 5,000 defect), Clinical discharge summary photograph Detailed Operative notes +/- Invoice of Mesh used 84 SG0 Hernia - SG051 Spigelian 17,400 Mesh - 15 X 15 Clinical notes and USG Post procedure clinical 51 Ventral D (Max 1) (specifying size of photograph, detailed 5,000 defect), Clinical discharge summary photograph Detailed Operative notes +/- Invoice of Mesh used 108 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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85 SG0 Repair of SG052 Repair of 20,000 Mesh - 30 X 30 Clinical notes including Post procedure clinical 52 Incisional A Incisional (Max 1) info about previous photograph, detailed Hernia Hernia 15,000 surgery in whose discharge summary incision this hernia has Detailed Operative occurred and USG notes +/- Invoice of (specifying size of Mesh used defect), Clinical photograph 86 SG0 Hiatus SG053 Hiatus Hernia 23,500 Clinical notes and X-ray/ Intra procedure clinical 53 Hernia A Repair - Open USG + UGI Endoscopy photograph, Detailed Repair / Operative notes & Fundoplicati discharge summary on 87 SG0 Hiatus SG053B Hiatus Hernia 23,500 Clinical notes and X-ray/ Intra procedure clinical 53 Hernia Repair - Lap. USG + UGI Endoscopy photograph, Detailed Repair / Operative notes & Fundoplicati discharge summary on 88 SG0 Hiatus SG053C Fundoplication 23,500 Clinical notes and X-ray/ Intra procedure clinical 53 Hernia - Open USG + UGI Endoscopy photograph, Detailed Repair / Operative notes & Fundoplicati discharge summary on 89 SG0 Hiatus SG053 Fundoplication 23,500 Clinical notes and X-ray/ Intra procedure clinical 53 Hernia D - Lap. USG + UGI Endoscopy photograph, Detailed Repair / Operative notes & Fundoplicati discharge summary on 90 SG0 Excision of SG054 Single Cyst 2,000 Deailed Clinical notes Intra operative clinical 54 cyst / A photograph, Detailed Sebaceous Operative notes; Cysts over detailed discharge scrotum summary. 91 SG0 Excision of SG054B Multiple Cysts 7,000 Deailed Clinical notes Intra operative clinical 54 cyst / photograph, Detailed Sebaceous Operative notes; Cysts over detailed discharge scrotum summary. 92 SG0 Excision SG055 Excision Filarial 6,500 Clinical notes +/- USG Histopath, detailed 55 Filarial A Scrotum report confirming the Operative notes, Scrotum diagnosis Detailed discharge 109 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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summary 93 SG0 Operation SG056 Operation for 5,000 Clinical notes and +/- Histopath, Intra 56 for A Hydrocele (U/L) Scrotal USG confirming procedure clinical Hydrocele the diagnosis photograph, Detailed (U/L) Operative notes and detailed discharge summary 94 SG0 Epididymal SG057 Epididymal Cyst 4,600 Clinical notes and USG Histopath, Intra 57 Cyst / A exision report confirming the operative clinical Nodule diagnosis photograph, Detailed Excision Operative notes, Detailed discharge summary 95 SG0 Epididymal SG057B Epididymal 4,600 Clinical notes and USG Histopath, Intra 57 Cyst / Nodule excision report confirming the operative clinical Nodule diagnosis photograph, Detailed Excision Operative notes, Detailed discharge summary 96 SG0 Vasovasosto SG058 Vasovasostomy 12,000 Clinical notes detailing Detailed discharge 58 my A need of surgery after summary, Detailed vasectomy? Evidence of Operative notes. Since When and where was this is microsurgery vasectomy done? Is the evaluate time taken (2 EHCP equipped for hours+) microsurgery? 97 SG0 Orchidecto SG059 Orchidectomy 11,200 Clinical notes and Histopath, Intra 59 my A describing Swelling in operative clinical scrotum, USG of photograph, Detailed scrotum, FNAC, tumour Operative notes, markers (if cancer of Detailed discharge prostate/testis,etc is the summary indication); justification of orchidectmy 98 SG0 Inguinal SG060 Inguinal Node 16,000 Clinical notes and USG/ Histopath, Intra 60 Node A (dissection) - Biopsy report confirming procedure clinical (dissection) U/L the diagnosis for which photograph detailed - U/L the surgery is done discharge summary, Detailed Operative notes 99 SG0 Estlander SG061 Estlander 9,300 Clinical notes detailing Post procedure clinical 110 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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61 Operation A Operation (lip) the original pathology photograph, Detailed (lip) thet has led to this Operative notes, surgery with suporting Detailed discharge investigation reports. summary FIR/MLC in case of traumatic aetiology, Clinical Photograph 100 SG0 Operation SG062 Wedge Excision 19,000 Clinical notes and Biopsy Histopath, Post 62 for A report, Clinical procedure clinical Carcinoma Photograph photograph, Detailed Lip Operative notes, Detailed discharge summary 101 SG0 Operation SG062B Wedge Excision 23,800 Clinical notes and Biopsy Histopath, Post 62 for and report, Clinical procedure clinical Carcinoma Vermilionecto Photograph photograph, Detailed Lip my Operative notes, Detailed discharge summary 102 SG0 Operation SG062C Cheek 26,800 Clinical notes and Biopsy Histopath, Post 62 for advancement report, Clinical procedure clinical Carcinoma Photograph photograph, Detailed Lip Operative notes, Detailed discharge summary 103 SG0 Complete SG063 Complete 9,400 Clinical notes confirming Histopath, Post 63 Excision of A Excision of the diagnosis, Clinical procedure clinical Growth Growth from Photograph; FNAC if photograph, Detailed from Tongue only done Operative notes; Tongue only (inclusive of detailed discharge (inclusive of Histopathology summary Histopathol ) ogy) 104 SG0 Excision of SG064 Excision of 23,500 Clinical notes and Histopath, Post 64 Growth A Growth from USG/CT/MRI report procedure clinical from Tongue with confirming the photograph, Detailed Tongue with neck node diagnosis, Clinical Operative notes; neck node dissection Photograph detailed discharge dissection summary 105 SG0 Microlaryng SG065 Microlaryngosc 18,500 Clinical notes and Nasal Post procedure Nasal 65 oscopic A opic Surgery Endoscopy confirming Endoscopy and post 111 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Surgery the diagnosis for which procedure clinical this surgery is done photograph OR Intra procedure clinical photograph, detailed discharge summary, Detailed Operative notes 106 SG0 Submandibu SG066 Submandibular 15,000 Clinical notes and Histopath, Post 66 lar Mass A Mass Excision USG/CT Scan confirming procedure clinical Excision the diagnosis for which photograph, Detailed the surgery is done +/- Operative notes, Biopsy/FNAC, Clinical detailed discharge Photograph summary 107 SG0 Radical Neck SG067 Radical Neck 15,000 Clinical notes and CT Histopath, Intra 67 Dissection A Dissection Scan/MRI Neck procedure clinical confirming the photograph OR Post diagnosis, Biopsy, procedure clinical Clinical Photograph photograph, detailed discharge summary, Detailed Operative notes 108 SG0 Surgical SG068 Surgical 15,000 Clinical notes with USG Histopathology report, 68 removal of A removal of or CT Scan confirming post procedure clinical Branchial Branchial Cyst diagnosis; Pre-op Clinical photograph, Detailed Cyst Photograph Operative notes & detailed discharge summary. 109 SG0 Carotid SG069 Carotid Body 20,000 Clinical notes and USG Intra procedure clinical 69 Body A tumour - Neck/ Colour doppler photograph, Detailed tumour - Excision confirming the diagnosis Operative notes, Excision Histopathology, Detailed discharge summary 110 SG0 Thyroidecto SG070 Hemi 17,000 Clinical notes and Histopath report, Post 70 my A thyroidectomy Thyroid Function Test, procedure clinical FNAC/USG confirming photograph, Detailed the diagnosis and Operative notes, justifying the surgery. Detailed discharge summary 111 SG0 Thyroidecto SG070B Total 20,000 Clinical notes and Histopath report, Post 70 my thyroidectomy Thyroid Function Test, procedure clinical 112 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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FNAC/USG confirming photograph, Detailed the diagnosis and Operative notes, justifying the surgery. Detailed discharge summary 112 SG0 Thyroidecto SG070C Total 28,000 Clinical notes and FNAC/ Histopath report, Post 70 my Thyroidectomy Biopsy/ Thyroid procedure clinical with Block Function Test/USG photograph, Scar Dissection confirming the diagnosis Photo, Detailed and need for surgery discharge summary, Detailed Operative notes 113 SG0 Excision of SG071 Excision of 20,400 Clinical notes and Histopathology, Intra 71 Parathyroid A Parathyroid USG/CT Scan/Nuclear procedure clinical Adenoma / Adenoma Imaging confirming the photograph, Detailed Carcinoma diagnosis. discharge summary,, Detailed Operative notes 114 SG0 Excision of SG071B Excision of 20,400 Clinical notes and Histopathology, Intra 71 Parathyroid Parathyroid USG/CT Scan/Nuclear procedure clinical Adenoma / Carcinoma Imaging confirming the photograph, Detailed Carcinoma diagnosis. discharge summary,, Detailed Operative notes 115 SG0 Thymectom SG072 Thymectomy 28,000 Clinical notes and Histopath, Post 72 y A Investigation report procedure clinical confirming the need for photograph, Detailed surgery (CT/MRI), Operative notes, Single-fiber Detailed discharge electromyography in summary case of myasthenia gravis, Clinical photograph 116 SG0 Sympathect SG073 Sympathectom 15,000 Clinical notes and Intra procedure clinical 73 omy A y supporting Evidence of photograph, detailed need of surgery discharge summary, (EMG,Nerve conduction Detailed Operative study, CT/MRI) Clinical notes Photograph 117 SG0 Breast Lump SG074 Breast Lump 6,000 Local Clinical notes, Sono Histopathology report, 74 Excision A Excision Anesthesia/General mammogram OR intra operative clinical (Benign) (Benign) Anesthesia Mamography showing photograph, Detailed 113 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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None/ "+6000" breast lump +/- FNAC Operative notes & report detailed discharge summary. 118 SG0 Mastectomy SG075 Simple 20,000 Clinical notes and Histopath, Post 75 A Mastectomy Mammography, Biopsy procedure clinical confirming the photograph, Detailed diagnosis, Clinical Operative notes; Photograph detailed discharge summary 119 SG0 Mastectomy SG075B Radical / 25,000 Clinical notes and Histopath, detailed 75 Modified Mammography and discharge summary, Radical Biopsy justifying surgery Detailed Operative Mastectomy notes 120 SG0 Excision SG076 Excision 14,500 Clinical notes and Histopath, Detailed 76 Mammary A Mammary sonomammogram Operative notes, Fistula Fistula report confirming the Detailed discharge diagnosis, summary 121 SG0 Intercostal SG077 Intercostal 4,800 Clinical notes and Analysis report of 77 drainage A drainage Only detailing need of ICD; drained fluid; post Only Clinical photograph, procedure clinical Chest X-Ray PA photograph, Detailed Operative notes; Detailed discharge summary 122 SG0 Rib SG078 Rib Resection & 14,000 Clinical notes and X Ray, Pus C/S, Post 78 Resection & A Drainage CT/ MRI confirming the procedure X Ray, Post Drainage diagnosis for which the procedure clinical surgery is done, Clinical photograph, Detailed photograph Operative notes, detailed discharge summary 123 SG0 Thoracoplas SG079 Thoracoplasty 20,000 Clinical notes and X Ray, Post procedure clinical 79 ty A CT/MRI Chest photograph, Detailed confirming the Operative notes, Intra indication for this procedure clinical surgery, Clinical photograph, Detailed Photograph discharge summary 124 SG0 Decorticatio SG080 Decortication 28,000 Clinical notes and Histopathology, 80 n A (Pleurectomy) USG/CT Scan confirming Detailed discharge (Pleurectom the diagnosis for which summary and Detailed y) the surgery is done, Operative notes 114 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Biopsy 125 SG0 Lobectomy SG081 Thoracoscopic 27,500 Clinical notes and CT Intra procedure clinical 81 A Thorax confirming the photograph, Detailed diagnosis, Biopsy +/- Operative notes, Cytology histopath, Detailed discharge summary, Scar Photo 126 SG0 Lobectomy SG081B Open 27,500 Clinical notes and CT Intra procedure clinical 81 Thorax confirming the photograph, Detailed diagnosis, Biopsy +/- Operative notes, Cytology histopath, Detailed discharge summary, Scar Photo 127 SG0 Thoracoscop SG082 Thoracoscopic 25,000 Clinical notes and CT Intra procedure clinical 82 ic Segmental A Segmental Thorax confirming the photograph, Detailed Resection Resection diagnosis, +/- Biopsy Operative notes, report histopath, Detailed discharge summary, Scar Photo 128 SG0 Lung SG083 Lung Hydatid 20,000 Clinical notes and X Ray, Post procedure clinical 83 Hydatid Cyst A Cyst removal CT/MRI Chest photograph, Detailed removal confirming the Operative notes, Intra diagnosis, Clinical procedure clinical Photograph photograph, Detailed discharge summary, Histopathology 129 SG0 Incision & SG084 Incision & 5,000 Local Clinical notes and USG C/S report of Wound or 84 Drainage of A Drainage of Anesthesia/General report confirming large Pus, Intra operative Abscess Abscess Anesthesia abscess. clinical photograph, None/ "+5000" Detailed Operative notes & detailed discharge summary. 130 SG0 Lipoma / SG085 Lipoma Excision 5,000 Local Clinical notes and Histopath, Post 85 Cyst / other A Anesthesia/General clinical photograph to procedure clinical cutaneous Anesthesia confirm diagnosis. photograph, Detailed swellings None/ "+5000" Operative notes, Excision detailed discharge summary 131 SG0 Lipoma / SG085B Cyst Excision 5,000 Local Clinical notes and Histopath, Post 85 Cyst / other Anesthesia/General clinical photograph to procedure clinical cutaneous Anesthesia confirm diagnosis. photograph, Detailed 115 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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swellings None/ "+5000" Operative notes, Excision detailed discharge summary 132 SG0 Lipoma / SG085C Other 5,000 Local Clinical notes and Histopath, Post 85 Cyst / other cutaneous Anesthesia/General clinical photograph to procedure clinical cutaneous swellings Anesthesia confirm diagnosis. photograph, Detailed swellings Excision None/ "+5000" Operative notes, Excision detailed discharge summary 133 SG0 Debridemen SG086 Debridement of 5,000 Local Clinical notes and Post procedure clinical 86 t of Ulcer A Ulcer Anesthesia/General Clinical photograph of photograph, Detailed Anesthesia affected part, Evidence Operative notes, None/ "+5000" of confirmed diagnosis Detailed discharge of Leprosy summary 134 SG0 Flap SG087 Flap 20,000 Clinical notes detailing Post procedure clinical 87 Reconstructi A Reconstructive the original pathology photograph, Detailed ve Surgery Surgery thet has led to this Operative notes, surgery with suporting Detailed discharge investigation reports. summary Clinical Photograph 135 SG0 Free Grafts - SG088 Free Grafts - 14,000 Clinical notes detailing Post procedure clinical 88 Wolfe Grafts A Wolfe Grafts original pathology, with photograph, Detailed suporting reports, Operative notes, Clinical Photograph Detailed discharge summary 136 SG0 Tissue SG089 Tissue 25,000 Clinical notes and Intra procedure clinical 89 Reconstructi A Reconstruction Clinical photograph of photograph, Post on Flap Flap affected part justifying procedure clinical surgery. Evidence of photograph (if flap confirmed diagnosis of taken from other site; Leprosy even of donor site), Detailed Operative notes, Detailed discharge summary 137 SG0 Split SG090 Small (< 4% 13,500 Clinical notes detailing Post procedure clinical 90 thickness A TBSA) time of Burns,, Clinical photograph, Detailed skin grafts Photograph Operative notes, Detailed discharge summary 138 SG0 Split SG090B Medium (4 - 8% 13,500 Clinical notes detailing Post procedure clinical 90 thickness TBSA) time of Burns,, Clinical photograph, Detailed 116 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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skin grafts Photograph Operative notes, Detailed discharge summary 139 SG0 Split SG090C Large (> 8% 13,500 Clinical notes detailing Post procedure clinical 90 thickness TBSA) time of Burns,, Clinical photograph, Detailed skin grafts Photograph Operative notes, Detailed discharge summary 140 SG0 Skin Flaps - SG091 Skin Flaps - 11,400 Clinical notes and Post procedure clinical 91 Rotation A Rotation Flaps Clinical Photograph, photograph, Detailed Flaps medical records of Operative notes, previous surgeries and detailed discharge indication of this surgery summary 141 SG0 Tendon SG092 Tendon 15,000 Clinical notes and Intra procedure clinical 92 Transfer A Transfer Clinical photograph of photograph, Post affected part, Evidence procedure clinical of confirmed diagnosis photograph, Detailed of Leprosy Operative notes, Detailed discharge summary 142 SG0 Lymphatics SG093 Lymphatics 10,000 Clinical notes and Histopathology report, 93 Excision of A Excision of detailing history, Clinical post procedure clinical Subcutaneo Subcutaneous Photograph photograph, Detailed us Tissues In Tissues In Operative notes, Lymphoede Lymphoedema Detailed discharge ma summary. 143 SG0 AV Fistula SG094 AV Fistula 6,000 Clinical notes detailing Post Procedure clinical 94 without A without need for AV shunt with photograph, Detailed prosthesis prosthesis supporting Evidence of Operative notes, Creatinine/ RFT Detailed discharge summary 144 SG0 Managemen SG095 Management 14,000 Clinical notes and Detailed discharge 95 t of Varicose A of Varicose Duplex summary, Post Veins Veins ultrasonography/ Colour procedure clinical Doppler confirming the photograph, Detailed diagnosis, pre-op clinical Operative notes photograph 145 SG0 Biopsy SG096 Lymph Node 5,000 Clinical notes and Histopathology report, 96 A Clinical Photograph of post procedure clinical Enlarged lymph nodes photograph, Detailed +/- FNAC report Operative notes 117 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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146 SG0 Biopsy SG096B Endometrial 2,000 Clinical notes with Pic of specimen, 96 Aspiration supporting Histopathology report, investigations discharge summary 147 SG0 Biopsy SG096C Cervix Cancer 1,000 Clinical notes with Pic of specimen, 96 screening (PAP supporting Histopathology report, + Colposcopy) investigations discharge summary 148 SG0 Biopsy SG096 Cervical (Neck) 1,500 Clinical notes with Pic of specimen, 96 D supporting Histopathology report, investigations discharge summary 149 SG0 Biopsy SG096E Vulval 1,500 Clinical notes with Pic of specimen, 96 supporting Histopathology report, investigations discharge summary 150 SG0 Stoma SG097 Stoma 4,500 Earlier discharge Invoice / Receipt of 97 Managemen A Management summary, Clinical Notes drugs and consumables t follow up of Ileostomy 151 SG0 Stoma SG097B Stoma 4,500 Earlier discharge Invoice / Receipt of 97 Managemen Management summary, Clinical Notes drugs and consumables t follow up of Colostomy 152 SG0 Foreign SG098 Foreign Body 5,000 Local Clinical notes and X-ray/ Post procedure clinical 98 Body A Removal Anesthesia/General USG report of the photograph, Detailed Removal Anesthesia affected part confirming Operative notes, None/ "+3000" the diagnosis, Still detailed discharge Photograph of the summary and relevant imaging imaging study for comparison
8. Infectious Disease
Package AB PM - Procedure AB PM - Code JAY Code JAY Mandatory Package Procedure Mandatory Documents - Documents - Claim S. No. HBP 2.0 Name HBP 2.0 Name Package Price Stratification Pre Authorization Processing
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Treatment of Level of sickness-Moderate COVID- Sickness,Level of sickness- Clinical Infectious 19 Severe Sickness,Level of Clinical Notes,Positive report Notes,Discharge 1 DL001 Diseases ID003UKA Infection 6400/10400/12000 sickness-Very Severe Sickness for COVID-19 Test Summary
9. Interventional Neuroradiology
• Total number of packages: 10 • Total number of procedures: 15 • Additional cross specialty procedures: 4 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Specific Pre and Post-op Investigations such as pre/ post-op X-ray, CT/ ultrasound report, pre and post-op blood tests, post op clinical photographs with scar etc. will need to be submitted/ uploaded for pre-authorization/ claims settlement purposes. The costs for such investigations will form part of the approved package cost. S. No. Package AB PM - JAY Procedure AB PM - JAY Package Stratification Implant Mandatory Mandatory Documents - Code Package Name Code Procedure Price Documents - Pre Claim Processing HBP 2.0 HBP 2.0 Name Authorization 1 IN001 Dural AVMs / IN001A Dural AVMs 70,000 Glue for AVMs / Clinical notes and Detailed Procedure / AVFs (per sitting) AVFs (Max 1) CT/MRI/ DSA Operative Notes. with glue confirming the Radiographic stills diagnosis photograph/CT/MRI/Angio, Invoice / bar code of glue used, Detailed Discharge Summary 2 IN001 Dural AVMs / IN001B Dural AVFs 70,000 Glue for AVMs / Clinical notes and Detailed Procedure / AVFs (per sitting) AVFs (Max 1) CT/MRI/ DSA Operative Notes. with glue confirming the Radiographic stills diagnosis photograph/CT/MRI/Angio, Invoice / bar code of glue used, Detailed Discharge Summary 119 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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3 IN001 Dural AVMs / IN001C Dural AVMs 1,50,000 Onyx for AVMs / Clinical notes and Detailed Procedure / AVFs (per sitting) AVFs CT/MRI/ DSA Operative Notes. with onyx confirming the Radiographic stills diagnosis photograph/CT/MRI/Angio, Invoice / bar code of Onyx used, Detailed Discharge Summary 4 IN001 Dural AVMs / IN001D Dural AVFs 1,50,000 Onyx for AVMs / Clinical notes and Detailed Procedure / AVFs (per sitting) AVFs CT/MRI/ DSA Operative Notes. with onyx confirming the Radiographic stills diagnosis photograph/CT/MRI/Angio, Invoice / bar code of Onyx used, Detailed Discharge Summary 5 IN002 Cerebral & IN002A Cerebral AVM 1,00,000 Clinical notes and Detailed Procedure / Spinal AVM embolization - CT/MRI/ DSA Operative Notes. embolization - Using confirming the Radiographic stills Using Histoacryl diagnosis photograph/CT/MRI/Angio, Histoacryl (per (per sitting) Invoice / bar code of sitting) histoacryl used, Detailed Discharge Summary 6 IN002 Cerebral & IN002B Spinal AVM 1,00,000 Clinical notes and Detailed Procedure / Spinal AVM embolization - CT/MRI/ DSA Operative Notes. embolization - Using confirming the Radiographic stills Using Histoacryl diagnosis photograph/CT/MRI/Angio, Histoacryl (per (per sitting) Invoice / bar code of sitting) histoacryl used, Detailed Discharge Summary 7 IN003 Coil IN003A Coil 1,00,000 Coil for Clinical notes and Post procedure x-ray embolization embolization embolization of CT Angio/MRA/ showing coils; Detailed for aneurysms for aneurysms aneurysms (Max DSA confirming Procedure / Operative (includes cost (includes cost 17) the diagnosis for Notes. Invoice / bar code of of first 3 coils + of first 3 coils + 24,000 which the used coil / balloon / stent, balloon and / balloon and / procedure is done detailed discharge summary or stent if or stent if used) used) 8 IN004 Carotico- IN004A Carotico- 30,000 Implant for Clinical notes and Post procedure x-ray cavernous cavernous "Carotico- CT/MRI/ DSA showing coils; Detailed Fistula (CCF) Fistula (CCF) cavernous Fistula confirming the Procedure / Operative embolization embolization (CCF) diagnosis Notes. Invoice / bar code of with coils. embolization with used coil / catheter and 120 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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[includes 5 coils. (Max 1) other accessories, detailed coils, guide 1,20,000 discharge summary catheter, micro- catheter, micro- guidewire, general items] 9 IN004 Carotico- IN004B Carotid- 64,000 Balloon for Clinical notes and Post procedure x-ray cavernous cavernous Embolization (Max CT/MRI/ DSA showing balloon; Detailed Fistula (CCF) Fistula (CCF) 1) confirming the Procedure / Operative embolization embolization 11,000 diagnosis Notes. Invoice / bar code of with balloon used coil / catheter and (includes one other accessories, detailed balloon, guide discharge summary catheter, micro- catheter, micro- guidewire, general items) 10 IN005 Pre-operative IN005A Pre-operative 40,000 Clinical notes and Intra procedure clinical tumour tumour CT/MRI/ DSA photograph, Detailed embolization embolization confirming the discharge summary, (per session) (per session) diagnosis Detailed Procedure / Operative Notes. Invoices / bar code of embolic agent used. 11 IN006 Intracranial IN006A Intracranial 1,60,000 Clinical notes and Intra procedure clinical balloon balloon CT/MRI/ DSA photograph, Detailed angioplasty angioplasty confirming the discharge summary, with stenting with stenting diagnosis Detailed Procedure / Operative Notes. Invoices / bar code of balloon and stent 12 IN007 Intracranial IN007A Intracranial 1,60,000 Clinical notes and Intra procedure clinical thrombolysis / thrombolysis / CT/MRI/ DSA photograph, Detailed clot retrieval clot retrieval confirming the discharge summary, diagnosis Detailed Procedure / Operative Notes. Invoices / bar code of thrombolytic 121 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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agentused. 13 IN008 Balloon test IN008A Balloon test 70,000 Clinical notes and Intra procedure clinical occlusion occlusion CT/MRI/ DSA photograph, Detailed confirming the discharge summary, diagnosis Detailed Procedure / Operative Notes. 14 IN009 Parent vessel IN009A Parent vessel 30,000 Clinical notes and Intra procedure still occlusion - occlusion - CT/MRI/ DSA photograph showing coil, Basic Basic confirming the Detailed Procedure / diagnosis Operative Notes with procedure deployed; detailed discharge summary; invoice / bar code of coil used 15 IN010 Vertebroplasty IN010A Vertebroplasty 40,000 Clinical notes and Intra procedure clinical CT/MRI photograph, Detailed confirming the discharge summary, diagnosis and Detailed Procedure / need of Operative Notes. Invoices of procedure; MLC/ cement used. FIR if traumatic
10. Medical Oncology
• Total number of packages: 71 • Total number of procedures: 263 • Additional cross specialty procedures: 2 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Prior approval must be taken for all treatments/ malignancies • The type and duration of treatment is different for all cancers. It is very important to complete the entire treatment which may in some cases last longer than a year. Relapse/recurrence may sometimes occur • Cancer care treatments are advised to go through a clinical treatment approval process before initiating the best suitable treatment. A clinical treatment approval
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process is mandated for cancer care, since it involves a multi-modal approach covering surgical, chemotherapy and radiation treatments and appropriate supportive care that could assess to determine the best course of patient management for such conditions
• There should be pre-authorization at each step for cancer care • It is advised that decision regarding appropriate patient care for cancer care treatments would need to be taken by a multidisciplinary tumor board (if available within the treating hospital or if not then it could be sent to the nearest regional cancer center (RCC) for approval) that should include a highly trained team of Surgical, Radiation and Medical Oncologist in order to ensure the most appropriate treatment for the patient. A detailed Oncology Treatment Plan could prove to be very vital, such as implications on the financial cover and to avoid unnecessary treatments S. Packa AB PM - Procedure AB PM - JAY Package Mandatory Documents - Pre Mandatory Documents - Claim Processing No. ge JAY Code Procedure Price Authorization Code Package HBP 2.0 Name HBP Name 2.0 1 MO0 CT for CA MO001A Cyclophosphami CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast de + Epirubcin 7,200 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery,ECG, SUMMARY OF INPATIENT DEPARTMENT, 2D-ECHO, USG abdomen and DISCHARGE SUMMARY OF DAY CARE pelvis, CXR PA view or CECT DEPARTMENT, CHARTS OF CHEMOTHERAPY chest+abdomen and pelvis in case REGIMEN, TRANFUSION SLIPS of metastatic disease 2 MO0 CT for CA MO001B Weekly CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast Paclitaxel for 5,800 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Adjuvant Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Therapy breast conservation surgery, USG SUMMARY OF INPATIENT DEPARTMENT, abdomen and pelvis, CXR PA view DISCHARGE SUMMARY OF DAY CARE or CECT chest+abdomen and pelvis DEPARTMENT, CHARTS OF CHEMOTHERAPY in case of metastatic disease REGIMEN, TRANFUSION SLIPS 3 MO0 CT for CA MO001C Weekly CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast Paclitaxel in 5,800 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, metastatic Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE setting breast conservation surgery, USG SUMMARY OF INPATIENT DEPARTMENT, abdomen and pelvis, CXR PA view DISCHARGE SUMMARY OF DAY CARE or CECT chest+abdomen and pelvis DEPARTMENT, CHARTS OF CHEMOTHERAPY in case of metastatic disease REGIMEN, TRANFUSION SLIPS 4 MO0 CT for CA MO001D Cyclophosphami CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast de + 3,200 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Methotrexate + Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE 123 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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5 - FU breast conservation surgery, USG SUMMARY OF INPATIENT DEPARTMENT, abdomen and pelvis, CXR PA view DISCHARGE SUMMARY OF DAY CARE or CECT chest+abdomen and pelvis DEPARTMENT, CHARTS OF CHEMOTHERAPY in case of metastatic disease REGIMEN, TRANFUSION SLIPS 5 MO0 CT for CA MO001E Docetaxel + CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast Cyclophosphami 19,800 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, de Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, USG SUMMARY OF INPATIENT DEPARTMENT, abdomen and pelvis, CXR PA view DISCHARGE SUMMARY OF DAY CARE or CECT chest+abdomen and pelvis DEPARTMENT, CHARTS OF CHEMOTHERAPY in case of metastatic disease REGIMEN, TRANFUSION SLIPS 6 MO0 CT for CA MO001F Trastuzumab CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 21,200 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, Her- SUMMARY OF INPATIENT DEPARTMENT, 2 neu IHC - 3+ or Her 2-neu DISCHARGE SUMMARY OF DAY CARE positive FISH,ECG,2D-ECHO,USG DEPARTMENT, CHARTS OF CHEMOTHERAPY abdomen and pelvis, CXR PA view REGIMEN, TRANFUSION SLIPS or CECT chest+abdomen and pelvis in case of metastatic disease 7 MO0 CT for CA MO001G Tamoxifen CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 1,200 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, ER or SUMMARY OF INPATIENT DEPARTMENT, PR positive , mammography,USG DISCHARGE SUMMARY OF DAY CARE abdomen and pelvis, CXR PA view DEPARTMENT, CHARTS OF CHEMOTHERAPY or CECT chest+abdomen and pelvis REGIMEN, TRANFUSION SLIPS in case of metastatic disease 8 MO0 CT for CA MO001H Letrozole CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 3,900 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, ER or SUMMARY OF INPATIENT DEPARTMENT, PR positive , mammography,USG DISCHARGE SUMMARY OF DAY CARE abdomen and pelvis, CXR PA view DEPARTMENT, CHARTS OF CHEMOTHERAPY or CECT chest+abdomen and pelvis REGIMEN, TRANFUSION SLIPS in case of metastatic disease 9 MO0 CT for CA MO001I Carboplatin + CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast Paclitaxel 14,900 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, , SUMMARY OF INPATIENT DEPARTMENT, mammography,USG abdomen and DISCHARGE SUMMARY OF DAY CARE 124 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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pelvis, CXR PA view or DEPARTMENT, CHARTS OF CHEMOTHERAPY CECThest+abdomen and pelvis in REGIMEN, TRANFUSION SLIPS case of metastatic disease 10 MO0 CT for CA MO001J Capecitabine CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 7,400 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, , SUMMARY OF INPATIENT DEPARTMENT, mammography,USG abdomen and DISCHARGE SUMMARY OF DAY CARE pelvis, CXR PA view or CECT DEPARTMENT, CHARTS OF CHEMOTHERAPY chest+abdomen and pelvis in case REGIMEN, TRANFUSION SLIPS of metastatic disease 11 MO0 CT for CA MO001K Carboplatin + CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast Gemcitabine 13,900 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, , SUMMARY OF INPATIENT DEPARTMENT, mammography,USG abdomen and DISCHARGE SUMMARY OF DAY CARE pelvis, CXR PA view or CECT DEPARTMENT, CHARTS OF CHEMOTHERAPY chest+abdomen and pelvis in case REGIMEN, TRANFUSION SLIPS of metastatic disease 12 MO0 CT for CA MO001L Cyclophosphami CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast de + Adriamycin 4,500 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery,ECG, SUMMARY OF INPATIENT DEPARTMENT, 2D-ECHO, USG abdomen and DISCHARGE SUMMARY OF DAY CARE pelvis, CXR PA view or CECT DEPARTMENT, CHARTS OF CHEMOTHERAPY chest+abdomen and pelvis in case REGIMEN, TRANFUSION SLIPS of metastatic disease 13 MO0 CT for CA MO001M Fulvestrant CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 11,000 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, ER or SUMMARY OF INPATIENT DEPARTMENT, PR positive , mammography,USG DISCHARGE SUMMARY OF DAY CARE abdomen and pelvis, CXR PA view DEPARTMENT, CHARTS OF CHEMOTHERAPY or CECT chest abdomen and pelvis REGIMEN, TRANFUSION SLIPS 14 MO0 CT for CA MO001N Paclitaxel CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 11,800 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, , SUMMARY OF INPATIENT DEPARTMENT, mammography,USG abdomen and DISCHARGE SUMMARY OF DAY CARE pelvis, CXR PA view or CECT chest DEPARTMENT, CHARTS OF CHEMOTHERAPY abdomen and pelvis REGIMEN, TRANFUSION SLIPS 125 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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15 MO0 CT for CA MO001O Exemestane CBC, LFT,RFT, Biopsy report or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 01 Breast 10,400 surgical pathology report of (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Modified radical mastectomy or HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE breast conservation surgery, ER or SUMMARY OF INPATIENT DEPARTMENT, PR positive , mammography,USG DISCHARGE SUMMARY OF DAY CARE abdomen and pelvis, CXR PA view DEPARTMENT, CHARTS OF CHEMOTHERAPY or CECT chest abdomen and pelvis REGIMEN, TRANFUSION SLIPS 16 MO0 CT for MO002A Zoledronic Acid RFT, skeletal survey/bone BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 02 Metastatic 4,500 scan/PET-CT showing bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, bone metastasis histopathology showing HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE malignancy myeloma, lung cancer,Breast SUMMARY OF INPATIENT DEPARTMENT, and cancer, renal cancer or other DISCHARGE SUMMARY OF DAY CARE multiple cancer DEPARTMENT, CHARTS OF CHEMOTHERAPY myeloma REGIMEN, TRANFUSION SLIPS 17 MO0 CT for CA MO003A Cisplatin + CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary Irinotecan 10,200 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 18 MO0 CT for CA MO003B Lipodox + CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary Carboplatin 17,200 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 19 MO0 CT for CA MO003C Etoposide CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary 3,400 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 20 MO0 CT for CA MO003D Irinotecan CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary 8,400 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 126 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 21 MO0 CT for CA MO003E Lipodox CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary 14,800 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 22 MO0 CT for CA MO003F Carboplatin + CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary Gemcitabine 13,900 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 23 MO0 CT for CA MO003G Carboplatin + CBc, LFT, RFT, RBS, CA-125, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 03 Ovary Paclitaxel 14,700 Thorax, abdomen and Pelvis, HPR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, or cytology suggestive of ovarian HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 24 MO0 CT for MO004A Carboplatin CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell (AUC 7) 5,800 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor and Pelvis, ECG, Histopathology - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE testicular seminoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 25 MO0 CT for MO004B Bleomycin + CBC, LFT, RFT, RBS, Beta-HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell Etoposide + 11,600 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor Cisplatin and Pelvis, ECG,PFT DLCo, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Histopathology -Ovarian, SUMMARY OF INPATIENT DEPARTMENT, testicular, mediastinal DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 26 MO0 CT for MO004C Etoposide + CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell Cisplatin 10,000 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor and Pelvis, ECG, Histopathology - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Ovarian, testicular, mediastinal SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE 127 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 27 MO0 CT for MO004D Gemcitabine + CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell Oxaliplatin 17,500 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor and Pelvis, ECG, Histopathology - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Ovarian, testicular, mediastinal SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 28 MO0 CT for MO004E Gemcitabine + CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell Paclitaxel 17,500 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor and Pelvis, ECG, Histopathology - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Ovarian, testicular, mediastinal SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 29 MO0 CT for MO004F Paclitaxel + CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell Ifosfamide + 24,400 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor Cisplatin and Pelvis, ECG, Histopathology - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Ovarian, testicular, mediastinal SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 30 MO0 CT for MO004G Vinblastin + CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 04 Germ Cell Ifosfamide + 12,600 AFP, LDH,CECT Thorax, abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor Cisplatin and Pelvis, ECG, Histopathology - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Ovarian, testicular, mediastinal SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 31 MO0 CT for MO005A EMA - CO CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 05 Gestational 11,400 CECT Thorax, abdomen and Pelvis (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Trophoblas HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE tic SUMMARY OF INPATIENT DEPARTMENT, Neoplasia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 32 MO0 CT for MO005B EMA - EP CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 05 Gestational 12,200 CECT Thorax, abdomen and Pelvis (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Trophoblas HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE tic SUMMARY OF INPATIENT DEPARTMENT, 128 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Neoplasia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 33 MO0 CT for MO005C Methotrexate CBC, LFT, RFT, RBS, Beta- HCG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 05 Gestational 1,100 CECT Thorax, abdomen and Pelvis (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Trophoblas HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE tic SUMMARY OF INPATIENT DEPARTMENT, Neoplasia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 34 MO0 CT for MO006A Carboplatin + CBC, LFT, RFT, RBS,CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 06 Cervical Paclitaxel 14,900 abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Pelvis,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 35 MO0 CT for MO006B Cisplatin CBC, LFT, RFT, RBS,CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 06 Cervical 2,200 abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Pelvis,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 36 MO0 CT for MO007A Carboplatin + CBC, LFT, RFT, RBS,CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 07 Endometri Paclitaxel 14,900 abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, al Cancer Pelvis,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 37 MO0 CT for MO007B Cisplatin + CBC, LFT, RFT, RBS,CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 07 Endometri Doxorubicin 4,200 abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, al Cancer Pelvis,histopathology , ECG,2D HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ECHO SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 38 MO0 CT for MO008A Cisplatin + 5 FU CBC, LFT, RFT, RBS, MRI BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 08 Vulvar 7,600 pelvis,histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE 129 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 39 MO0 CT for MO008B Cisplatin CBC, LFT, RFT, RBS, MRI BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 08 Vulvar 2,200 pelvis,histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 40 MO0 CT for MO009A VTC + ITMZ for CBC, Biochemistry, PET CT or CT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 09 Ewing Relapsed Ewing 22,400 CHEST/BONE SCAN, Bone marrow (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma Sarcoma studies, Biopsy, ECG, 2D-ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 41 MO0 CT for MO009B EFT 2001 CBC, Biochemistry, PET CT or CT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 09 Ewing 9,700 CHEST/BONE SCAN, Bone marrow (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma studies, Biopsy, ECG, 2D-ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 42 MO0 CT for MO009C VAC + IE CBC, Biochemistry, PET CT or CT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 09 Ewing 12,500 CHEST/BONE SCAN, Bone marrow (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma studies, Biopsy, ECG, 2D-ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 43 MO0 CT for MO010A Methotrexate + CBC, LFT, RFT, RBS, DTPA GFR, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 10 Osteogenic Doxorubicin + 21,800 NCCT chest, MRI of the involved (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma Cisplatin site,2D ECHO, Pure tone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE audiometry,histopathology SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 44 MO0 CT for MO010B Methotrexate + CBC, Biochemistry, CT CHEST, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 10 Osteogenic Doxorubicin + 27,000 BONE SCAN, Biopsy, ECG, 2D- (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, 130 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Sarcoma Cisplatin for ECHO, AUDIOMETRY, GFR HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Relapsed SUMMARY OF INPATIENT DEPARTMENT, Osteogenic DISCHARGE SUMMARY OF DAY CARE Sarcoma DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 45 MO0 CT for MO010C OGS - 12 CBC, LFT, RFT, RBS, DTPA GFR, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 10 Osteogenic 29,600 NCCT chest, MRI of the involved (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma site,2D ECHO, Pure tone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE audiometry,histopathology SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 46 MO0 CT for MO010D OGS - 12 CBC, LFT, RFT, RBS, DTPA GFR,2D BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 10 Osteogenic 36,200 ECHO, Pure tone,histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 47 MO0 CT for Soft MO011A Gemcitabine + CBC, LFT, ECHO, MRI of the BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 11 Tissue Docetaxel 30,900 involved part, CECT Thorax, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma abdomen and HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Pelvis,histopathology SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 48 MO0 CT for Soft MO011B Ifosfamide+ CBC, LFT, ECHO, MRI of the BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 11 Tissue Adriamycin 13,700 involved part, CECT Thorax, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Sarcoma abdomen and HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Pelvis,histopathology SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 49 MO0 CT for MO012A Dacarbazine + CBC, RFT, LFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 12 Metastatic Cisplatin 7,100 abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Melanoma Pelvis,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 50 MO0 CT for MO012B Temozolamide CBC, RFT, LFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 131 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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12 Metastatic 23,100 abdomen and Pelvis (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Melanoma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 51 MO0 CT for Anal MO013A 5 FU + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 13 Cancer Mitomycin C 10,500 abdomen , MRI Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 52 MO0 CT for Anal MO013B Capecitabine + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 13 Cancer Mitomycin C 13,800 abdomen , MRI Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 53 MO0 CT for Anal MO013C Cisplatin + 5 FU CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 13 Cancer 7,600 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 54 MO0 CT for Anal MO013D Carboplatin + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 13 Cancer Paclitaxel 14,900 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 55 MO0 CT for Anal MO013E Cisplatin + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 13 Cancer Paclitaxel 13,300 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 132 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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56 MO0 CT for MO014A 5 FU + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal Leucovorin 4,700 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology ,Colonoscopy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 57 MO0 CT for MO014B Capecitabine + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal Irinotecan 12,500 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 58 MO0 CT for MO014C Folfox CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal 11,100 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology ,Colonoscopy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 59 MO0 CT for MO014D Folfiri CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal 8,700 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 60 MO0 CT for MO014E Capecitabine + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal Oxaliplatin 16,500 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology ,Colonoscopy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 61 MO0 CT for MO014F Capecitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal 7,200 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology ,Colonoscopy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 133 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 62 MO0 CT for MO014G Capecitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal 7,300 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology ,Colonoscopy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 63 MO0 CT for MO014H Folfirinox CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 14 Colorectal 15,100 abdomen ,Pelvis, CEA, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology ,Colonoscopy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 64 MO0 CT for MO015A Carboplatin + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 15 Esophageal Paclitaxel 14,900 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 65 MO0 CT for MO015B Cisplatin + 5 FU CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 15 Esophageal 9,600 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 66 MO0 CT for MO015C Cisplatin + 5 FU CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 15 Esophageal 9,600 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 67 MO0 CT for MO015D Paclitaxel + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 15 Esophageal Carboplatin for 25,100 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer definitive Non - ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE metastatic SUMMARY OF INPATIENT DEPARTMENT, (With RT) DISCHARGE SUMMARY OF DAY CARE 134 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 68 MO0 CT for MO015E Paclitaxel + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 15 Esophageal Carboplatin for 25,100 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer metastatic ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE (Without RT) SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 69 MO0 CT for MO016A Cisplatin + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal Docetaxel 12,100 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 70 MO0 CT for MO016B Irinotecan CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 8,300 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 71 MO0 CT for MO016C 5 FU CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 8,000 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 72 MO0 CT for MO016D Capecitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 7,200 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 73 MO0 CT for MO016E CAPOX CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 16,500 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, 135 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 74 MO0 CT for MO016F Docetaxel + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal Cisplatin + 5 FU 16,400 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 75 MO0 CT for MO016G Docetaxel + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal Cisplatin + 19,700 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach Xeloda ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 76 MO0 CT for MO016H Docetaxel + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal Oxaliplatin + 5 20,400 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach FU ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 77 MO0 CT for MO016I Docetaxel + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal Oxaliplatin + 24,900 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach Xeloda ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 78 MO0 CT for MO016J Folfiri CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 8,700 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 79 MO0 CT for MO016K Folfox CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 11,100 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE 136 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 80 MO0 CT for MO016L Paclitaxel CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 16 Esophageal 5,800 abdomen ,Pelvis, Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, / Stomach ,UGI endoscospy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 81 MO0 CT for MO017A Doxorubicin CBC,LFT, RFT, RBS, Triphasic CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 17 Hepatocell 10,000 Thorax , abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ular Histopathology , AFP,MRI HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Carcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 82 MO0 CT for MO017B Sorafenib CBC,LFT, RFT, RBS, Triphasic CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 17 Hepatocell 7,400 Thorax , abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ular Histopathology , AFP, Lipid Profile, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Carcinoma Urine R/M, 2D ECHO SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 83 MO0 CT for MO018A Gemcitabine + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 18 Panceratic Nanopaclitaxel 23,500 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 84 MO0 CT for MO018B Gemcitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 18 Panceratic 9,000 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 85 MO0 CT for MO018C Gemcitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 18 Panceratic 9,000 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, 137 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Cancer Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 86 MO0 CT for MO018D Folfirinox CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 18 Panceratic 15,500 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 87 MO0 CT for MO018E Capecitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 18 Panceratic 7,400 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 88 MO0 CT for MO018F Capecitabine + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 18 Panceratic Gemcitabine 31,500 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 89 MO0 CT for Gall MO019A Capecitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder 7,300 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 90 MO0 CT for Gall MO019B Cisplatin + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder Gemcitabine 10,900 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 91 MO0 CT for Gall MO019C Folfiri CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 138 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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19 Bladder 8,900 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 92 MO0 CT for Gall MO019D Gemcitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder 9,000 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 93 MO0 CT for Gall MO019E Gemcitabine CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder 8,900 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 94 MO0 CT for Gall MO019F Oxaliplatin + CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder Gemcitabine 17,100 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 95 MO0 CT for Gall MO019G CAPIRI CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder 12,600 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 96 MO0 CT for Gall MO019H Folfox CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 19 Bladder 11,300 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer / Histopathology/FNAC, CA19.9, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cholangioc SUMMARY OF INPATIENT DEPARTMENT, arcinoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 139 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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97 MO0 CT for MO020A Imatinib CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 20 Gastointest 19,400 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, inal Histopathology/FNAC, Ckit- HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stromal mutation (not mandatory) SUMMARY OF INPATIENT DEPARTMENT, tumor DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 98 MO0 CT for MO020B Sunitinib CBC,LFT, RFT, RBS, CECT Thorax , BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 20 Gastointest 24,400 abdomen ,Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, inal Histopathology/FNAC, Ckit- HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stromal mutation (not mandatory) SUMMARY OF INPATIENT DEPARTMENT, tumor DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 99 MO0 CT for CA MO021A Temozolamide CBC,LFT, RFT, RBS, MRI brain, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 21 Brain 13,000 Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 100 MO0 CT for CA MO021B Temozolamide CBC,LFT, RFT, RBS, MRI brain, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 21 Brain 67,600 Histopathology (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 101 MO0 CT for MO022A Gemcitabine + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 22 Mesothelio Cisplatin 11,100 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ma histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 102 MO0 CT for MO022B Pemetrexed + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 22 Mesothelio Cisplatin 9,200 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ma histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 140 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 103 MO0 CT for MO022C Pemetrexed + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 22 Mesothelio Carboplatin 10,000 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ma histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 104 MO0 CT for MO023A Cisplatin + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 23 Thymic Etoposide 5,300 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Carcinoma histopathology , ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 105 MO0 CT for MO023B Cisplatin + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 23 Thymic Adriamycin 5,000 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Carcinoma histopathology , ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 106 MO0 CT for CA MO024A Cisplatin + CBC, LFT,RFT,RBS,CECT/MR Face BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Docetaxel 12,400 and neck, histopathology - (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck squamous carcinoma, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Nasopharyngeal carcinoma Pure SUMMARY OF INPATIENT DEPARTMENT, tone audiometry DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 107 MO0 CT for CA MO024B Cisplatin CBC, LFT,RFT,RBS,CECT/MR Face BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 9,800 and neck, histopathology - (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck squamous carcinoma, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE nasopharyngeal carcinoma,Pure SUMMARY OF INPATIENT DEPARTMENT, tone audiometry DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 108 MO0 CT for CA MO024C Carboplatin + CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Gemcitabine 14,300 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE 141 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 109 MO0 CT for CA MO024D Docetaxel + CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Cisplatin + 5 FU 16,500 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 110 MO0 CT for CA MO024E Docetaxel CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 15,000 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 111 MO0 CT for CA MO024F Docetaxel CBC, LFT,RFT,RBS,CECT/MR Face BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 14,400 and neck, histopathology - (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck squamous carcinoma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 112 MO0 CT for CA MO024G Etoposide + CBC, LFT,RFT,RBS,histopathology - BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Carboplatin 7,100 esthesioneuroblastoma, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck Neuroendocrine, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 113 MO0 CT for CA MO024H Etoposide + CBC, LFT,RFT,RBS,histopathology - BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Cisplatin 9,200 esthesioneuroblastoma, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck Neuroendocrine, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 114 MO0 CT for CA MO024I Gemcitabine CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 9,200 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, 142 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 115 MO0 CT for CA MO024J Gemcitabine + CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Cisplatin 11,100 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 116 MO0 CT for CA MO024K Paclitaxel + CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Carboplatin 7,700 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 117 MO0 CT for CA MO024L Paclitaxel + CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & Carboplatin 15,100 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 118 MO0 CT for CA MO024M Paclitaxel CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 5,700 squamous carcinoma, salivary (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck gland HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 119 MO0 CT for CA MO024N Paclitaxel CBC, LFT,RFT,RBS, histopathology- BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 12,200 squamous (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck carcinoma,nasopharyngeal HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma, salivary gland SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 120 MO0 CT for CA MO024O Carboplatin CBC, LFT,RFT,RBS,CECT/MR Face BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 2,400 and neck, histopathology - (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck squamous carcinoma, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE 143 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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nasopharyngeal carcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 121 MO0 CT for CA MO024P Cisplatin CBC, LFT,RFT,RBS,CECT/MR Face BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 24 Head & 2,200 and neck, histopathology - (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Neck squamous carcinoma, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 122 MO0 CT for MO025A Sunitinib CBC, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 25 Renal Cell 26,400 abdomen and Pelvis,lipid profile, 2 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cancer D ECHO, TFT, 24 hour urine protein HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 123 MO0 CT for MO026A Cisplatin + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / Methotrexate + 6,000 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / Vinblastin histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 124 MO0 CT for MO026B Carboplatin + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / Gemcitabine 14,300 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / MRI,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 125 MO0 CT for MO026C Cisplatin + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / Gemcitabine 11,100 abdomen and Pelvis, MRI, ECG, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / 2D-ECHO,Histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 126 MO0 CT for MO026D Cisplatin + 5 FU CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / 7,800 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, 144 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 127 MO0 CT for MO026E Cisplatin + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / Paclitaxel 13,500 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 128 MO0 CT for MO026F Docetaxel CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / 14,400 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 129 MO0 CT for MO026G Gemcitabine + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / Paclitaxel 17,500 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 130 MO0 CT for MO026H Gemcitabine CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / 9,200 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 131 MO0 CT for MO026I Methotrexate + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / Vinblastin + 6,600 abdomen and Pelvis, MRI, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / Doxorubicin + histopathology,ECG, ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra Cisplatin SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 132 MO0 CT for MO026J Paclitaxel + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 145 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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26 Ureter / Carboplatin 15,100 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 133 MO0 CT for MO026K Paclitaxel CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 26 Ureter / 5,700 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Bladder / histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Urethra SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 134 MO0 CT for CA MO027A Cisplatin + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis Paclitaxel 13,500 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 135 MO0 CT for CA MO027B 5 FU + Cisplatin CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis 7,800 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 136 MO0 CT for CA MO027C Capecitabine CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis 7,400 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 137 MO0 CT for CA MO027D Paclitaxel + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis Carboplatin 15,100 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 146 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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138 MO0 CT for CA MO027E Paclitaxel CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis 5,700 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 139 MO0 CT for CA MO027F Paclitaxel CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis 12,200 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 140 MO0 CT for CA MO027G Paclitaxel + CBC, RFT, LFT, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 27 Penis Carboplatin 7,900 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 141 MO0 CT for CA MO028A Docetaxel CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate 11,700 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 142 MO0 CT for CA MO028B Docetaxel CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate 14,100 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 143 MO0 CT for CA MO028C Etoposide + CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate Carboplatin 7,100 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 147 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 144 MO0 CT for CA MO028D LHRH Agonist CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate 15,300 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 145 MO0 CT for CA MO028E Mitoxantrone + CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate Prednisolone 4,200 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 146 MO0 CT for CA MO028F Paclitaxel + CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate Carboplatin 7,700 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 147 MO0 CT for CA MO028G Paclitaxel + CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate Carboplatin 15,100 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 148 MO0 CT for CA MO028H Docetaxel CBC, RFT, LFT, PSA, ECG, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 28 Prostate 14,700 CECTThorax, abdomen and (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Pelvis,bone scan,histopathology HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 149 MO0 CT for B - MO029A R - CEOP CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 29 Cell NHL - 26,200 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, High Grade marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE (Except flow/PB cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, Burkitt's & DISCHARGE SUMMARY OF DAY CARE 148 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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PCNSL) DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 150 MO0 CT for B - MO029B R - CHOP CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 29 Cell NHL - 27,000 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, High Grade marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE (Except flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, Burkitt's & DISCHARGE SUMMARY OF DAY CARE PCNSL) DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 151 MO0 CT for High MO030A Rituxmab + CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 30 - Grade Dexamethasone 34,900 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, NHL - B + marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Cell High Dose flow cytometry. SUMMARY OF INPATIENT DEPARTMENT, Cytarabine + DISCHARGE SUMMARY OF DAY CARE Cisplatin DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 152 MO0 CT for MO031A GDP - R CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 31 Relapsed B 35,300 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, - Cell NHL - marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE High Grade flow cytometry, SUMMARY OF INPATIENT DEPARTMENT, (Except DISCHARGE SUMMARY OF DAY CARE Burkitt's & DEPARTMENT, CHARTS OF CHEMOTHERAPY PCNSL) REGIMEN, TRANFUSION SLIPS 153 MO0 CT for MO031B ICE - R CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 31 Relapsed B 31,900 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, - Cell NHL - marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE High Grade flow cytometry SUMMARY OF INPATIENT DEPARTMENT, (Except DISCHARGE SUMMARY OF DAY CARE Burkitt's & DEPARTMENT, CHARTS OF CHEMOTHERAPY PCNSL) REGIMEN, TRANFUSION SLIPS 154 MO0 CT for MO032A EPOCH CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 32 PMBCL / 31,700 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Burkitt's marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, / DISCHARGE SUMMARY OF DAY CARE Seropositiv DEPARTMENT, CHARTS OF CHEMOTHERAPY e REGIMEN, TRANFUSION SLIPS B - Cell NHLR 155 MO0 CT for MO033A Codox - M - IVAC CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 33 Burkitt's / GMALL / BFM / 34,500 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, 149 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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NHL Hyper CVAD marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 156 MO0 CT for Low MO034A Bendamustine + CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 34 Grade B - Rituximab 30,700 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cell NHL marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE flow cytometry. SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 157 MO0 CT for Low MO034B Lenalidomide + CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 34 Grade B - Rituximab 27,500 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cell NHL marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE flow cytometry. SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 158 MO0 CT for Low MO035A Rituximab CBC,Biochemistry,CECT Chest BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 35 Grade NHL 24,800 abdomen and pelvis, Bone marrow (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, studies, Biopsy or fluid flow HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE cytometry. SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 159 MO0 CT for Low MO035B Rituximab + CBC,Biochemistry,USG abdmen BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 35 Grade NHL Cyclophosphami 25,800 and Pelvis CECT Chest abdomen (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, de + Vincristine and pelvis, Bone marrow studies, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE + Prednisolone Biopsy or fluid flow cytometry. SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 160 MO0 CT for MO036A Fludarabine + CBC,Biochemistry,Chest X ay and BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 36 Chronic Cyclophosphami 18,100 USG abdomen/pelvis or CECT (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphocyti de Chest abdomen and pelvis, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE c Leukemia marrow studies, Biopsy or fluid SUMMARY OF INPATIENT DEPARTMENT, flow cytometry. DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 161 MO0 CT for MO036B Rituxmab + CBC,Biochemistry,Chest X ay and BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 150 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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36 Chronic Chlorambucil 24,900 USG abdomen/pelvis or CECT (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphocyti Chest abdomen and pelvis, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE c Leukemia marrow studies, Biopsy or fluid SUMMARY OF INPATIENT DEPARTMENT, flow cytometry. DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 162 MO0 CT for MO036C Rituximab + CBC,Biochemistry,Chest X ay and BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 36 Chronic Fludarabine + 40,700 USG abdomen/pelvis or CECT (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphocyti Cyclophosphami Chest abdomen and pelvis, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE c Leukemia de marrow studies, Biopsy or fluid SUMMARY OF INPATIENT DEPARTMENT, flow cytometry. DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 163 MO0 CT for MO036D Lenalidomide CBC,Biochemistry,Chest X ay and BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 36 Chronic 4,800 USG abdomen/pelvis or CECT (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphocyti Chest abdomen and pelvis, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE c Leukemia marrow studies, Biopsy or fluid SUMMARY OF INPATIENT DEPARTMENT, flow cytometry. DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 164 MO0 CT for MO037A CHOEP CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 37 Peripheral 5,000 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, T - Cell Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 165 MO0 CT for MO037B CHOP CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 37 Peripheral 4,000 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, T - Cell Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 166 MO0 CT for MO037C SMILE CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 37 Peripheral 19,300 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, T - Cell Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 151 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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167 MO0 CT for NK - MO038A GELOX CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 38 T Cell 18,900 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphoma Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 168 MO0 CT for NK - MO038B LVP CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 38 T Cell 7,600 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphoma Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 169 MO0 CT for MO039A COPP CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 39 Hodgkin's 3,600 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphoma marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 170 MO0 CT for MO039B ABVD CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 39 Hodgkin's 10,200 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphoma marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 171 MO0 CT for MO039C AEVD CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 39 Hodgkin's 10,200 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphoma marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 172 MO0 CT for MO040A ICE CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 40 Relapsed 9,700 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkin Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 152 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 173 MO0 CT for MO040B MINE CBC,Biochemistry,LDH,PET CECT or BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 40 Relapsed 9,700 CECT chest abdomen and pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkin Bone marrow studies, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 174 MO0 CT for MO040C PTCL - GDP CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 40 Relapsed 12,500 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkin marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 175 MO0 CT for MO041A DHAP CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 41 Relapsed 11,500 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, NHL & HL marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 176 MO0 CT for MM MO042A LD CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 42 / 6,000 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s / POEMS marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 177 MO0 CT for MM MO042B POM DEX CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 42 / 6,800 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s / POEMS marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 178 MO0 CT for MM MO043A CTD CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 4,000 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE 153 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 179 MO0 CT for MM MO043B MPT CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 4,100 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 180 MO0 CT for MM MO043C VCD CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 14,600 electrophoresis, Bone marrow (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi studies, skeletal survey, Urine BJP. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 181 MO0 CT for MM MO043D VD CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 13,300 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 182 MO0 CT for MM MO043E VMP CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 12,600 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 183 MO0 CT for MM MO043F VRD CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 17,800 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 184 MO0 CT for MM MO043G VTD CBC, Biochemistry, Serum protein BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 43 / 15,000 electrophoresis, Immunofixation, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Amyloidosi Serum free light chain assay, Bone HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE s marrow studies, Skeletal survey, SUMMARY OF INPATIENT DEPARTMENT, 154 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Urine BJP DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 185 MO0 CT for MO044A Imatinib CBC,RFT,LFT,MDC,BONE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 44 Chronic 19,400 MARROW, BIOPSY,CYTOGENETICS, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Myeloid RQ PCR BCR ABL HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Leukemia SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 186 MO0 CT for MO045A Hydroxurea CBC,RFT,LFT,MDC,BONE MARROW BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 45 Myeloproli 2,200 ,CYTOGENETICS (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ferative HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Neoplasm SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 187 MO0 CT for MO046A Consolidation CBC, LFT,RFT, RBS, Bone marrow BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 46 Acute 60,000 aspiration, flow cytometry or (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Myeloid Peripheral blood flow cytometry, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Leukemia cytogenetics, Molecular SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 188 MO0 CT for MO046B Induction CBC, LFT,RFT, RBS, Bone marrow BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 46 Acute 96,000 aspiration, flow cytometry or (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Myeloid Peripheral blood flow cytometry, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Leukemia cytogenetics, Molecular SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 189 MO0 CT for MO047A Consolidation CBC BIOCHEM BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 47 Acute (Phase II, CNS 1,60,000 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphobla Therapy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stic Reinduction) SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 190 MO0 CT for MO047B Induction CBC,MDC,HIV,HBSAG,HCV,2D BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 47 Acute 80,000 ECHO,NCCT CHEST,BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphobla MARROW or Peripheral HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE 155 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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stic bloodFLOW SUMMARY OF INPATIENT DEPARTMENT, Leukemia CYTOMETRY,CYTOGENETICS,Molec DISCHARGE SUMMARY OF DAY CARE ular,BIOPSY, PET-CT or CECT chest DEPARTMENT, CHARTS OF CHEMOTHERAPY abdomen and Pelvis(if LBL) REGIMEN, TRANFUSION SLIPS 191 MO0 CT for MO047C Maintenance CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 47 Acute 4,000 M,CSF CYTOMORPHOLOGY,FLOW (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphobla CYTOMETRY,BONE MARROW HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stic FLOW SUMMARY OF INPATIENT DEPARTMENT, Leukemia CYTOMETRY,CYTOGENETICS,NGS,B DISCHARGE SUMMARY OF DAY CARE IOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 192 MO0 CT for MO048A Consolidation CBC BIOCHEM BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 48 Lymphobla (Phase II, CNS 1,60,000 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, stic Therapy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma Reinduction) SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 193 MO0 CT for MO048B Induction CBC,MDC,HIV,HBSAG,HCV,2D BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 48 Lymphobla 80,000 ECHO,NCCT CHEST,BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, stic MARROW or Peripheral HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma bloodFLOW SUMMARY OF INPATIENT DEPARTMENT, CYTOMETRY,CYTOGENETICS,Molec DISCHARGE SUMMARY OF DAY CARE ular,BIOPSY, PET-CT or CECT chest DEPARTMENT, CHARTS OF CHEMOTHERAPY abdomen and Pelvis(if LBL) REGIMEN, TRANFUSION SLIPS 194 MO0 CT for MO048C Maintenance CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 48 Lymphobla 4,000 M,CSF CYTOMORPHOLOGY,FLOW (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, stic CYTOMETRY,BONE MARROW HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma FLOW SUMMARY OF INPATIENT DEPARTMENT, CYTOMETRY,CYTOGENETICS,NGS,B DISCHARGE SUMMARY OF DAY CARE IOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 195 MO0 CT for MO049A High Risk CBC BIOCHEM ECG BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 49 Acute Consolidation 32,000 BONEMARROW RQPCR PML RARA (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Promyeloc HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ytic SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE (High Risk) DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 196 MO0 CT for MO049B High Risk CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 49 Acute Induction 96,000 M,PT,APTT,FIBRINOGEN,2D (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, 156 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Promyeloc ECHO,NCCT CHEST,BONE HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ytic MARROW FLOW SUMMARY OF INPATIENT DEPARTMENT, Leukemia CYTOMETRY,CYTOGENETICS,RQPC DISCHARGE SUMMARY OF DAY CARE (High Risk) R PML RARA,BIOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 197 MO0 CT for MO049C High Risk CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 49 Acute Maintenance 8,000 M,PT,APTT,FIBRINOGEN,2D (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Promyeloc ECHO,NCCT CHEST,BONE HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ytic MARROW FLOW SUMMARY OF INPATIENT DEPARTMENT, Leukemia CYTOMETRY,CYTOGENETICS,RQPC DISCHARGE SUMMARY OF DAY CARE (High Risk) R PML RARA,BIOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 198 MO0 CT for MO050A Low Risk CBC LFT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 50 Acute Consolidation 12,000 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Promyeloc HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ytic SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE (Low Risk) DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 199 MO0 CT for MO050B Low Risk CBC BIOCHEM BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 50 Acute Induction 80,000 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Promyeloc HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ytic SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE (Low Risk) DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 200 MO0 Febrile MO051A First Line CBC, BIOCHEM, ECG, BONE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 51 Neutopeni Antibiotics 28,000 MARROW, RQ PCR, PML RARA (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, a HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 201 MO0 Febrile MO051B Second Line CBC, LFT, RQ PCR, PML RARA BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 51 Neutopeni Antibiotics and 60,000 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, a Antifungals HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 202 MO0 Chemother MO052A Chemotherapy CBC, LFT, Serum Electrolytes, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 157 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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52 apy Complications - 24,000 Blood Phosphate levels, Uric Acid, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Complicati Tumor Lysis BUN HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE ons - Syndrome SUMMARY OF INPATIENT DEPARTMENT, Tumor DISCHARGE SUMMARY OF DAY CARE Lysis DEPARTMENT, CHARTS OF CHEMOTHERAPY Syndrome REGIMEN, TRANFUSION SLIPS 203 MO0 Granulocyt MO053A Granulocyte CBC, Bone marrow, RFT, LFT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 53 e Colony Colony 12,800 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Stimulating Stimulating HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Factor Use Factor Use SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 204 MO0 CT for MO054A Langerhans Cell CBC,RFT,LFT,MDC,BONE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 54 Langerhans Histiocytosis 22,400 MARROW, BIOPSY, SKELETAL (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cell (Histiocytosis SURVEY OR PET CECT HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Histiocytosi Protocol - SUMMARY OF INPATIENT DEPARTMENT, s Induction) DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 205 MO0 CT for MO054B Langerhans Cell CBC,RFT,LFT,MDC,BONE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 54 Langerhans Histiocytosis 17,000 MARROW, SKELETAL SURVEY OR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Cell (Histiocytosis PET CECT HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Histiocytosi Protocol - SUMMARY OF INPATIENT DEPARTMENT, s Maintenance) DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 206 MO0 CT for Low MO055A Vincristine + CBC, Biochemistry, MRI, Biopsy BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 55 Grade Carboplatin 5,600 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Glioma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 207 MO0 CT for Low MO055B Vinblastin CBC, Biochemistry, MRI, Biopsy BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 55 Grade 1,900 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Glioma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 158 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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208 MO0 CT for MO056A PACKER CBC, Biochemistry, MRI (BRAIN BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 56 Medullobla 4,900 AND SPINE), Biopsy, CSF (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, stoma / CYTOLOGY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Brain PNET SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 209 MO0 CT for MO056B CET CBC, Biochemistry, MRI (BRAIN BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 56 Medullobla 8,300 AND SPINE), Biopsy, CSF (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, stoma / CYTOLOGY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE CNS PNET SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 210 MO0 CT for MO057A Cabroplatin + CBC, Biochemistry, CECT/MRI, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 57 Neuroblast Etoposide + 7,900 BONE MARROW STUDIES, MIBG (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, oma Cyclophosphami OR BONE OR PET CT SCAN, BIOPSY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE de + Doxorubicin FISH SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 211 MO0 CT for MO057B RAPID COJEC CBC, Biochemistry, CECT/MRI, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 57 Neuroblast 6,800 BONE MARROW STUDIES, MIBG (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, oma OR BONE OR PET CT SCAN, BIOPSY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE FISH SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 212 MO0 CT for MO057C RETINOID CBC, Biochemistry BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 57 Neuroblast 2,000 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, oma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 213 MO0 CT for MO058A JOE / COPE CBC, Biochemistry, MRI/CT (BRAIN BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 58 Retinoblast 7,100 AND ORBITS), (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, oma ULTRASONOGRAPHY, BONE HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE MARROW AND CSF STUDIES SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 159 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 214 MO0 CT for MO059A VCD CBC, Biochemistry, MRI OR CECT, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 59 Rhabdomy 4,800 BONE MARROW STUDIES, BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, osarcoma SCAN OR PET CT, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 215 MO0 CT for MO059B VIE CBC, Biochemistry, MRI OR CECT, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 59 Rhabdomy 16,200 BONE MARROW STUDIES, BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, osarcoma SCAN OR PET CT, Biopsy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 216 MO0 CT for MO060A VTC + VAC CBC, Biochemistry, MRI OR CECT, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 60 Relapse 12,200 BONE MARROW STUDIES, BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Rhabdomy SCAN OR PET CT, Biopsy, 2D ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE osarcoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 217 MO0 CT for MO061A VINC + ACTIN. D CBC, Biochemistry, CT CHEST BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 61 Wilms 3,000 ABDOMEN, ULTRASONOGRAPHY, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor BIOPSY HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 218 MO0 CT for MO061B VINC + ACTIN. D CBC, Biochemistry, CT CHEST BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 61 Wilms + DOX 4,200 ABDOMEN, ULTRASONOGRAPHY, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor BIOPSY, 2D ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 219 MO0 CT for MO061C Cyclo + Dox + CBC, Biochemistry, CT CHEST BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 61 Wilms Etop + Vinc + 12,300 ABDOMEN, ULTRASONOGRAPHY, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Tumor Actino . D BIOPSY, 2D ECHO HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE 160 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 220 MO0 CT for MO062A Consolidation CBC BIOCHEM BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 62 Pediatric (Phase II, CNS 2,08,600 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute Therapy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphobla Reinduction) SUMMARY OF INPATIENT DEPARTMENT, stic DISCHARGE SUMMARY OF DAY CARE Leukemia DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 221 MO0 CT for MO062B Induction CBC,MDC,HIV,HBSAG,HCV,2D BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 62 Pediatric 72,000 ECHO,NCCT CHEST,BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute MARROW or Peripheral HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphobla bloodFLOW SUMMARY OF INPATIENT DEPARTMENT, stic CYTOMETRY,CYTOGENETICS,Molec DISCHARGE SUMMARY OF DAY CARE Leukemia ular,BIOPSY, PET-CT or CECT chest DEPARTMENT, CHARTS OF CHEMOTHERAPY abdomen and Pelvis(if LBL) REGIMEN 222 MO0 CT for MO062C Maintenance CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 62 Pediatric 2,500 M,CSF CYTOMORPHOLOGY,FLOW (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute CYTOMETRY,BONE MARROW HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphobla FLOW SUMMARY OF INPATIENT DEPARTMENT, stic CYTOMETRY,CYTOGENETICS,NGS,B DISCHARGE SUMMARY OF DAY CARE Leukemia IOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 223 MO0 CT for MO063A Consolidation CBC BIOCHEM BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 63 Pediatric (Phase II, CNS 2,08,600 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphobla Therapy HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stic Reinduction) SUMMARY OF INPATIENT DEPARTMENT, Lymphoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 224 MO0 CT for MO063B Induction CBC,MDC,HIV,HBSAG,HCV,2D BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 63 Pediatric 72,000 ECHO,NCCT CHEST,BONE (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphobla MARROW or Peripheral HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stic bloodFLOW SUMMARY OF INPATIENT DEPARTMENT, Lymphoma CYTOMETRY,CYTOGENETICS,Molec DISCHARGE SUMMARY OF DAY CARE ular,BIOPSY, PET-CT or CECT chest DEPARTMENT, CHARTS OF CHEMOTHERAPY abdomen and Pelvis(if LBL) REGIMEN 225 MO0 CT for MO063C Maintenance CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 63 Pediatric 2,500 M,CSF CYTOMORPHOLOGY,FLOW (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Lymphobla CYTOMETRY,BONE MARROW HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE stic FLOW SUMMARY OF INPATIENT DEPARTMENT, 161 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Lymphoma CYTOMETRY,CYTOGENETICS,NGS,B DISCHARGE SUMMARY OF DAY CARE IOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 226 MO0 CT for MO064A Consolidation - CBC, LFT,RFT, RBS, Bone marrow BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 64 Pediatric High Dose 57,600 aspiration, flow cytometry or (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute Cytarabine Peripheral blood flow cytometry, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Myeloid cytogenetics, Molecular SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 227 MO0 CT for MO064B Induction CBC, LFT,RFT, RBS, Bone marrow BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 64 Pediatric 94,400 aspiration, flow cytometry or (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute Peripheral blood flow cytometry, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Myeloid cytogenetics, Molecular SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 228 MO0 CT for MO064C Induction CBC, LFT,RFT, RBS, Bone marrow BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 64 Pediatric 92,800 aspiration, flow cytometry or (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute Peripheral blood flow cytometry, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Myeloid cytogenetics, Molecular SUMMARY OF INPATIENT DEPARTMENT, Leukemia DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 229 MO0 CT for MO065A Consolidation CBC BIOCHEM ECG BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 65 Pediatric 36,800 BONEMARROW RQPCR PML RARA (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Promyeloc SUMMARY OF INPATIENT DEPARTMENT, ytic DISCHARGE SUMMARY OF DAY CARE Leukemia DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 230 MO0 CT for MO065B Induction CBC BIOCHEM BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 65 Pediatric 97,600 (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Promyeloc SUMMARY OF INPATIENT DEPARTMENT, ytic DISCHARGE SUMMARY OF DAY CARE Leukemia DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 231 MO0 CT for MO065C Maintenance CBC,MDC,HIV,HBSAG,HCV,BIOCHE BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 65 Pediatric 39,300 M,PT,APTT,FIBRINOGEN,2D (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Acute ECHO,NCCT CHEST,BONE HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE 162 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Promyeloc MARROW FLOW SUMMARY OF INPATIENT DEPARTMENT, ytic CYTOMETRY,CYTOGENETICS,RQPC DISCHARGE SUMMARY OF DAY CARE Leukemia R PML RARA,BIOPSY DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 232 MO0 CT for MO066A COPDAC CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 66 Pediatric 7,800 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkins marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 233 MO0 CT for MO066B OPEA CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 66 Pediatric 13,000 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkins marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 234 MO0 CT for MO067A ICE CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 67 Pediatric 21,500 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkins marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, Relapse DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 235 MO0 CT for MO067B DECA CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 67 Pediatric 17,800 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkins marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, Relapse DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 236 MO0 CT for MO067C IGVD CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 67 Pediatric 34,000 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hodgkins marrow studies, node Biopsy. HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lymphoma SUMMARY OF INPATIENT DEPARTMENT, Relapse DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 237 MO0 CT for MO068A LMB 89 - 96 - CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 68 Pediatric Consolidation 33,500 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, 163 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Non marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Hodgkins flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, Lymphoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 238 MO0 CT for MO068B LMB 89 - 96 - CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 68 Pediatric Induction - 33,100 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Non COPADAM marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Hodgkins flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, Lymphoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 239 MO0 CT for MO068C LMB 89 - 96 - CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 68 Pediatric Maintenance 15,400 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Non marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Hodgkins flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, Lymphoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 240 MO0 CT for MO068D MCP - 842 CBC,Biochemistry,PET CT or CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 68 Pediatric 13,200 Chest abdomen and pelvis, Bone (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Non marrow studies, Biopsy or fluid HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Hodgkins flow cytometry,ECG,2D-ECHO SUMMARY OF INPATIENT DEPARTMENT, Lymphoma DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN 241 MO0 PEDIATRIC- MO069A PEDIATRIC- CBC, Biochemistry, TUMOR BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 69 GCT/JEB GCT/JEB 10,000 MARKERS, CECT CHEST AND (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, ABDOMEN, Biopsy, AUDIOMETRY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE GFR SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 242 MO0 CT for MO070A Carboplatin + CBC, Biochemistry, CECT CHEST BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 70 Pediatric Cisplatin + 4,900 AND ABDOMEN, Biopsy, ECG, 2D- (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hepatoblas Doxorubicin ECHO, AUDIOMETRY, GFR HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE toma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 243 MO0 CT for MO070B Cisplatin CBC, Biochemistry, S.AFP, CECT BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 164 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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70 Pediatric 5,600 CHEST AND ABDOMEN, Biopsy, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, Hepatoblas AUDIOMETRY, GFR HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE toma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 244 MO0 CT for CA MO071A Docetaxel CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 16,200 abdomen and Pelvis (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 245 MO0 CT for CA MO071B Erlotinib CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 13,000 abdomen and Pelvis, EGFR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, mutation positive HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 246 MO0 CT for CA MO071C Gefitnib CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 11,000 abdomen and Pelvis, EGFR (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, mutation positive HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 247 MO0 CT for CA MO071D Paclitaxel + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Carboplatin 15,100 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology (non small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma) SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 248 MO0 CT for CA MO071E Pemetrexed + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Carboplatin 10,000 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology (non small cell - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma or SUMMARY OF INPATIENT DEPARTMENT, adenosquamous carcinoma) DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 165 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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249 MO0 CT for CA MO071F Topotecan CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 24,600 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology - Small Cell Lung HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Carcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 250 MO0 CT for CA MO071G Docetaxel CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 14,600 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 251 MO0 CT for CA MO071H Etoposide + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Carboplatin 7,100 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology - Small Cell Lung HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Carcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 252 MO0 CT for CA MO071I Etoposide + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Cisplatin 5,500 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology - Small Cell Lung HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Carcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 253 MO0 CT for CA MO071J Gemcitabine CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 8,900 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology (non small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma) SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 254 MO0 CT for CA MO071K Gemcitabine + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Carboplatin 14,300 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY 166 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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REGIMEN, TRANFUSION SLIPS 255 MO0 CT for CA MO071L Gemcitabine + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Cisplatin 11,100 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 256 MO0 CT for CA MO071M Paclitaxel CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 5,800 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 257 MO0 CT for CA MO071N Paclitaxel CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 12,000 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 258 MO0 CT for CA MO071O Paclitaxel + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Carboplatin 7,900 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology (non small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE carcinoma) SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 259 MO0 CT for CA MO071P Paclitaxel + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Cisplatin 13,500 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 260 MO0 CT for CA MO071Q Pemetrexed + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Cisplatin 9,200 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology - adenocarcinoma HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE and adenosquamous carcinoma SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE 167 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 261 MO0 CT for CA MO071R Pemetrexed CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung 7,600 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology (non small cell - HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE adenocarcinoma or SUMMARY OF INPATIENT DEPARTMENT, adenosquamous carcinoma) DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 262 MO0 CT for CA MO071S Vinorelbine + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Carboplatin 22,800 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS 263 MO0 CT for CA MO071T Vinorelbine + CBC, LFT, RFT, RBS, CECT Thorax, BAR CODE OF THE DRUGS, REPORTS OF THE TESTS 71 Lung Cisplatin 20,600 abdomen and Pelvis, (PATHOLOGY, RADIOLOGY, MICROBIOLOGY, histopathology- Non Small cell HEMATOLOGY, BIOCHEMISTRY,ETC.) DISCHARGE Lung cancer SUMMARY OF INPATIENT DEPARTMENT, DISCHARGE SUMMARY OF DAY CARE DEPARTMENT, CHARTS OF CHEMOTHERAPY REGIMEN, TRANFUSION SLIPS
11. Mental Disorders Package
• Total number of packages: 10 • Total number of procedures: 10 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages for progressive extension of treatment/ hospital stay • Pre-authorization remarks: Prior approval must be taken for all mental health conditions/ packages under this domain for progressive extension of therapeutic treatments • Procedures can be done only in public sector hospital with specialty available
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• All clinical test reports, diagnosis, Mental Status Examination (MSE), case sheet / clinical notes and discharge summary need to be submitted for extension of packages and during claims submission S. Packag AB PM - JAY Procedu AB PM - JAY Package Stratification Mandatory Documents - Pre Mandatory No e Code Package Name re Code Procedure Name Price Authorization Documents - Claim . HBP HBP 2.0 Processing 2.0 1 MM00 Mental Retardation MM001 Mental Retardation Routine Detailed history with chronicity; Detailed treatment 1 A 1,500 Ward/HDU need for hospitalization. notes; all None/2500 Admission under empanneled investigations done; Psychiatrist is a must. detailed discharge summary. 2 MM00 Mental disorders - Organic, MM002 Mental disorders - Organic, Routine Detailed history with chronicity; Detailed treatment 2 including symptomatic A including symptomatic 1,500 Ward/HDU need for hospitalization. notes; all None/2500 Admission under empanneled investigations done; Psychiatrist is a must. detailed discharge summary. 3 MM00 Schizophrenia, schizotypal MM003 Schizophrenia, schizotypal Routine Detailed history with chronicity; Detailed treatment 3 and delusional disorders A and delusional disorders 1,500 Ward/HDU need for hospitalization. notes; all None/2500 Admission under empanneled investigations done; Psychiatrist is a must. detailed discharge summary. 4 MM00 Neurotic, stress-related and MM004 Neurotic, stress-related Routine Detailed history with chronicity; Detailed treatment 4 somatoform disorders A and somatoform disorders 1,500 Ward/HDU need for hospitalization. notes; all None/2500 Admission under empanneled investigations done; Psychiatrist is a must. detailed discharge summary. 5 MM00 Mood (affective) disorders MM005 Mood (affective) disorders Routine Detailed history with chronicity; Detailed treatment 5 A 1,500 Ward/HDU need for hospitalization. notes; all None/2500 Admission under empanneled investigations done; Psychiatrist is a must. detailed discharge summary. 6 MM00 Behavioural syndromes MM006 Behavioural syndromes Routine Detailed history with chronicity; Detailed treatment 6 associated with A associated with 1,500 Ward/HDU need for hospitalization. notes; all physiological disturbances physiological disturbances None/2500 Admission under empanneled investigations done; and physical factors and physical factors Psychiatrist is a must. detailed discharge summary. 7 MM00 Mental and Behavioural MM007 Mental and Behavioural Routine Detailed history of psychoactive Detailed treatment 7 disorders due to A disorders due to 1,500 Ward/HDU substanec with chronicity; need notes; all psychoactive substance use psychoactive substance None/2500 for hospitalization. Admission investigations done; use under empanneled Psychiatrist detailed discharge 169 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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is a must. summary. 8 MM00 Pre - Electro Convulsive MM008 Pre - Electro Convulsive Detailed history with chronicity; Detailed treatment 8 Therapy (ECT) and Pre - A Therapy (ECT) and Pre - 10,000 need for specific treatment and notes; all Transcranial Magnetic Transcranial Magnetic expected results. Admission investigations done; Stimulation (TMS) Package Stimulation (TMS) Package under empanneled Psychiatrist detailed discharge (Cognitive Tests, Complete (Cognitive Tests, Complete is a must. summary. Haemogram, Liver Function Haemogram, Liver Test, Renal Function Test, Function Test, Renal Serum Electrolytes, Electro Function Test, Serum Cardiogram (ECG), CT / MRI Electrolytes, Electro Brain, Cardiogram (ECG), CT / Electroencephalogram, MRI Brain, Thyroid Function Test, Electroencephalogram, VDRL, HIV Test, Vitamin Thyroid Function Test, B12 levels, Folate levels, VDRL, HIV Test, Vitamin Lipid Profile, Homocysteine B12 levels, Folate levels, levels) Lipid Profile, Homocysteine levels) 9 MM00 Electro Convulsive Therapy MM009 Electro Convulsive Therapy Detailed history with chronicity; Detailed treatment 9 (ECT) - per session A (ECT) - per session 3,000 need for specific treatment and notes; all expected results. Admission investigations done; under empanneled Psychiatrist detailed discharge is a must. summary. 10 MM01 Transcranial Magnetic MM010 Transcranial Magnetic Detailed history with chronicity; Detailed treatment 0 Stimulation (TMS) - per A Stimulation (TMS) - per 1,000 need for specific treatment and notes; all session session expected results. Admission investigations done; under empanneled Psychiatrist detailed discharge is a must. summary.
12. Neonatal Care Package
• Total number of packages: 10 • Total number of procedures: 10 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages for progressive extension of treatment/ hospital stay
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/ shifting across packages • Pre-authorization remarks: Prior approval must be taken for progressive extension of therapeutic treatments (i.e. for extending stay beyond the prescribed limit/ in cases which might need shifting of packages based on clinical vitals and need - then the previously blocked package needs to be unblocked and the total amount of new package needs to be considered to be debited). • All clinical test reports, diagnosis, TPR charting, case sheet / clinical notes and discharge summary need to be submitted for extension of packages and during claims submission. • Packages would include neonates up to age of 28 days after birth
S. Package AB PM - JAY Procedure AB PM - JAY Package Mandatory Mandatory No. Code Package Name Code Procedure Name Price Documents - Pre Documents - HBP 2.0 HBP 2.0 Authorization Claim Processing 1 MN001 Basic neonatal care package: Babies that MN001A Basic neonatal care package: Babies that Detailed clinical notes Detailed ICPs can be managed by side of mother in can be managed by side of mother in 500 (incl trigger for (daily postnatal ward without requiring postnatal ward without requiring hospitalization and Treatment admission in SNCU/NICU: admission in SNCU/NICU: examiantion findings), details), • Any newborn needing feeding support • Any newborn needing feeding support supporting detailed • Babies requiring closer monitoring or • Babies requiring closer monitoring or investigations. discharge short-term care for conditions like: short-term care for conditions like: Admission under summary, All o Birth asphyxia (need for positive o Birth asphyxia (need for positive neonatologist in NICU investigations pressure ventilation; no HIE) pressure ventilation; no HIE) (in major locations) reports. o Moderate jaundice requiring o Moderate jaundice requiring and under phototherapy phototherapy Pediatrician in smaller o Large for dates (>97 percentile) Babies o Large for dates (>97 percentile) Babies locations is a must. o Small for gestational age (less than 3rd o Small for gestational age (less than 3rd centile) centile) 2 MN002 Special Neonatal Care Package: Babies MN002A Special Neonatal Care Package: Babies Clinical notes with Detailed ICPs that required admission to SNCU or NICU: that required admission to SNCU or NICU: 3,000 planned line of (daily Babies admitted for short term care for Babies admitted for short term care for treatment (incl birth Treatment conditions like: conditions like: & past history), details), • Mild Respiratory Distress/tachypnea • Mild Respiratory Distress/tachypnea Investigation Reports Procedure / • Mild encephalopathy • Mild encephalopathy supporting diagnosis, Operative • Severe jaundice requiring intensive • Severe jaundice requiring intensive Planned line of Notes (if phototherapy phototherapy treatment applicable), • Haemorrhagic disease of newborn • Haemorrhagic disease of newborn Detailed • Unwell baby requiring monitoring • Unwell baby requiring monitoring Discharge • Some dehydration • Some dehydration Summary, All • Hypoglycaemia • Hypoglycaemia investigations 171 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Mother's stay and food in the hospital for Mother's stay and food in the hospital for reports. breastfeeding, family centred care and breastfeeding, family centred care and (Kangaroo Mother Care) KMC is (Kangaroo Mother Care) KMC is mandatory and included in the package mandatory and included in the package rate rate 3 MN003 Intensive Neonatal Care Package MN003A Intensive Neonatal Care Package Detailed clinical notes Detailed ICPs Babies with birthweight 1500-1799 g Babies with birthweight 1500-1799 g 5,000 (incl trigger for (daily or or hospitalization and Treatment Babies of any birthweight and at least one Babies of any birthweight and at least one examiantion findings), details), of the following conditions: of the following conditions: supporting detailed • Need for mechanical ventilation for less • Need for mechanical ventilation for less investigations. discharge than 24 hours or non-invasive respiratory than 24 hours or non-invasive respiratory Admission under summary, All support (CPAP, HFFNC) support (CPAP, HFFNC) neonatologist in NICU investigations • Sepsis / pneumonia without • Sepsis / pneumonia without (in major locations) reports. complications complications and under • Hyperbilirubinemia requiring exchange • Hyperbilirubinemia requiring exchange Pediatrician in smaller transfusion transfusion locations is a must. • Seizures • Seizures • Major congenital malformations (pre- • Major congenital malformations (pre- surgical stabilization, not requiring surgical stabilization, not requiring ventilation) ventilation) • Cholestasis significant enough requiring • Cholestasis significant enough requiring work up and in-hospital management work up and in-hospital management • Congestive heart failure or shock • Congestive heart failure or shock Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and breastfeeding, family centred care and (Kangaroo Mother Care) KMC is (Kangaroo Mother Care) KMC is mandatory and included in the package mandatory and included in the package rate rate 4 MN004 Advanced Neonatal Care Package: MN004A Advanced Neonatal Care Package: Detailed clinical notes Detailed ICPs Babies with birthweight of 1200-1499 g Babies with birthweight of 1200- 1499 g 6,000 (incl trigger for (daily or or hospitalization and Treatment Babies of any birthweight with at least Babies of any birthweight with at least examiantion findings), details), one of the following conditions: one of the following conditions: supporting detailed • Any condition requiring invasive • Any condition requiring invasive investigations. discharge ventilation longer than 24 hours ventilation longer than 24 hours Admission under summary, All • Hypoxic Ischemic encephalopathy • Hypoxic Ischemic encephalopathy neonatologist in NICU investigations requiring Therapeutic Hypothermia requiring Therapeutic Hypothermia (in major locations) reports. • Cardiac rhythm disorders needing • Cardiac rhythm disorders needing and under intervention (the cost of cardiac surgery intervention (the cost of cardiac surgery Pediatrician in smaller or implant will be covered under cardiac or implant will be covered under cardiac locations is a must. 172 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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surgery packages) surgery packages) • Sepsis with complications such as • Sepsis with complications such as meningitis or bone and joint infection, DIC meningitis or bone and joint infection, DIC or shock or shock • Renal failure requiring dialysis • Renal failure requiring dialysis • Inborn errors of metabolism • Inborn errors of metabolism Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and breastfeeding, family centred care and (Kangaroo Mother Care) KMC is (Kangaroo Mother Care) KMC is mandatory and included in the package mandatory and included in the package rate rate 5 MN005 Critical Care Neonatal Package: MN005A Critical Care Neonatal Package: Detailed clinical notes Detailed ICPs Babies with birthweight of <1200 g Babies with birthweight of <1200 g 7,000 (incl trigger for (daily or or hospitalization and Treatment Babies of any birthweight with at least Babies of any birthweight with at least examiantion findings), details), one of the following conditions: one of the following conditions: supporting detailed • Severe Respiratory Failure requiring • Severe Respiratory Failure requiring investigations. discharge High Frequency Ventilation or inhaled High Frequency Ventilation or inhaled Admission under summary, All Nitric Oxide (iNO) Nitric Oxide (iNO) neonatologist in NICU investigations • Multisystem failure requiring multiple • Multisystem failure requiring multiple (in major locations) reports. organ support including mechanical organ support including mechanical and under ventilation and multiple inotropes ventilation and multiple inotropes Pediatrician in smaller • Critical congenital heart disease • Critical congenital heart disease locations is a must. Mother's stay and food in the hospital for Mother's stay and food in the hospital for breastfeeding, family centred care and breastfeeding, family centred care and (Kangaroo Mother Care) KMC is (Kangaroo Mother Care) KMC is mandatory and included in the package mandatory and included in the package rate rate 6 MN006 Chronic Care Package: If the baby requires MN006A Chronic Care Package: If the baby requires Claim number of Detailed ICPs stay beyond the upper limit of usual stay stay beyond the upper limit of usual stay 3,000 having utilized (daily in Package no MN004A or MN005A for in Package no MN004A or MN005A for Package no MN004A Treatment conditions like severe BPD requiring conditions like severe BPD requiring or MN005A and Notes details), respiratory support, severe NEC requiring respiratory support, severe NEC requiring mentioning need for detailed prolonged TPN support prolonged TPN support stay beyond discharge prescribed upper limit summary, All investigations reports. 7 MN007 High Risk Newborn Post Discharge Care MN007A High Risk Newborn Post Discharge Care Need of planned care Detailed ICP Package (Protocol Driven) Package 2,400 and details of planned with daily (Protocol Driven) post discharge care notes, vitals, drugs given, 173 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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investigation reports Card with pre and post admission general conditions and vital parameters. Details of procedures/op erations required for any congenital heart conditions if any. 8 MN008 Laser Therapy for Retinopathy of MN008A Laser Therapy for Retinopathy of Clinical notes and Details of Laser Prematurity (Irrespective of no. of eyes Prematurity 1,500 Fundoscope reports / therapy done. affected) - per session (Irrespective of no. of eyes affected) - per stills showing extent session of ROP and need for procedure. 9 MN009 Advanced Surgery for Retinopathy of MN009A Advanced Surgery for Retinopathy of Clinical notes and Detailed Prematurity Prematurity 15,000 Fundoscope reports / discharge stills showing extent summary, of ROP and need for Detailed surgery. Procedure / Operative Notes, Intra procedure clinical photograph 10 MN010 Ventriculoperitoneal Shunt Surgery (VP) MN010A Ventriculoperitoneal Shunt Surgery (VP) Clinical history and Detailed or Omaya Reservoir or External Drainage or Omaya Reservoir or External Drainage 5,000 CT/ MRI; pre-op discharge for Hydrocephalus for Hydrocephalus clinical photograph summary, Detailed Procedure / Operative Notes, Intra procedure clinical photograph 174 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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• All the packages are inclusive of everything including drugs, diagnostics, consultations, procedures, treatment modalities that the baby would require for its management • In case a baby in a lower cost package develops a complication requiring higher level of care,the baby should be moved for higher cost package • For procedures MN002A, MN003A, MN004A and MN005A, mother's stay and food in the hospital [postnatal ward / special ward for such mothers] for breastfeeding, family centered care and KMC (Kangaroo Mother Care) is mandatory • For procedures MN002A, MN003A, MN004A and MN005A mothers should be allotted KMC bed when the newborn is eligible for Kangaroo mother care. The cost of bare bed and food to the mother is included. If the mother requires treatment for her own illnesses, it would be covered under the mother's packages • It is mandatory to ensure that the neonate receives vaccination as per National Immunization Schedule before discharge
13. Obstetrics & Gynecology
• Total number of packages: 59 • Total number of procedures: 77 • Additional cross specialty procedures: 25 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Prior approval must be taken for all elective Surgeries/Procedures. Although the following packages, namely C-Section, High Risk Delivery, Hysterectomy are primarily for government facilities, they are open to the private hospitals upon referral by government hospitals/Doctors. • Packages will include drugs, diagnostics, consultations, procedures, stay and food for patient. Medical conditions during pregnancy such as Hypertension, Diabetes etc are to be treated as per medical packages
S. Packag AB PM - JAY Procedu AB PM - JAY Package Stratification Implant Mandatory Documents - Mandatory Documents - N e Code Package Name re Code Procedure Name Price Pre Authorization Claim Processing o. HBP HBP 2.0 2.0 1 SO001 Lap. Salpingo- SO001A Lap. Salpingo- 14,000 Clinical notes establishing Detailed Operative oophrectomy oophrectomy indication, USG Abdomen notes,HPE Pic of Pelvis/ CT/ MRI abdomen specimen. Intraop stills
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Pelvis with date & patient ID, Detailed discharge summary 2 SO002 Laparotomy and SO002A Laparotomy and 38,000 Clinical notes and USG Histopathology, Detailed proceed for Ovarian proceed for Ovarian Abdomen + Pelvis/ CT Operative notes, per op Cancers. Omentomy Cancers. Omentomy abdomen+ Pelvis pic of specimen with Bilateral with Bilateral establishing indication removed, Detailed Salpingo- Salpingo- Discharge Summary. oophorectomy oophorectomy 3 SO003 Laparoscopic tubal SO003A Laparoscopic tubal 13,900 Clinical notes establishing Detailed Operative surgeries surgeries indication for the notes, HPE if ectopic (for any indication (for any indication procedure, USG uterus & pregnancy or including ectopic including ectopic adnexa, Beta HCG salpingectomy for any pregnancy) pregnancy) other indication, Detailed discharge summary 4 SO004 Procedure on SO004A Procedure on 11,600 Indication of the procedure Detailed discharge Fallopian Tube for Fallopian Tube for preferably with record of summary; Detailed establishing Tubal establishing Tubal previous sterilization/ Operative notes. Intra Patency Patency reason for non-availability procedure clinical photograph 5 SO005 Laparotomy for SO005A Laparotomy for 16,000 Clinical notes with physical Detailed discharge broad ligament broad ligament examination findings summary; Detailed haematoma haematoma supported by evidence of Operative notes. Intra hematoma (USG) procedure clinical photograph 6 SO006 Abdominal SO006A Abdominal 20,000 Clinical notes establishing Detailed Operative Myomectomy Myomectomy indication, USG Abdomen notes,HPE, Pic of Pelvis/ MRI abdomen. Pap specimen removed- smear Gross and Histopathology, Detailed discharge summary 7 SO007 Hysteroscopic SO007A Hysteroscopic 9,900 physical examination Detailed Operative myomectomies myomectomies findings with indications notes, HPE, Intraop stills for the procedure. USG with date & patient ID, pelvis / MRI Pelvis Detailed discharge summary 8 SO008 Polypectomy SO008A Polypectomy 1,500 Clinical notes with planned Procedure / Operative line of treatment (including Notes, Intraop. Stills,Pic System Examination) and of specimen, Relavant Investigations Histopathology report, 176 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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(USG Abdomen + Pelvis/ CT Detailed Discharge abdomen+ Pelvis), Summary 9 SO009 Hysteroscopic SO009A Hysteroscopic 7,200 Admission Notes Detailed Procedure / polypectomy polypectomy comprising of history and Operative Notes examination with together with indication indications for the of surgery, Intraop. stills procedure, Relavant with date & patient ID, Investigations (establishing pic off gross specimen diagnosis),USG showing removed , HPE,Progress polyp notes,detailed discharge summary. 10 SO010 Hysterectomy SO010A Abdominal 20,000 Clinical notes with planned Histopathology, Detailed Hysterectomy line of treatment (including Discharge Summary with System Examination) and Procedure / Operative Relavant Investigations Notes (USG Abdomen + Pelvis/ CT abdomen+ Pelvis) confirming the indication 11 SO010 Hysterectomy SO010B Abdominal 20,000 Admission Notes Detailed Procedure / Hysterectomy + comprising of history and Operative Notes Salpingo- examination with together with indication oophorectomy indications for the of surgery, Intraop. stills procedure,Clinical notes with date & patient ID, with planned line of pic off gross specimen treatment (clearly removed , HPE,Progress indicating medical notes,detailed discharge management tried and summary. failed or not indicated. If failed documents proving duration of treatment and failure. The medical management should have been tried for atleast 4-6 months covering 1 course of hormone cycle) and USG Abdomen + Pelvis/ CT/ MRI abdomen+ Pelvis confirming the indication, Pap smear, EB/EAC 12 SO010 Hysterectomy SO010C Non descent vaginal 20,000 Clinical notes with planned Detailed Procedure / hysterectomy line of treatment (clearly Operative Notes 177 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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indicating medical together with indication management tried and of surgery, Intraop. stills failed or not indicated. If with date & patient ID, failed documents proving pic off gross specimen duration of treatment and removed , HPE, Progress failure. The medical notes,detailed discharge management should have summary. been tried for atleast 4-6 months covering 1 course of hormone cycle), USG Abdomen + Pelvis, Pap smear, EB/EAC 13 SO010 Hysterectomy SO010D Vaginal hysterectomy 20,000 Clinical notes with planned Detailed Procedure / with anterior and line of treatment (clearly Operative Notes posterior indicating medical together with indication colpoperineorrhaphy management tried and of surgery, Intraop. stills failed or not indicated with with date & patient ID, reason. If failed documents pic off gross specimen proving duration of removed , HPE, Progress treatment and failure. The notes,detailed discharge medical management summary. should have been tried for atleast 4-6 months covering 1 course of hormone cycle), Photographic documentation with patient’s consent, Pap smear ( EB/EAC is optional ) 14 SO010 Hysterectomy SO010E Laparoscopic 20,000 Clinical notes with planned Histopathology, Detailed hysterectomy (TLH) line of treatment and USG Discharge Summary with Abdomen + Pelvis/ CT Detailed operative notes abdomen+ Pelvis confirming the indication 15 SO010 Hysterectomy SO010F Laparoscopically 20,000 Admission Notes Detailed Procedure / assisted vaginal comprising of history and Operative Notes hysterectomy (LAVH) examination(clearly together with indication indicating medical of surgery, Intraop. stills management tried and with date & patient ID, failed or not indicated, pic off gross specimen 178 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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with reason. If failed removed , HPE, Progress documents proving notes,detailed discharge duration of treatment and summary. failure. The medical management should have been tried for atleast 4-6 months covering 1 course of hormone cycle) , USG Abdomen + Pelvis/ MRI abdomen+ Pelvis confirming the indication, Pap smear, EB/EAC 16 SO011 Caesarean SO011A Caesarean 20,000 Admission Notes Detailed Procedure / hysterectomy hysterectomy comprising of history and Operative Notes. examination (clearly Histopath of uterus indicating medical removed, per op pic of management tried and specimen removed; failed or not indicated with status of the child at the reason. If failed documents time of delivery and at proving duration of the time of discharge; treatment and failure. The progress notes,Detailed medical management discharge summary should have been tried for atleast 4-6 months covering 1 course of hormone cycle), detailed Ante natal care records/ reasons for non-availability of ANC records. Per op clinical pic is optional 17 SO012 Manchester Repair SO012A Manchester Repair 15,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes, examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), 18 SO013 Surgeries for SO013A Surgeries for 28,900 Sling (Max 1) Admission Notes Detailed Procedure / Prolapse - Sling Prolapse - Sling 5,000 comprising of history and Operative Notes, Surgeries Surgeries examination with Intraop. stills ,Barcode of indications for the sling used; progress 179 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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procedure,Relavant notes,Detailed discharge Investigations (establishing summary diagnosis) ; Photographic documentation of degree/severity of prolapse with patient’s consent,Pap smear. 19 SO014 Hysterotomy SO014A Hysterotomy 5,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes, examination with Intraop. stills with date & indications for the patient ID, HPE of procedure,Relavant specimen,Progress Investigations (establishing notes, Detailed discharge diagnosis), USG - Obstetric summary confirming the above package. Has medicolegal compliance been done? 20 SO015 Lap. Surgery for SO015A Lap. Surgery for 11,200 Admission Notes Detailed Procedure / Endometriosis Endometriosis comprising of history and Operative Notes (Other than (Other than examination, Relavant together with indication Hysterectomy) Hysterectomy) Investigations (establishing of surgery, Intraop. stills diagnosis) USG/ CT/ MRI/ with date & patient ID, laparoscopy findings pic off gross specimen removed , HPE, Progress notes,detailed discharge summary. 21 SO016 Diagnostic SO016A With biopsy 6,000 Admission Notes Detailed Procedure / hysteroscopy comprising of history and Operative Notes examination with together with indication indications for the of surgery, Intraop. stills procedure, Relavant with date & patient ID, Investigations (establishing pic off gross specimen diagnosis),USG uterus & removed , HPE of biopsy adnexa specimen,Progress notes, Detailed discharge summary 22 SO016 Diagnostic SO016B Without biopsy 6,000 Admission Notes Detailed Procedure / hysteroscopy comprising of history and Operative Notes examination with together with indication indications for the of surgery, Intraop. stills procedure, Relavant with date & patient ID, 180 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Investigations (establishing pic off gross specimen diagnosis),USG uterus & removed , HPE of biopsy adnexa specimen,Progress notes, Detailed discharge summary 23 SO017 Hysteroscopic IUCD SO017A Hysteroscopic IUCD 4,700 Clinical notes with details Detailed Procedure / removal removal of IUCD insertion (reason Operative Notes for non availability of together with indication details), indication for of surgery, Intraop. stills removing IUCD, USG with date & patient ID, showing misplaced IUD pic off gross specimen removed , HPE,Progress notes,detailed discharge summary. 24 SO018 D&C SO018A D&C 3,000 Admission Notes Detailed Procedure / (Dilatation&curretag (Dilatation&curretag comprising of history and Operative Notes, e) e) examination with Intraop. Stills, indications for the Histopathology of procedure,Relavant curetted material, Investigations (establishing Progress notes, Detailed diagnosis), (USG Abdomen discharge summary + Pelvis)- optional 25 SO019 Dilation and SO019A Dilation and 5,000 Admission Notes Detailed Procedure / Evacuation (D&E) Evacuation (D&E) comprising of history and Operative Notes, examination with Intraop. indications for the Stills,Histopathology of procedure,Relavant evacuated material, Investigations (establishing Progress notes, Detailed diagnosis),USG abdomen discharge summary and pelvis) 26 SO020 Pyometra drainage SO020A Pyometra drainage 5,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes, examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis) 27 SO021 Intrauterine SO021A Intrauterine 11,000 Admission Notes Detailed Procedure / transfusions transfusions comprising of history and Operative Notes, examination with Intraop. Stills, Progress indications for the notes, Detailed discharge 181 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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procedure,Relavant summary Investigations (establishing diagnosis) 28 SO022 Hysteroscopic SO022A Hysteroscopic 6,900 Admission Notes Detailed Procedure / adhesiolysis adhesiolysis comprising of history and Operative Notes examination with together with indication indications for the of surgery, Intraop. stills procedure, Relavant with date & patient ID, Investigations (establishing pic off gross specimen diagnosis),USG Abdomen removed , HPE,Progress Pelvis / CT/MRI Abdomen notes,detailed discharge Pelvis summary. 29 SO023 Laparoscopic SO023A Laparoscopic 6,000 Admission Notes Detailed Procedure / adhesiolysis adhesiolysis comprising of history and Operative Notes examination, Relavant together with indication Investigations (establishing of surgery, Intraop. stills diagnosis), USG Abdomen/ with date & patient ID, Pelvis (CT abdomen- pic off gross specimen Optional) removed , HPE, Progress notes,detailed discharge summary. 30 SO024 Trans - vaginal tape SO024A Trans-vaginal tape 15,200 Tension free Admission Notes Detailed Procedure / / Trans-obturator Vaginal Tape comprising of history and Operative Notes, tape examination with Barcode of TVT/TOT tape indications for the used; progress procedure,Relavant notes,Detailed discharge Investigations (establishing summary diagnosis) 31 SO024 Trans - vaginal tape SO024B Trans-obturator tape 15,200 Trans Admission Notes Detailed Procedure / / Trans-obturator Obturator comprising of history and Operative Notes, tape Tape examination with Barcode of TVT/TOT tape indications for the used; progress procedure,Relavant notes,Detailed discharge Investigations (establishing summary diagnosis) 32 SO025 Sacrocolpopexy SO025A Open 23,900 Mesh - 15 X Admission Notes Detailed Procedure / (Abdominal) 15 (Max 1) comprising of history and Operative Notes, 5,000 examination with Intraop. stills with date & indications for the patient ID, Barcode of procedure,Relavant mesh used; progress Investigations (establishing notes,Detailed discharge 182 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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diagnosis) , Photographic summary summary documentation with patient’s consent. 33 SO025 Sacrocolpopexy SO025B Lap. 23,900 Mesh - 15 X Admission Notes Detailed Procedure / (Abdominal) 15 (Max 1) comprising of history and Operative Notes, 5,000 examination with Intraop. stills with date & indications for the patient ID, Barcode of procedure,Relavant mesh used; progress Investigations (establishing notes,Detailed discharge diagnosis) , Photographic summary summary documentation with patient’s consent. 34 SO026 LLETZ (including PAP SO026A LLETZ (including PAP 9,900 Admission Notes Detailed Procedure / smear and smear and comprising of history and Operative Notes, colposcopy) colposcopy) examination with Intraop. stills with date & indications for the patient ID, HPE of procedure,Relavant specimen,Progress Investigations (establishing notes, Detailed discharge diagnosis) , Evidence of summary cervical pre-cancer (PAP smear) Colposcopiy. Cervical Biopsy is optional 35 SO027 Vaginal Sacrospinus SO027A Vaginal Sacrospinus 15,000 Admission Notes Detailed Procedure / fixation with repair fixation with repair comprising of history and Operative Notes, examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), 36 SO028 Excision of Vaginal SO028A Excision of Vaginal 14,500 Admission Notes Detailed Procedure / Septum (vaginal Septum (vaginal comprising of history and Operative Notes, route) route) examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), need of procedure (USG Abdomen + Pelvis) 37 SO029 Hymenectomy for SO029A Hymenectomy for 3,000 Admission Notes Detailed Procedure / imperforate hymen imperforate hymen comprising of history and Operative Notes, examination with Intraop. Stills, Progress 183 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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indications for the notes, Detailed discharge procedure and need of summary procedure 38 SO030 Anterior & Posterior SO030A Anterior & Posterior 8,000 Admission Notes Detailed Procedure / Colpoperineorrhapy Colpoperineorrhapy comprising of history and Operative Notes, examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), clinical pic if feasible 39 SO031 Vaginoplasty SO031A Vaginoplasty 11,000 Admission Notes Detailed Procedure / (McIndoe (McIndoe procedure) comprising of history and Operative Notes, procedure) examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), need of procedure (USG Abdomen + Pelvis) 40 SO032 Vaginal repair for SO032A Vaginal repair for 34,000 Admission Notes Detailed Procedure / vesico-vaginal fistula vesico-vaginal fistula comprising of history and Operative Notes, examination with Intraop. stills with date & indications for the patient ID, Progress procedure,Relavant notes,detailed discharge Investigations (establishing summary.detailed diagnosis) and Cystoscopy/ discharge summary. Cystourethroscopy. Voiding Cystourethrogram is optional. 41 SO033 Rectovaginal fistula SO033A Rectovaginal fistula 24,000 Admission Notes Detailed Procedure / repair repair comprising of history and Operative Notes, examination with Intraop. stills with date & indications for the patient ID, Progress procedure,Relavant notes,detailed discharge Investigations (establishing summary. diagnosis) 42 SO034 Vulval Hamatoma SO034A Vulval Hamatoma 3,000 Admission Notes Detailed Procedure / drainage drainage comprising of history and Operative Notes, examination with Intraop. Stills, Progress indications for the notes, Detailed discharge 184 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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procedure,Relavant summary Investigations (establishing diagnosis), 43 SO035 Vulvectomy simple SO035A Vulvectomy simple 15,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes, Intra examination with procedure clinical indications for the photograph/ stills, procedure,Relavant histopathology; progress Investigations (establishing notes,Detailed discharge diagnosis) with Evidence summary (biopsy). Clinical pic if patient permits 44 SO036 Radical Vulvectomy SO036A Radical Vulvectomy 38,500 Admission Notes Detailed Procedure / with Inguinal and with Inguinal and comprising of history and Operative Notes Pelvic lymph node Pelvic lymph node examination with together with indication disection disection indications for the of surgery, Intraop. stills procedure, Relavant with date & patient ID, Investigations (establishing pic off gross specimen diagnosis),vulval biopsy, removed , HPE, Progress CT/MRI for staging notes,detailed discharge summary. 45 SO037 Abdomino Perineal SO037A Abdomino Perineal 20,000 Admission Notes Detailed Procedure / repair for Mullerian repair for Mullerian comprising of history and Operative Notes, Anomaly Anomaly examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), (USG/ CT/ MRI) 46 SO038 Pelvic Abscess SO038A Pelvic Abscess 1,200 Admission Notes Detailed Procedure / Management Management comprising of history and Operative Notes, Intra including Colpotomy including Colpotomy examination with procedure clinical indications for the photograph/ stills; procedure,Relavant progress notes,Detailed Investigations (establishing discharge summary diagnosis) , USG Abdomen & Pelvis 47 SO039 Diagnostic / Staging SO039A Diagnostic / Staging 9,700 Admission Notes Detailed Procedure / laparoscopy laparoscopy comprising of history and Operative Notes examination, Relavant together with indication Investigations of surgery, Intraop. stills (establishing diagnosis) with date & patient ID, 185 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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pic off gross specimen removed , HPE, Progress notes,detailed discharge summary. 48 SO040 Laparotomy for SO040A Ectopic 14,000 Admission Notes Detailed Procedure / benign disorders comprising of history and Operative Notes examination with together with indication indications for the of surgery, Intraop. stills procedure,Clinical notes with date & patient ID, establishing ruptured pic off gross specimen ectopic with Evidence of removed , HPE,detailed beta hCG & USG discharge summary. 49 SO040 Laparotomy for SO040B PID 14,000 Admission Notes Detailed Procedure / benign disorders comprising of history and Operative Notes examination with together with indication indications for the of surgery, Intraop. stills procedure,Clinical notes with date & patient ID, establishing ruptured pic off gross specimen ectopic with Evidence of removed , HPE,detailed beta hCG & USG discharge summary. 50 SO041 Laparoscopic SO041A Laparoscopic 15,000 Admission Notes Detailed Procedure / cystectomy cystectomy comprising of history and Operative Notes examination, Relavant together with indication Investigations (establishing of surgery, Intraop. stills diagnosis), USG Abdomen with date & patient ID, Pelvis/ CT abdomen. pic off gross specimen removed , HPE, Progress notes,detailed discharge summary. 51 SO042 Cystocele - Anterior SO042A Cystocele - Anterior 6,000 Admission Notes Detailed Procedure / repair repair comprising of history and Operative Notes, examination with findings Intraop. Stills, Progress establishing Cystocoele . notes, Detailed discharge Clinical pic if feasible summary 52 SO043 Burch SO043A Abdominal 30,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes; examination with Intraop. stills ,progress indications for the notes,Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis) ; Urodynamic 186 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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studies are optional. 53 SO043 Burch SO043B Laparoscopic 30,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes; examination with Intraop. stills ,progress indications for the notes,Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis) ; Urodynamic studies are optional. 54 SO044 Electro SO044A Electro Cauterisation 4,000 Admission Notes Detailed Procedure / Cauterisation / Cryo / Cryo Surgery comprising of history and Operative Notes, Surgery examination with Intraop. Stills, Progress indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), pap smear- optional 55 SO045 EUA for (minor girls SO045A EUA for (minor girls / 2,000 Admission Notes Detailed Procedure / / unmarried sexually unmarried sexually comprising of history and Operative Notes, inactive / victims of inactive / victims of examination with Intraop. Stills, Progress sexual abuse) sexual abuse) indications for the notes, Detailed discharge procedure,Relavant summary Investigations (establishing diagnosis), and parental consent (incase of minor girls) 56 SO046 Hospitalisation for SO046A Hospitalisation for 1,800 Routine Admission Notes Detailed Procedure / Antenatal Antenatal Ward/HDU/ICU - comprising of history and Operative Notes, Complications Complications Without examination with Intraop. Stills, Progress Ventilator/ICU - indications for the notes, Detailed discharge With Ventilator procedure,Relavant summary None/2700/3600 Investigations (establishing /4500 diagnosis), 57 SO047 Amniocentesis SO047A Amniocentesis 14,500 Consulting notes giving the Detailed Procedure / indication for Operative Notes, amniocentesis; does the Intraop. Stills, ; Amniotic hospital have fetal fluid analysis report; medicine expert? Progress notes, Detailed discharge summary 58 SO048 Chorionic villus SO048A Chorionic villus 14,500 Admission Notes Procedure / Operative sampling sampling comprising of history and Notes with report of 187 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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examination with chorionic villi sampling; indications for the Progress notes, Detailed procedure,Relavant discharge summary Investigations (establishing diagnosis), 59 SO049 Cordocentesis SO049A Cordocentesis 14,500 Admission Notes Detailed Procedure / comprising of history and Operative Notes, examination with Intraop. Stills, report of indications for the cordocentesis; Progress procedure,Relavant notes, Detailed discharge Investigations (establishing summary diagnosis), 60 SO050 McDonald's stitch SO050A McDonald's stitch 4,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes, ANC findings justifying Intraop. Stills, Progress cervical incompetence and notes, Detailed discharge the procedure. summary 61 SO051 Shirodkar's stitch SO051A Shirodkar's stitch 4,000 Admission Notes Detailed Procedure / comprising of history and Operative Notes, ANC findings justifying Intraop. Stills, Progress cervical incomptenecs and notes, Detailed discharge the procedure. summary 62 SO052 Medical SO052A Medical 1,800 Routine Admission Notes Detailed Procedure / management of management of Ward/HDU/ICU - comprising of history and Operative Notes, ectopic pregnancy ectopic pregnancy Without examination with Intraop. Stills, Progress Ventilator/ICU - indications for the notes, Detailed discharge With Ventilator procedure,Relavant summary None/2700/3600 Investigations (establishing /4500 diagnosis), 63 SO053 Medical Termination SO053A MTP upto 8 weeks 3,500 Admission Notes Detailed Procedure / of Pregnancy comprising of history and Operative Notes, examination with Intraop. stills , HPE of indications for the specimen,Progress procedure,Relavant notes, Detailed discharge Investigations (establishing summary diagnosis), USG - Obstetric confirming the above package. Has medicolegal compliance been done? 64 SO053 Medical Termination SO053B MTP 8 to 12 weeks 5,000 Admission Notes Detailed Procedure / of Pregnancy comprising of history and Operative Notes, 188 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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examination with Intraop. stills , HPE of indications for the specimen,Progress procedure,Relavant notes, Detailed discharge Investigations (establishing summary diagnosis), USG - Obstetric confirming the above package. Has medicolegal compliance been done? 65 SO053 Medical Termination SO053C MTP > 12 weeks 6,500 Admission Notes Detailed Procedure / of Pregnancy comprising of history and Operative Notes, examination with Intraop. stills , HPE of indications for the specimen,Progress procedure,Relavant notes, Detailed discharge Investigations (establishing summary diagnosis), USG - Obstetric confirming the above package. Has medicolegal compliance been done? 66 SO054 High risk delivery SO054A Pre-mature delivery 11,500 Admission Notes Detailed delivery notes, comprising of history and PNC notes along with detailed Ante natal care relevant investigation records/ reasons for non- details; status of the availability of ANC records. child at the time of Obstetric USG. All high risk delivery and at the time deliveries are to be of discharge; progress clubbed & case specific notes, Detailed discharge documents required. summary. 67 SO054 High risk delivery SO054B Mothers with 11,500 Admission Notes Detailed delivery notes, eclampsia / imminent comprising of history and PNC notes along with eclampsia / severe detailed Ante natal care relevant investigation pre-eclampsia records/ reasons for non- details; status of the availability of ANC records. child at the time of Obstetric USG. All high risk delivery and at the time deliveries are to be of discharge; progress clubbed & case specific notes, Detailed discharge documents required. summary. 68 SO054 High risk delivery SO054C Major Fetal 11,500 Admission Notes Detailed delivery notes, malformation comprising of history and PNC notes along with requiring detailed Ante natal care relevant investigation intervention records/ reasons for non- details; status of the immediately after availability of ANC records. child at the time of 189 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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birth Obstetric USG. All high risk delivery and at the time deliveries are to be of discharge; progress clubbed & case specific notes, Detailed discharge documents required. summary. 69 SO054 High risk delivery SO054D Mothers with severe 11,500 Admission Notes Detailed delivery notes, anaemia (<7 g/dL) comprising of history and PNC notes along with detailed Ante natal care relevant investigation records/ reasons for non- details; status of the availability of ANC records. child at the time of Obstetric USG. All high risk delivery and at the time deliveries are to be of discharge; progress clubbed & case specific notes, Detailed discharge documents required. summary. 70 SO054 High risk delivery SO054E Other maternal and 11,500 Admission Notes Detailed delivery notes, fetal conditions as comprising of history and PNC notes along with per guidelines-eg detailed Ante natal care relevant investigation previous caesarean records with special details; status of the section, diabetes, reference to investigations child at the time of severe growth supporting the diagnosis/ delivery and at the time retardation, etc that reasons for non-availability of discharge; progress qualify for high risk of ANC records. Obstetric notes, Detailed discharge delivery. USG. All high risk deliveries summary. are to be clubbed & case specific documents required. 71 SO055 Manual removal of SO055A Manual removal of 8,500 Clinical notes documenting Detailed Procedure / placenta placenta need of manual removal of Operative Notes,stills of placenta/ use of Active placenta, progress note Management of Third Detailed discharge Stage of Labor (AMTSL) summary; Post natal course 72 SO056 Secondary suturing SO056A Secondary suturing 2,500 Admission Notes Detailed Procedure / of episiotomy of episiotomy comprising of history Operative Notes, detailing when was first Intraop. Stills, Progress surgery done? and notes, Detailed discharge examination with summary indications for the procedure, Physical examination findings with indications for the procedure. 190 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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73 SO057 Caesarean Delivery SO057A Caesarean Delivery 11,500 Admission Notes Detailed Procedure / comprising of history and Operative Notes, status examination with detailed of the child at the time of Ante natal care records/ delivery and at the time reasons for non-availability of discharge; progress of ANC records. Indications notes,Detailed discharge for the procedure. USG summary Obstetrics with Doppler is case specific & optional. Labor charting, CTG if available. 74 SO058 Re exploration after SO058A Re exploration after 14,000 Admission Notes Detailed Procedure / laparotomy / Caesarean Section comprising of history and Operative Notes, Intra Caesarean Section examination with procedure clinical indications for the photograph/ stills; procedure,Relavant progress notes,Detailed Investigations (establishing discharge summary diagnosis) , USG 75 SO058 Re exploration after SO058B Re exploration after 14,000 Admission Notes Detailed Procedure / laparotomy / laparotomy comprising of history and Operative Notes, Intra Caesarean Section examination with procedure clinical indications for the photograph/ stills; procedure,Relavant progress notes,Detailed Investigations (establishing discharge summary diagnosis) , USG 76 SO059 Vulvo vaginal cyst SO059A Vulvo vaginal cyst 4,700 Admission Notes Detailed operative notes, enucleation / enucleation comprising of history and discharge summary, drainage examination with histopathology report of indications for the tissue removed procedure, Relavant Investigations (establishing diagnosis) 77 SO059 Vulvo vaginal cyst SO059B Vulvo vaginal cyst 4,700 Admission Notes Detailed operative notes, enucleation / drainage comprising of history and discharge summary drainage examination with indications for the procedure, Relavant Investigations (establishing diagnosis)
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14. Ophthalmology
• Total number of packages: 40 • Total number of procedures: 53 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Nil • Following cataract surgery that implants an IOL, it is prescribed to mention/ attach the barcode no. on the lens used during claims submission by the provider as means to provide information on expiration dates and details from manufacturers for increased quality and safety S. Packa AB PM - JAY Procedu AB PM - JAY Packa Implant Mandatory Documents - Pre Mandatory Documents - No. ge Package Name re Code Procedure Name ge Authorization Claim Processing Code HBP 2.0 Price HBP 2.0 1 SE001 Ptosis Surgery SE001A Ptosis Surgery Clinical Photograph of affected eye Still image of the the 8,000 (Photographic record of the patient procedure with pt. ID should be maintained for and date, Detailed comparison. Photographs should discharge summary, have be taken in primary position detailed operative notes. as well as in lateral gazes) 2 SE002 Entropion SE002A Entropion correction Clinical notes and Clinical Detailed discharge correction 6,600 Photograph summary, Still image of the the procedure with pt. ID and date,operative notes. 3 SE003 Ectropion SE003A Ectropion correction Clinical notes and Clinical Detailed discharge correction 6,500 Photograph summary, Still image of the the procedure with pt. ID and date,operative notes. 4 SE004 Lid Tear Repair SE004A Lid Tear Repair Clinical notes; FIR/MLC in case of Still image of the the 5,000 accident, Clinical Photograph procedure with pt. ID and date,operative notes. Detailed discharge
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summary 5 SE005 Lid Abscess SE005A Lid Abscess Drainage Patient details, diagnosis, doctors Discharge notes, Drainage 3,000 notes, photo microbiology report,Still image of the patient undergoing the procedure with date stamp 6 SE006 Lid Tumor excision + SE006A Lid Tumor excision + Clinical notes and Clinical Still image of the the Lid Reconstruction Lid Reconstruction 10,00 Photograph of affected part, stated procedure with pt. ID 0 plan for lab investigation of host and date, HP report, tissue (HP/ Microbiology/other) Procedure / Operative Notes. Detailed discharge summary 7 SE007 Chalazion Removal SE007A Chalazion Removal Patient details, diagnosis, doctors Discharge notes, 2,000 notes, photo pathology report, Still image of the patient undergoing the procedure with date stamp 8 SE008 Squint correction SE008A Minor - upto 2 Clinical notes detailing which Still image of the the muscles 4,000 muscles affected; indication procedure with pt. ID justifying the need for GA (if and date,Procedure / required), Clinical Photograph Operative Notes. Detailed discharge summary 9 SE008 Squint correction SE008B Major - 3 or more Clinical notes detailing which Still image of the the muscles (complex 14,00 muscles affected; indication procedure with pt. ID surgery involving 0 justifying the need for GA (if and date,Procedure / four muscles or required), Clinical Photograph Operative Notes. oblique muscles) Detailed discharge summary 10 SE009 Conjunctival tumour SE009A Conjunctival tumour Tissue graft- amniotic Clinical notes , Clinical Photograph Still image of the the excision including excision including 7,000 membrane (Max 1) of affected part procedure with pt. ID Amniotic Amniotic Membrane and date, HP report, Membrane Graft Graft detailed discharge summary, detailed Procedure / Operative Notes. 11 SE010 Dacryocystorhinost SE010A Canaliculo Silicon Tube / Silicon Dye disappearance test , Tear Still image of the the omy Dacryocystorhinosto 8,000 stent (Max 1) meniscus height measurement, procedure with pt. ID my with Silicon Tube 2,000 Probing and irrigation and date, operative 193 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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/ Stent notes 12 SE010 Dacryocystorhinost SE010B Canaliculo Dye disappearance test , Tear Still image of the the omy Dacryocystorhinosto 8,000 meniscus height measurement, procedure with pt. ID my without Silicon Probing and irrigation and date, operative Tube / Stent notes 13 SE010 Dacryocystorhinost SE010C Dacryocystorhinosto Silicon Tube / Silicon Clinical notes and establishing Still image of the the omy my with Silicon Tube 8,000 stent (Max 1) lacrimal cancer with Evidence of procedure with pt. ID / Stent 2,000 biopsy. Pre-op clinical photograph. and date,operative notes. Detailed discharge summary Invoice of implants 14 SE010 Dacryocystorhinost SE010D Dacryocystorhinosto Clinical notes and establishing Still image of the the omy my without Silicon 8,000 lacrimal cancer with Evidence of procedure with pt. ID Tube / Stent biopsy. Pre-op clinical photograph. and date,operative notes. Detailed discharge summary Invoice of implants 15 SE011 Corneal Ulcer SE011A Corneal Ulcer clinical presentation photo Still image of the patient Management Management 4,000 undergoing the procedure with date stamp 16 SE012 Corneal Grafting SE012A Corneal Grafting Clinical notes detailing Indication Still image of the the 8,500 for corneal grafting and supporting procedure with pt. ID investigation, Clinical Photograph; and date,operative details of donor cornea, stated plan notes. Detailed discharge for lab investigation of host tissue summary (HPE/ Microbiology/other) 17 SE012 Corneal Grafting SE012B Corneal Graft - clinical notes Still image of the patient Follow Up 2,000 undergoing the procedure with date stamp 18 SE013 Corneal Collagen SE013A Corneal Collagen PENTACAM PROGRESSION MAPS 3 Still image of the patient Crosslinking Crosslinking 9,000 to 6 months apart undergoing the procedure with date stamp 19 SE014 Pterygium + SE014A Pterygium + Clinical notes and Retinoscopy, Still image of the the Conjunctival Conjunctival 5,000 Corneal topography (not procedure with pt. ID Autograft Autograft mandatory), keratometry, Clinical and date, detailed Photograph discharge summary, detailed operative notes.
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20 SE015 Corneo / Scleral / SE015A Corneo / Scleral / Clinical notes and FIR/MLC (since Still image of the the Corneo scleral tear Corneo scleral tear 11,50 injury), USG B scan, Clinical procedure with pt. ID repair repair 0 Photograph and date, Detailed discharge summary, barcode of Intraocular Lens used,operative notes. 21 SE016 Corneal / Scleral SE016A Corneal / Scleral preoperative clinical photo operative notes, Still Patch Graft Patch Graft 3,000 image of the patient undergoing the procedure with date stamp 22 SE017 Scleral buckling SE017A Scleral buckling Clinical notes operative notes. Detailed surgery surgery 15,00 discharge summary,Still 0 image of the the procedure with pt. ID and date 23 SE018 Scleral Buckle SE018A Scleral Buckle Clinical notes with, Indication for Still image of the the Removal Removal 5,500 removal, stated plan for lab procedure with pt. ID investigation of host tissue and date, operative (Microbiology) notes. Detailed discharge summary, microbiological report 24 SE019 Limbal Dermoid SE019A Limbal Dermoid Tissue graft - Cornea / Clinical notes and Indication for Still image of the the Removal Removal 1,000 Sclera (Max 1) Limbal Dermoid Removal like procedure with pt. ID 3,000 increase in dermoid size/ increasing and date, Detailed astigmatism/visual discharge summary, deterioration/central opacification detailed operative notes. of the cornea) Clinical Photograph 25 SE020 Cataract surgery SE020A Phaco emulsification Foldable Hydrophobic Clinical notes detailing visual Detailed discharge with foldable 4,500 intraocular lens (Max 1) impairment (Best corrected visual summary, operative hydrophobic acrylic 3,000 acquity- BCVA) of cataract and , notes. Barcode of IOL IOL Ocular Biometry (A scan and used. Still image of the ketometry) and Clinical photo of the procedure with pt. ID affected part and date 26 SE020 Cataract surgery SE020B SICS with non- Non foldable IOL (Max Clinical notes detailing visual Detailed discharge foldable IOL 4,000 1) impairment (Best corrected visual summary, operative 1,000 acquity- BCVA) of cataract and , notes. Barcode of IOL Ocular Biometry (A scan and used. Still image of the ketometry) and Clinical photo of the procedure with pt. ID affected part and date 195 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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27 SE021 Surgery for SE021A Paediatric Foldable Hydrophobic Clinical notes detailing Indication Still image of the the Pediatric Cataract lensectomy 9,200 intraocular lens (max 1) for Lensectomy /pediatric lens procedure with pt. ID 3,000 aspiration/ membranectomy and and date, Detailed supporting investigation, Clinical discharge summary, Photograph detailed operative notes with visual outcomes. Barcode of IOL used 28 SE021 Surgery for SE021B Pediatric lens Foldable Hydrophobic Clinical notes detailing Indication Still image of the the Pediatric Cataract aspiration with 9,200 intraocular lens (max 1) for Lensectomy /pediatric lens procedure with pt. ID posterior 3,000 aspiration/ membranectomy and and date, Detailed capsulotomy & supporting investigation, Clinical discharge summary, anterior vitrectomy Photograph detailed operative notes with visual outcomes. Barcode of IOL used 29 SE021 Surgery for SE021C Paediatric Foldable Hydrophobic Clinical notes detailing Indication Still image of the the Pediatric Cataract Membranectomy & 9,200 intraocular lens (max 1) for Lensectomy /pediatric lens procedure with pt. ID anterior vitrectomy 3,000 aspiration/ membranectomy and and date, Detailed supporting investigation, Clinical discharge summary, Photograph detailed operative notes with visual outcomes. Barcode of IOL used 30 SE022 Capsulotomy (YAG) SE022A Capsulotomy (YAG) Clinical notes detailing when was procedure notes, 1,500 cataract surgery was done and Detailed discharge notes mentioning indication for this summary, Still image of procedure with vision and fundus. the the procedure with Clinical photo of patient before pt. ID and date procedure 31 SE023 SFIOL (inclusive of SE023A SFIOL (inclusive of Glue for Scleral fixated Clinical notes with planned line of Still image of the patient Vitrectomy) Vitrectomy) 15,00 IOL (max 1) treatment, Pre operative Clinical undergoing the 0 3,000 Photograph of affected part procedure with date stamp operative notes. Detailed discharge summary, Barcode of SFIOL. 32 SE024 Secondary IOL / IOL SE024A Secondary IOL / IOL IOL (Max 1) Clinical notes, pre operative Still image of the patient Exchange / Explant Exchange / Explant 2,000 3,000 documentation of indication for undergoing the intervention and Clinical procedure with date Photograph of affected part stamp, operative notes. Detailed discharge summary; Barcode of IOL 33 SE025 IRIS Prolapse – SE025A IRIS Prolapse – Clinical notes, pre operative Still image of the patient 196 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Repair Repair 4,000 documentation of indication for undergoing the intervention and Clinical procedure with date Photograph of affected part stamp, operative notes. Detailed discharge summary 34 SE026 Iridectomy SE026A Iridectomy Clinical notes showing Indication Still image of the the 2,000 for Iridectomy(Laser), Tonometry, procedure with pt. ID Gonioscopy,and clinical photo and date, procedure notes. Detailed discharge summary 35 SE027 Glaucoma Surgery SE027A Cyclocryotherapy / Clinical notes establishing long Detailed Procedure / Cyclophotocoagulati 3,700 standing history of Glaucoma with Operative Notes and on recent documentation of vision and discharge summary. reports of field of vision. 36 SE027 Glaucoma Surgery SE027B Glaucoma Surgery Clinical notes and IOP Still image of the the (Trabeculectomy 11,00 measurement, documentary procedure with pt. ID only) with or without 0 evidence supporting chronicity and date ,operative Mitomycin C, notes. Detailed discharge including summary; ensure that postoperative post op medicine for 12 medications for 12 weeks is given weeks (and wherever surgical or laser procedures required for bleb augmentation and anterior chamber maintenance) 37 SE027 Glaucoma Surgery SE027C Glaucoma Shunt Valved / Non Valved Clinical notes and IOP Still image of the patient Surgery 13,00 Glaucoma tube – shunt measurement, documentary undergoing the 0 (Max 1) evidence supporting chronicity/ procedure with date 7,000 Failed Trabeculectomy stamp, operative notes. Detailed discharge summary 38 SE027 Glaucoma Surgery SE027D Pediatric Glaucoma Clinical notes and IOP Still image of the patient Surgery 15,00 measurement, documentary undergoing the 0 evidence of paediatric glaucoma procedure with date with confirmation of diagnosis stamp, operative notes. under GA/Examination under Detailed discharge anaesthesia (EUA) summary 197 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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39 SE028 EUA for SE028A EUA for Confirmation Clinical notes and/or documentary Still image of the patient Confirmation of of Pediatric 3,000 evidence undergoing the Pediatric Glaucoma Glaucoma procedure with date stamp, operative notes. Detailed discharge summary with IOP,Fundus,Corneal diameter 40 SE029 Retinal Laser SE029A For retinal tear repair clinical notes and or supportive discharge summary, Photocoagulation Per Eye Per Sitting 1,500 documents clinical notes, Still image of the the procedure with pt. ID and date 41 SE029 Retinal Laser SE029B Pan Retinal clinical notes and or supportive Still image of the the Photocoagulation Photocoagulation 8,500 documents procedure with pt. ID (PRP) - Retinal Laser and date; discharge including 3 sittings / summary, clinical notes package of retino laser photocoagulation (3 sittings per eye for both eyes) 42 SE030 ROP Laser - Per Eye SE030A ROP Laser - Per Eye Clinical notes Discharge summary, Still 5,000 image of the patient undergoing the procedure with date stamp 43 SE031 Retinal Cryopexy SE031A Retinal Cryopexy Clinical notes with Indication for Detailed Procedure notes 3,800 procedure and discharge summary,Still image of the the procedure with pt. ID and date 44 SE032 Vitreoretinal SE032A Vitreoretinal Surgery Implant for Clinical notes and or Clinical Detailed discharge Surgery (with Silicon (with Silicon Oil 17,90 "Vitreoretinal Surgery" documents, B Scan (optional) summary, operative Oil Insertion) Insertion) 0 (IOL & Per flouro carbon notes, IOL sticker, Still liquid) (Max 1) image of the the 6,000 procedure with pt. ID and date 45 SE033 SOR (Silicon Oil SE033A SOR (Silicon Oil Clinical notes and or Clinical Detailed discharge Removal) Removal) 9,300 documents, B Scan summary, operative notes., sticker of IOL,Still image of the the 198 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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procedure with pt. ID and date 46 SE034 Endophthalmitis SE034A Endophthalmitis Clinical notes with planned line of Still image of the patient (excluding (excluding 8,000 treatment, Pre operative Clinical undergoing the Vitrectomy) Vitrectomy) Photograph of affected part procedure with date stamp, operative notes. Detailed discharge summary 47 SE035 Enucleation SE035A Without implant Clinical notes establishing Intra procedure clinical 8,400 Indication and justifying photograph, detailed enucleation and supporting discharge summary, investigation, Clinical Photograph; ,operative notes, Recommendation/opinion of 2 confirmation that ophthalmologists for the procedure specimen was sent for histopathology. 48 SE035 Enucleation SE035B With implant Implant for Clinical notes establishing Still image of the the 8,000 "Enucleation" Indication and justifying procedure with pt. ID (Conformers + Plastic / enucleation and supporting and date, detailed silicon ball type implant) investigation, Clinical Photograph, discharge summary, (Max 1) Recommendation/opinion of 2 ,operative notes. Invoice 1,000 ophthalmologists for the procedure of implant, confirmation/ declaration that the specimen has been sent for histopathology and report will be sent for filing later 49 SE036 Evisceration SE036A Evisceration Implant for Indication for Evisceration and Detailed discharge 3,800 "Evisceration" supporting investigation report, summary, Still image of (Conformers + Plastic / Clinical Photograph, the the procedure with silicon ball type implant) Recommendation/opinion of 2 pt. ID and date,operative (Max 1) ophthalmologists for the notes, 1,000 procedure, stated plan for lab Confirmation/declaration investigation of host tissue (HP/ that specimen sent for Microbiology/other) lab investigationmicrobio/pa th and report will be submitted 50 SE037 Exenteration SE037A Exenteration Indication for Exenteration and Still image of the the 15,00 supporting investigation, (Biopsy / procedure with pt. ID 0 CT / MRI establishing indication for and date,operative Exenteration) Clinical Photograph, notes. Histopathological 199 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Recommendation/opinion of 2 exam report. Detailed ophthalmologists for the procedure discharge summary, confirmation/ declaration that the specimen has been sent for histopathology and report will be sent for filing later 51 SE038 Socket SE038A Socket Clinical notes and showing Still image of the the Reconstruction Reconstruction 11,20 Indication for socket procedure with pt. ID including Amniotic including Amniotic 0 reconstruction, Clinical Photograph and date,operative Membrane Graft Membrane Graft of affected part notes. Detailed discharge summary 52 SE039 Orbitotomy SE039A Orbitotomy Clinical notes detailing indication Still image of the the 14,00 and CT Scan, Clinical Photograph, procedure with pt. ID 0 stated plan for lab investigation of and date, HP Report of host tissue (HP/ actual surgery, operative Microbiology/other) notes, Lab (Histopath) report 53 SE040 GA / EUA separate SE040A GA / EUA separate Clinical Notes justifying the need Clinical Notes for the add on package add on package 3,000 for GA in the associated surgery associated surgery / disease along with Pre OP, Operative and Anesthesia, Post OP notes
15. Orthopedics
• Total number of packages: 71 • Total number of procedures: 132 • Additional cross specialty procedures: 30 • Number of procedures recommended for auto-approval: 63 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Prior approval must be taken for all replacement surgeries and others as indicated S. No. Package AB PM - JAY Procedure AB PM - JAY Package Stratification Implant Mandatory Mandatory
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Code Package Name Code Procedure Name Price Documents - Pre Documents - Claim HBP 2.0 HBP 2.0 Authorization Processing 1 SB001 Fracture - SB001A Fracture - 2,000 Clinical notes with Procedure / Conservative Conservative planned line of Operation notes, Management - Management - treatment Post procedure X- Without plaster Without plaster including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 2 SB002 Application of SB002A Skeletal Tractions 2,000 Clinical notes and Post Procedure Traction with pin X-ray showing the clinical photgraph need of procedure, with pins, detailed clinical photograph Procedure / of affected part Operative Notes. Detailed discharge summary 3 SB002 Application of SB002B Skin Traction 700 Clinical notes and Post Procedure Traction X-ray showing the clinical photgraph, need of procedure, detailed Procedure clinical photograph / Operative Notes. of affected part Detailed discharge summary 4 SB003 Application of SB003A Upper Limbs 3,000 Clinical notes and Post Procedure P.O.P. casts X-ray showing the clinical photgraph need of procedure, with POP cast, clinical photograph detailed Procedure of affected part / Operative Notes. Detailed discharge summary 5 SB003 Application of SB003B Lower Limbs 3,000 Clinical notes and Post Procedure P.O.P. casts X-ray showing the clinical photgraph need of procedure, with POP cast, clinical photograph detailed Procedure of affected part / Operative Notes. Detailed discharge summary 6 SB004 Application of SB004A Spikas 3,500 Clinical notes and Post Procedure P.O.P. Spikas & X-ray showing the clinical photgraph Jackets need of procedure, with POP spika, clinical photograph detailed Procedure of affected part / Operative Notes. 201 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Detailed discharge summary 7 SB004 Application of SB004B Jackets 3,500 Clinical notes and Post Procedure P.O.P. Spikas & X-ray showing the clinical photgraph Jackets need of procedure, with POP Jacket, clinical photograph detailed Procedure of affected part / Operative Notes. Detailed discharge summary 8 SB005 External fixation SB005A Long bone 14,000 External Fixator Clinical notes and Post Procedure of Fracture (Max 1) X-ray confirming clinical photgraph, 5,000 the diagnosis, detailed Procedure clinical photograph / Operative Notes. of affected part Detailed discharge summary Invoice and barcode of implant 9 SB005 External fixation SB005B Small bone 9,500 External Fixator Clinical notes and Post Procedure of Fracture (Max 1) X-ray confirming clinical photgraph, 5,000 the diagnosis, detailed Procedure clinical photograph / Operative Notes. of affected part Detailed discharge summary Invoice and barcode of implant 10 SB005 External fixation SB005C Pelvis 14,000 External Fixator Clinical notes and Post Procedure of Fracture (Max 1) X-ray confirming clinical photgraph, 5,000 the diagnosis, detailed Procedure clinical photograph / Operative Notes. of affected part Detailed discharge summary Invoice and barcode of implant 11 SB005 External fixation SB005D Both bones - 15,000 External Fixator Clinical notes and Post Procedure of Fracture forearms (Max 1) X-ray confirming clinical photgraph, 5,000 the diagnosis, detailed Procedure clinical photograph / Operative Notes. of affected part Detailed discharge summary Invoice and barcode of implant 202 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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12 SB006 Percutaneous - SB006A Percutaneous - 3,000 Local Implant for Clinical notes with Procedure / Fixation of Fixation of Anesthesia/General Percutaneous - planned line of Operation notes, Fracture Fracture Anesthesia Fixation of treatment Post procedure X- None/ "+5000" Fracture (Max 1) including planned ray films with 2,000 line of treatment, reports, Stickers of X-ray films with implants used, reports Detailed Discharge Summary 13 SB007 Elastic nailing for SB007A Femur 11,000 Implant for Clinical notes with Procedure / fracture fixation Percutaneous - planned line of Operation notes, Fixation of treatment Post procedure X- Fracture (Max 1) including planned ray films with 5,000 line of treatment, reports, Stickers of X-ray films with implants used, reports Detailed Discharge Summary 14 SB007 Elastic nailing for SB007B Humerus 11,000 Implant for Elastic Clinical notes with Procedure / fracture fixation Nailing of Femur / planned line of Operation notes, Humerus / treatment Post procedure X- Forearm (Max 1) including planned ray films with 5,000 line of treatment, reports, Stickers of X-ray films with implants used, reports Detailed Discharge Summary 15 SB007 Elastic nailing for SB007C Forearm 11,000 Implant for Elastic Clinical notes with Procedure / fracture fixation Nailing of Femur / planned line of Operation notes, Humerus / treatment Post procedure X- Forearm (Max 1) including planned ray films with 5,000 line of treatment, reports, Stickers of X-ray films with implants used, reports Detailed Discharge Summary 16 SB008 Internal Fixation SB008A Internal Fixation 8,500 Implant for Clinical notes and Post Procedure of Small Bones of Small Bones Internal Fixation of X-ray confirming clinical photgraph, Small Bones (Max the diagnosis, Post procedure X- 1) clinical photograph rayshowing 1,500 of affected part implant; detailed Procedure / Operative Notes. Detailed discharge summary Invoice 203 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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and barcode of implant. 17 SB009 Fracture - Long SB009A Fracture - Long 12,700 Locking Plate for Clinical notes with Procedure / Bones - Bones - Metaphyseal planned line of Operation notes, Metaphyseal - Metaphyseal - fracture - Long treatment Post procedure X- ORIF ORIF Bone (Max 2) including planned ray films with 7,000 line of treatment, reports, Stickers of X-ray films with implants used, reports Detailed Discharge Summary 18 SB010 Fixation of SB010A Open Reduction 14,900 Plate for ORIF - Clinical notes and Post procedure Diaphyseal Internal Fixation Diaphyseal radiological imaging study (X Fracture - Long fracture - Long investigations Ray), Post Bone Bone (Max 1) confirming the Procedure clinical 6,000 diagnosis (X-ray), photograph, clinical photograph detailed Procedure of affected part / Operative Notes. invoice and barcode of implant 19 SB010 Fixation of SB010B Closed Reduction 18,000 IM Nail for CR&F - Clinical notes and Post procedure Diaphyseal & Fixation Diaphyseal radiological imaging study (X Fracture - Long fracture - Long investigations Ray), Post Bone Bone (Max 1) confirming the Procedure clinical 7,000 diagnosis (X-ray), photograph, clinical photograph detailed Procedure of affected part / Operative Notes. invoice and barcode of implant 20 SB011 Surgery for SB011A Plating 11,800 Plate for Clinical notes and Post Procedure Comminuted Comminuted X-ray confirming clinical photgraph, Fracture - Fracture - the diagnosis, Post procedure X- Olecranon of Ulna Olecranon of Ulna clinical photograph ray; detailed (Max 1) of affected part Procedure / 8,000 Operative Notes. Detailed discharge summary, Invoice and barcode of implant 21 SB012 Fracture Head SB012A Fixation 10,000 Implant for Clinical notes and Post procedure radius Fracture Head X-ray confirming imaging study (X radius (Plate / the diagnosis, Ray), Post 204 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Screw) (Max 1) clinical photograph Procedure clinical 5,000 of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary, Invoice and barcode of implant 22 SB012 Fracture Head SB012B Excision 9,200 Clinical notes and Post procedure radius X-ray confirming imaging study (X the diagnosis, Ray), Post clinical photograph Procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary 23 SB013 Fracture - Single SB013A Fracture - Single 8,900 Implant for Clinical notes and Post Procedure Bone - Forearm - Bone - Forearm - Fracture - Single X-ray confirming clinical photgraph, ORIF - Plating / ORIF - Plating / Bones - Forearm – the diagnosis, Post procedure X- Nailing Nailing ORIF (Max 1) clinical photograph rayshowing 3,500 of affected part implant; detailed Procedure / Operative Notes. Detailed discharge summary Invoice and barcode of implant. 24 SB014 Fracture - Both SB014A Fracture - Both 12,700 Implants for Clinical notes and Post Procedure Bones - Forearm - Bones - Forearm - Fracture - Both X-ray confirming clinical photgraph, ORIF - Plating / ORIF - Plating / Bones - Forearm – the diagnosis, Post procedure X- Nailing Nailing ORIF (Max 1) clinical photograph rayshowing 7,000 of affected part implant; detailed Procedure / Operative Notes. Detailed discharge summary Invoice and barcode of implant. 25 SB015 Fracture Condyle - SB015A Lateral Condyle 8,500 Implant for Clinical notes and Post Procedure Humerus - ORIF Fracture Condyle - X-ray confirming clinical photgraph, 205 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Humerus – ORIF the diagnosis, Post procedure X- (Max 1) clinical photograph rayshowing 1,500 of affected part implant; detailed Procedure / Operative Notes. Detailed discharge summary Invoice and barcode of implant. 26 SB015 Fracture Condyle - SB015B Medial Condyle 8,500 Implant for Clinical notes and Post Procedure Humerus - ORIF Fracture Condyle - X-ray confirming clinical photgraph, Humerus – ORIF the diagnosis, Post procedure X- (Max 1) clinical photograph rayshowing 1,500 of affected part implant; detailed Procedure / Operative Notes. Detailed discharge summary Invoice and barcode of implant. 27 SB016 Fracture SB016A Fracture 15,100 Implant for Clinical notes and Post Procedure X- intercondylar intercondylar Fracture X-ray showing the ray showing Humerus + Humerus + intercondylar need of procedure, osteotomy as well olecranon olecranon Humerus + clinical photograph as frature osteotomy osteotomy olecranon of affected part maneged; detailed osteotomy (TBW + Procedure / 2 Plates) (Max 1) Operative Notes. 11,000 Detailed discharge summary, Invoice and barcode of implant 28 SB017 Displaced Clavicle SB017A Open Reduction 20,000 Implant for Clinical notes with Procedure / Fracture Internal Fixation Displaced Clavicle planned line of Operation notes, Fracture (Plate) treatment Post procedure X- (Max 1) including planned ray films with 3,000 line of treatment, reports, Stickers of X-ray films with implants used, reports Detailed Discharge Summary 29 SB018 Fracture - SB018A Single Approach 28,000 Implant for Clinical notes with Procedure / Acetabulum "Fracture - planned line of Operation notes, 206 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Acetabulum - treatment Post procedure X- Single Approach" - including planned ray films with Recon Plate (2) line of treatment, reports, Detailed (Max 1) X-ray films with Discharge 10,000 reports Summary, Invoice and barcode of implant 30 SB018 Fracture - SB018B Combined 33,500 Implant for Clinical notes with Procedure / Acetabulum Approach "Fracture - planned line of Operation notes, Acetabulum - treatment Post procedure X- Combined including planned ray films with Approach" - Recon line of treatment, reports, Detailed Plate (3) (Max 1) X-ray films with Discharge 15,000 reports Summary, Invoice and barcode of implant 31 SB019 Fracture - Neck SB019A Closed Reduction 10,000 Cannulated Screws Clinical notes and Post procedure Femur and Percutaneous for Closed X-ray confirming imaging study (X Screw Fixation Reduction and the diagnosis, Ray), Post Percutaneous clinical photograph Procedure clinical Screw Fixation of affected part photgraph, (neck femur) (Max detailed Procedure 1) / Operative Notes. 5,000 Invoice and barcode of implant 32 SB019 Fracture - Neck SB019B Intertrochanteric 15,800 Dynamic Hip Screw Clinical notes and Post procedure Femur Fracture with for X-ray confirming imaging study (X Dynamic Hip Intertrochanteric the diagnosis, Ray), Post Screw Fracture (Max 1) clinical photograph Procedure clinical 5,000 of affected part photgraph, detailed Procedure / Operative Notes. Invoice and barcode of implant 33 SB019 Fracture - Neck SB019C Intertrochanteric 16,100 Proximal Femoral Clinical notes and Post procedure Femur Fracture with Nail X-ray confirming imaging study (X Proximal Femoral (Max 1) the diagnosis, Ray), Post Nail 8,000 clinical photograph Procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. 207 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Invoice and barcode of implant 34 SB020 Ankle Fractures SB020A Open Reduction 14,000 Implant for Ankle Clinical notes and Detailed discharge Internal Fixation Fracture ORIF (max X-ray of ankle joint, summary Post 1) clinical photograph Procedure clinical 5,000 of affected part photgraph, detailed Procedure / Operative Notes, Invoice and barcode of implant 35 SB021 Cervical spine SB021A Cervical spine 20,000 Implant for Clinical notes with Procedure / fixation including fixation including Cervical spine planned line of Operation notes, odontoid odontoid fixation including treatment Post procedure X- odontoid (Screw) including planned ray films with (max 1) line of treatment, reports, Detailed 5,000 X-ray films with Discharge reports Summary, Invoice and barcode of implant 36 SB022 Dorsal and lumber SB022A Anterior 40,000 Implant for Dorsal Clinical notes with Procedure / spine fixation and lumber spine planned line of Operation notes, fixation (Max 6) treatment Post procedure X- 5,000 including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary, Invoice and barcode of implant 37 SB022 Dorsal and lumber SB022B Posterior 30,000 Implant for Dorsal Clinical notes with Procedure / spine fixation and lumber spine planned line of Operation notes, fixation (Max 6) treatment Post procedure X- 5,000 including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary, Invoice and barcode of implant 38 SB023 Bone grafting for SB023A Bone grafting for 10,000 Clinical notes Post procedure Non union Non union detailing earlier imaging study (X surgery that Ray), Post resulted in non- Procedure clinical 208 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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union and photgraphof donor radiological and recipient sites, investigations detailed Procedure confirming the / Operative Notes. diagnosis (X-ray of Detailed discharge affected joint), summary clinical photograph 39 SB024 Arthorotomy of SB024A Arthorotomy of 14,000 Clinical notes and Post op clinical any joint any joint X-ray confirming photgraph, the diagnosis, detailed Procedure clinical photograph / Operative Notes. of affected part Detailed Discharge summary 40 SB025 Arthrolysis of joint SB025A Elbow 15,000 Clinical notes and Post Procedure X-ray confirming clinical photgraph, the diagnosis, detailed Procedure clinical photograph / Operative Notes., of affected part Post procedure imaging study (X Ray) 41 SB025 Arthrolysis of joint SB025B Knee 15,000 Clinical notes and Post Procedure X-ray confirming clinical photgraph, the diagnosis, detailed Procedure clinical photograph / Operative Notes., of affected part Post procedure imaging study (X Ray) 42 SB025 Arthrolysis of joint SB025C Ankle 15,000 Clinical notes and Post Procedure X-ray confirming clinical photgraph, the diagnosis, detailed Procedure clinical photograph / Operative Notes., of affected part Post procedure imaging study (X Ray) 43 SB026 Arthrodesis SB026A Ankle / Triple with 15,000 N/A Clinical notes Post procedure X- implant detailing indication ray, Post Procedure and X-ray of ankle clinical photgraph, and foot, clinical detailed Procedure photograph of / Operative Notes, affected part Detailed Discharge summary, Invoice 209 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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and barcode of implant 44 SB026 Arthrodesis SB026B Shoulder 15,000 Implant for Clinical notes Post procedure X- Arthrodesis of detailing indication ray, Post Procedure Shoulder (Screw / and X-ray of ankle clinical photgraph, Plate) (Max 1) and foot, clinical detailed Procedure 5,000 photograph of / Operative Notes, affected part Invoice and barcode of implant 45 SB026 Arthrodesis SB026C Wrist 15,000 Implant for Clinical notes Post procedure X- Arthrodesis of detailing indication ray, Post Procedure Wrist (Plate) (Max and X-ray of ankle clinical photgraph, 1) and foot, clinical detailed Procedure 5,000 photograph of / Operative Notes, affected part Invoice and barcode of implant 46 SB026 Arthrodesis SB026D Knee 15,000 Implant for Clinical notes Post procedure X- Arthrodesis of detailing indication ray, Post Procedure Knee (Max 1) and X-ray of ankle clinical photgraph, 10,000 and foot, clinical detailed Procedure photograph of / Operative Notes, affected part Invoice and barcode of implant 47 SB026 Arthrodesis SB026E Hand 27,000 Clinical notes Post procedure X- detailing indication ray, Post Procedure and X-ray of ankle clinical photgraph, and foot, clinical detailed Procedure photograph of / Operative Notes. affected part 48 SB026 Arthrodesis SB026F Foot 27,000 Clinical notes Post procedure X- detailing indication ray, Post Procedure and X-ray of ankle clinical photgraph, and foot, clinical detailed Procedure photograph of / Operative Notes, affected part Detailed Discharge summary. 49 SB026 Arthrodesis SB026G Ankle / Triple 15,000 Clinical notes Post procedure X- without implant detailing indication ray, Post Procedure and X-ray of ankle clinical photgraph, and foot, clinical detailed Procedure photograph of / Operative Notes, 210 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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affected part Detailed Discharge summary. 50 SB027 Disarticulation SB027A Hind quarter 25,000 Clinical notes Post Procedure justifying surgery clinical photgraph, with X Ray of detailed Procedure affected limb, / Operative Notes. clinical photograph Detailed Discharge of affected part summary showing the gangrene/ injury/ severe anatomical deformity 51 SB027 Disarticulation SB027B Fore quarter 25,000 Clinical notes Post Procedure justifying surgery clinical photgraph, with X Ray of detailed Procedure affected limb, / Operative Notes. clinical photograph Detailed Discharge of affected part summary showing the gangrene/ injury/ severe anatomical deformity 52 SB028 Closed reduction SB028A Hip 7,400 Clinical notes and Post procedure of joint X-ray confirming imaging study (X dislocation the diagnosis, Ray), Post clinical photograph Procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary, 53 SB028 Closed reduction SB028B Shoulder 5,500 Clinical notes and Post procedure of joint X-ray confirming imaging study (X dislocation the diagnosis, Ray), Post clinical photograph Procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary, 54 SB028 Closed reduction SB028C Elbow 5,500 Clinical notes and Post procedure 211 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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of joint X-ray confirming imaging study (X dislocation the diagnosis, Ray), Post clinical photograph Procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary, 55 SB028 Closed reduction SB028D Knee 5,500 Clinical notes and Post procedure of joint X-ray confirming imaging study (X dislocation the diagnosis, Ray), Post clinical photograph Procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary, 56 SB029 Open Reduction SB029A Open Reduction 8,500 Implant for Open Clinical and Post procedure of Small Joint of Small Joint Reduction of Small radiological imaging study (X joints (Max 1) investigations Ray), Post 1,500 confirming the Procedure clinical diagnosis (X-ray of photgraph, affected joint), detailed Procedure clinical photograph / Operative Notes. of child Detailed discharge summary, Invoice and barcode of implant 57 SB030 Tension Band SB030A Tension Band 13,000 Implant for Clinical notes with Procedure / Wiring Wiring Tension Band planned line of Operation notes, Wiring (Wire) (Max treatment Post procedure X- 1) including planned ray films with 2,000 line of treatment, reports, Detailed X-ray films with Discharge reports Summary, Invoice and barcode of implant 58 SB031 Hemiarthroplasty SB031A Unipolar 15,000 Implant for Clinical notes and Post Procedure Unipolar X-ray/ CT justifying clinical photgraph, Hemiarthroplasty the surgery, detailed discharge (Max 1) summary, detailed 212 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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3,000 Procedure / Operative Notes. Post op X-ray showing the implant & invoice / bar code of implant. 59 SB031 Hemiarthroplasty SB031B Bipolar (Non - 15,000 Non - Modular - Clinical notes and Post Procedure Modular) Non – Cemented X-ray/ CT justifying clinical photgraph, (Max 1) the surgery, detailed discharge 7,000 summary, detailed Procedure / Operative Notes. Post op X-ray showing the implant & invoice / bar code of implant. 60 SB031 Hemiarthroplasty SB031C Bipolar (Modular) 15,000 Modular – Clinical notes and Post Procedure Cemented (Max 1) X-ray/ CT justifying clinical photgraph, 20,000 the surgery, detailed discharge summary, detailed Procedure / Operative Notes. Post op X-ray showing the implant & invoice / bar code of implant. 61 SB032 AC Joint SB032A Rockwood Type - I 20,500 Implant for AC Clinical notes Post-op X-ray of reconstruction / Joint detailing Rockwood operated limb, Post Stabilization reconstruction / type of fracture, X- Procedure clinical Stabilization (Max ray/ MRI and photgraph, 1) justification of detailed Procedure 10,000 surgery done / Operative Notes, Detailed Discharge summary, Invoice and barcode of implant 62 SB032 AC Joint SB032B Rockwood Type - 20,500 Implant for AC Clinical notes Post-op X-ray of reconstruction / II Joint detailing Rockwood operated limb, Post 213 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Stabilization reconstruction / type of fracture, X- Procedure clinical Stabilization (Max ray/ MRI and photgraph, 1) justification of detailed Procedure 10,000 surgery done / Operative Notes, Detailed Discharge summary, Invoice and barcode of implant 63 SB032 AC Joint SB032C Rockwood Type - 20,500 Implant for AC Clinical notes Post-op X-ray of reconstruction / III Joint detailing Rockwood operated limb, Post Stabilization reconstruction / type of fracture, X- Procedure clinical Stabilization (Max ray/ MRI and photgraph, 1) justification of detailed Procedure 10,000 surgery done / Operative Notes, Detailed Discharge summary, Invoice and barcode of implant 64 SB032 AC Joint SB032D Rockwood Type - 20,500 Implant for AC Clinical notes Post-op X-ray of reconstruction / IV Joint detailing Rockwood operated limb, Post Stabilization reconstruction / type of fracture, X- Procedure clinical Stabilization (Max ray/ MRI and photgraph, 1) justification of detailed Procedure 10,000 surgery done / Operative Notes, Detailed Discharge summary, Invoice and barcode of implant 65 SB032 AC Joint SB032E Rockwood Type - 20,500 Implant for AC Clinical notes Post-op X-ray of reconstruction / V Joint detailing Rockwood operated limb, Post Stabilization reconstruction / type of fracture, X- Procedure clinical Stabilization (Max ray/ MRI and photgraph, 1) justification of detailed Procedure 10,000 surgery done / Operative Notes, Detailed Discharge summary, Invoice and barcode of implant 66 SB032 AC Joint SB032F Rockwood Type - 20,500 Implant for AC Clinical notes Post-op X-ray of reconstruction / VI Joint detailing Rockwood operated limb, Post Stabilization reconstruction / type of fracture, X- Procedure clinical 214 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Stabilization (Max ray/ MRI and photgraph, 1) justification of detailed Procedure 10,000 surgery done / Operative Notes, Detailed Discharge summary, Invoice and barcode of implant 67 SB033 Excision SB033A Excision 17,500 Clinical notes Post Procedure Arthoplasty of Arthoplasty of detailing indication clinical photgraph, Femur head Femur head and X-ray, clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge summary 68 SB034 Open Reduction SB034A Open Reduction 20,000 Clinical and Post procedure of CDH of CDH radiological imaging study (X investigations Ray), Post confirming the Procedure clinical diagnosis (X-ray of photgraph, both hips), clinical detailed Procedure photograph / Operative Notes. Detailed discharge summary 69 SB035 Patellectomy SB035A Patellectomy 11,000 Clinical notes and Post procedure X-ray of the patella imaging study (X justifying the Ray), Post procedure, clinical Procedure clinical photograph of photgraph, affected part detailed Procedure / Operative Notes. Detailed discharge summary 70 SB036 Arthroscopic SB036A Arthroscopic 12,000 Clinical notes and Intra operative still Meniscus Repair / Meniscus Repair / MRI justifying image, post Meniscectomy Meniscectomy procedure procedure clinical photgraph, detailed Procedure / Operative Notes, Detailed Discharge summary. 71 SB037 Elbow SB037A Elbow 14,100 Implant for Elbow Clinical notes and Post Procedure replacement replacement Replacement (Max X-ray/ CT justifying clinical photgraph, 215 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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1) the surgery detailed discharge 31,000 summary, detailed Procedure / Operative Notes. Post op X-ray showing the implant & invoice / bar code of implant. 72 SB038 Total Hip SB038A Cemented 35,000 Implant for Total Clinical notes and Post Procedure X- Replacement Hip Replacement – X-ray/ CT justifying ray showing Cemented (Max 1) the surgery implant, detailed 35,000 Procedure / Operative Notes. Bar code of implant & cement used, Detailed discharge summary 73 SB038 Total Hip SB038B Cementless 37,000 Implant for Total Clinical notes and Post Procedure X- Replacement Hip Replacement – X-ray/ CT justifying ray showing Cementless (Max the surgery implant, detailed 1) Procedure / 60,000 Operative Notes. Bar code of implant used, Detailed discharge summary 74 SB038 Total Hip SB038C Hybrid 32,000 Implant for Total Clinical notes and Post Procedure X- Replacement Hip Replacement – X-ray/ CT justifying ray showing Hybrid (Max 1) the surgery implant, detailed 45,000 Procedure / Operative Notes. Bar code of implant / cement used, Detailed discharge summary 75 SB038 Total Hip SB038D Revision - Total 1,40,000 Implant for Clinical notes and Post Procedure X- Replacement Hip Replacement Revision Total Hip X-ray/ CT justifying ray showing Replacement (Max the surgery implant, detailed 1) Procedure / 1,00,000 Operative Notes. Bar code of implant 216 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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/ cement used, Detailed discharge summary 76 SB039 Total Knee SB039A Primary - Total 80,000 Implant for Total Clinical notes and Post Procedure Replacement Knee Knee Replacement X-ray/ CT justifying clinical photgraph, Replacement (max 1) the surgery detailed discharge 55,000 summary, detailed Procedure / Operative Notes. Post op X-ray showing the implant & invoice / bar code of implant. 77 SB039 Total Knee SB039B Revision - Total 1,30,000 Implant for Clinical notes and Post Procedure Replacement Knee Revision Total X-ray/ CT justifying clinical photgraph, Replacement Knee Replacement the surgery detailed discharge (Max 1) summary, detailed 100,000 Procedure / Operative Notes. Post op X-ray showing the implant & invoice / bar code of implant. 78 SB040 Bone Tumour SB040A Bone Tumour 57,000 Modular Custom Clinical notes Post procedure Excision Excision Prosthesis for justifying need of imaging study (X (malignant) (malignant) Bone Tumour this surgery and X- Ray), Post including GCT + including GCT + Excision - ray/ MRI of Procedure with Joint replacement Joint replacement malignant affected part, implant; invoice (depending upon (depending upon including GCT + Biopsy, clinical and barcode of type of joint and type of joint and Joint replacement photograph of implant. detailed implant) implant) (Max 1) affected part Procedure / 1,20,000 Operative Notes. Histopathology of excised tissue, Detailed Discharge summary 79 SB041 Bone Tumour SB041A Bone Tumour 30,000 Implant for Bone Clinical notes Post procedure Excision + Excision + Tumour Excision + justifying need of imaging study (X reconstruction reconstruction reconstruction this surgery and X- Ray), Post 217 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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(Max 1) ray/ MRI of procedure clinical 10,000 affected part, photgraph, Biopsy, clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge summary, invoice and barcode of implant 80 SB042 Bone Tumour SB042A Bone Tumour 20,000 Clinical notes Post procedure (benign) (benign) justifying need of imaging study (X curettage / curettage / this surgery and X- Ray), Post Excision Excision and bone ray/ MRI of Procedure clinical and bone grafting grafting affected part, photgraph of both Biopsy, clinical donor and photograph of recipient sites, affected part detailed Procedure / Operative Notes. Histopathology of curreted tissue, Detailed Discharge summary 81 SB043 Single Stage SB043A Above Elbow 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 82 SB043 Single Stage SB043B Below Elbow 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 83 SB043 Single Stage SB043C Above Knee 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. 218 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 84 SB043 Single Stage SB043D Below Knee 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 85 SB043 Single Stage SB043E Foot 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 86 SB043 Single Stage SB043F Hand 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 87 SB043 Single Stage SB043G Wrist 15,000 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 88 SB044 Two Stage SB044A Above Elbow 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge 219 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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justifying the summary indication; MLC/ FIR if traumatic 89 SB044 Two Stage SB044B Below Elbow 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 90 SB044 Two Stage SB044C Above Knee 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 91 SB044 Two Stage SB044D Below Knee 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 92 SB044 Two Stage SB044E Foot 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 93 SB044 Two Stage SB044F Hand 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary 220 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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indication; MLC/ FIR if traumatic 94 SB044 Two Stage SB044G Wrist 23,200 X Ray of affected Post Procedure Amputation limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 95 SB045 Amputation - SB045A Finger(s) 10,400 X Ray of affected Post Procedure Fingers / Toes limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 96 SB045 Amputation - SB045B Toe(s) 10,400 X Ray of affected Post Procedure Fingers / Toes limb, clinical notes clinical photgraph, and clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge justifying the summary indication; MLC/ FIR if traumatic 97 SB046 Tendon Grafting / SB046A Tendon Grafting 15,000 Clinical notes Post Procedure Repair detailing clinical photgraph jusification of of donor and surgery, clinical receipent sites; photograph of detailed Procedure affected part / Operative Notes. Detailed discharge summary 98 SB046 Tendon Grafting / SB046B Tendon Repair 15,000 Clinical notes Post Procedure Repair detailing clinical photgraph; jusification of detailed Procedure surgery, clinical / Operative Notes. photograph of Detailed discharge affected part summary 99 SB047 Tendon Release / SB047A Tendon Release / 5,000 Clinical notes and Post Procedure 221 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Tenotomy Tenotomy justifying need of clinical photgraph, surgery, clinical detailed Procedure photograph of / Operative Notes. affected part Detailed discharge summary 100 SB048 Tenolysis SB048A Tenolysis 5,000 Clinical notes and Post Procedure justifying need of clinical photgraph, surgery, clinical detailed Procedure photograph of / Operative Notes affected part including agent used for lysis of tendon. Detailed discharge summary 101 SB049 Reconstruction of SB049A Anterior 25,700 Implant & brace Clinical notes and Post Procedure Cruciate Ligament for Reconstruction MRI scan of clinical photgraph, with implant and of ACL / PCL (Max affected knee, detailed Procedure brace 1) Clinical photograph / Operative Notes. 17,000 of affected part Post proedure X- ray showing implant; ensure brace is provided in package cost, Detailed Discharge summary 102 SB049 Reconstruction of SB049B Posterior 25,700 Implant & brace Clinical notes and Post Procedure Cruciate Ligament for Reconstruction MRI scan of clinical photgraph, with implant and of ACL / PCL (Max affected knee, detailed Procedure brace 1) Clinical photograph / Operative Notes. 17,000 of affected part Post proedure X- ray showing implant; ensure brace is provided in package cost, Detailed Discharge summary 103 SB050 Fasciotomy SB050A Fasciotomy 10,500 Clinical documents Detailed discharge justifying surgery summary, Post with USG Evidence, Procedure clinical clinical photograph photgraph, of affected part detailed Procedure / Operative Notes. 222 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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104 SB051 Duputryen’s SB051A Duputryen’s 8,500 Clinical notes and Detailed discharge Contracture Contracture clinical photograph summary Post release + release + of affected part Procedure clinical rehabilitation rehabilitation confirming the photgraph, diagnosis detailed Procedure / Operative Notes. 105 SB052 Debridement & SB052A Anti-biotic + 10,900 Clinical notes +/- X- Post Procedure Closure of injuries dressing - ray confirming the clinical photgraph, - contused minimum of 5 diagnosis, clinical detailed Procedure lacerated wounds sessions photograph of / Operative Notes. affected part Detailed discharge summary Evidence of 5 sessions dressing 106 SB052 Debridement & SB052B Anti-biotic + 3,000 Clinical notes +/- X- Post Procedure Closure of injuries dressing - ray confirming the clinical photgraph, - contused minimum of 2 diagnosis, clinical detailed Procedure lacerated wounds sessions photograph of / Operative Notes. affected part Detailed discharge summary Evidence of 2 sessions dressing 107 SB053 Sequestectomy / SB053A Sequestectomy / 10,000 Clinical notes with Procedure / Curettage Curettage planned line of Operation notes, treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 108 SB054 Spine deformity SB054A Spine deformity 30,000 Implant for Spine Clinical notes with Procedure / correction correction deformity planned line of Operation notes, correction (Max 6) treatment Post procedure X- 5,000 including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary, Invoice and barcode of implant 109 SB055 Osteotomy SB055A Long Bone 18,000 Implant for Clinical notes and Post procedure Osteotomy - Long X-ray of the imaging study (X Bone (Screw) (Max affected bone Ray), Post 223 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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1) justifying the procedure clinical 5,000 procedure, clinical photgraph, photograph of detailed Procedure affected part / Operative Notes. Detailed discharge summary, invoice and barcode of implant 110 SB055 Osteotomy SB055B Small Bone 10,000 Clinical notes and Post procedure X-ray of the imaging study (X affected bone Ray), Post justifying the Procedure clinical procedure, clinical photgraph, photograph of detailed Procedure affected part / Operative Notes. Detailed discharge summary 111 SB056 Pelvic Osteotomy SB056A Pelvic Osteotomy 20,000 Clinical notes and Post procedure and fixation and fixation X-ray of the patella imaging study (X justifying the Ray) showing the procedure, clinical implant, Post photograph of Procedure clinical affected part photgraph, detailed Procedure / Operative Notes. Invoice and barcode of implant used. Detailed discharge summary 112 SB057 High Tibial SB057A High Tibial 16,000 Plate for High Clinical notes and Post procedure Osteotomy Osteotomy Tibial Osteotomy X-ray confirming imaging study (X (Max 1) the diagnosis, Ray), Post 7,000 clinical photograph procedure clinical of affected part photgraph, detailed Procedure / Operative Notes. Detailed discharge summary, invoice and barcode of implant 113 SB058 Ilizarov Fixation SB058A Ilizarov Fixation 15,000 Implant for Ilizarov Clinical and Post Procedure 224 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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fixation (Max 1) radiological clinical photgraph / 10,000 investigations Post procedure X- confirming the ray showing indication, clinical implant; detailed photograph of Procedure / affected part Operative Notes. Detailed discharge summary Invoice and barcode of implant. 114 SB059 Limb Lengthening SB059A Limb Lengthening 23,700 Implant for Limb Clinical and Post procedure / Bone Transport / Bone Transport Lengthening / radiological clinical by Ilizarov by Ilizarov Bone Transport by investigations photograph; Intra Ilizarov (Max 1) confirming the procedure still 12,000 diagnosis, clinical pictures; Detailed photograph of discharge summary affected part Detailed Procedure showing short limb / Operative Notes, as compared to Invoice and other limb barcode of implant 115 SB060 Growth SB060A Growth 5,000 Implant for Growth Clinical notes with Procedure / Modulation and Modulation and Modulation & planned line of Operation notes, fixation fixation Fixation (Plate) treatment Post procedure X- (Max 6) including planned ray films with 5,000 line of treatment, reports, Detailed X-ray films with Discharge reports Summary, Invoice and barcode of implant 116 SB061 Corrective SB061A Vertical Talus 15,000 Clinical notes with Procedure / Surgery for foot planned line of Operation notes, deformities treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 117 SB061 Corrective SB061B Other foot 15,000 Clinical notes with Procedure / Surgery for foot deformities planned line of Operation notes, deformities treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed 225 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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X-ray films with Discharge reports Summary 118 SB062 Correction of club SB062A Correction of club 3,000 Clinical notes and Post Procedure foot per cast foot per cast X-ray confirming clinical photgraph the diagnosis, with cast, detailed clinical photograph Procedure / of affected part Operative Notes, Detailed Discharge summary. 119 SB063 Corrective SB063A Corrective 20,000 JESS Fixator (Max Clinical notes with Procedure / Surgery in Club Surgery in Club 1) planned line of Operation notes, Foot / JESS Fixator Foot / JESS Fixator 8,000 treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary, Invoice and barcode of implant 120 SB064 Excision of SB064A Osteochondroma 10,000 Clinical notes Post Procedure Osteochondroma justifying surgery clinical photgraph, / Exostosis with evidence from detailed Procedure X-ray / MRI scan of / Operative affected part, Notes.Detailed clinical photograph Discharge summary of affected part Histopath of removed tissue 121 SB064 Excision of SB064B Exostosis 10,000 Clinical notes Post Procedure Osteochondroma justifying surgery clinical photgraph, / Exostosis with evidence from detailed Procedure X-ray / MRI scan of / Operative affected part, Notes.Detailed clinical photograph Discharge summary of affected part Histopath of removed tissue 122 SB065 Excision of Bursa SB065A Excision of Bursa 3,000 Clinical notes Detailed discharge detailing findings summary, Post confirming the Procedure clinical diagnosis, clinical photgraph, photograph of detailed Procedure affected part / Operative Notes. 123 SB066 Nerve SB066A Nerve 13,000 Clinical notes Intra Procedure 226 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Transposition / Transposition justifying surgery still images, Release / with evidence of detailed Procedure Neurolysis MRI / EMG/ NCV / Operative Notes. Detailed Discharge summary 124 SB066 Nerve SB066B Nerve Release 13,000 Clinical notes Intra Procedure Transposition / justifying surgery still images, Release / with evidence of detailed Procedure Neurolysis MRI / EMG/ NCV / Operative Notes. Detailed Discharge summary 125 SB066 Nerve SB066C Nerve Neurolysis 13,000 Clinical notes Intra Procedure Transposition / justifying surgery still images, Release / with evidence of detailed Procedure Neurolysis MRI / EMG/ NCV / Operative Notes. Detailed Discharge summary 126 SB067 Nerve Repair SB067A Nerve Repair 13,800 Clinical notes Intra procedure Surgery Surgery justifying surgery still images, Post with evidence of Procedure clinical MRI / EMG/ NCV photgraph, detailed Procedure / Operative Notes. Detailed discharge summary 127 SB068 Nerve root block SB068A Nerve root block 3,000 Clinical notes with Procedure / planned line of Operation notes, treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 128 SB069 Exploration and SB069A Exploration and 9,800 Clinical +/- and Detailed discharge Ulnar nerve Ulnar nerve radiological summary, Post Repair Repair investigations Procedure clinical confirming the photgraph, need of surgery; detailed Procedure +/- NCV report / Operative Notes. 129 SB070 Implant Removal SB070A K - Wire 5,000 Clinical notes with Procedure / under LA planned line of Operation notes, treatment Post procedure X- 227 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 130 SB070 Implant Removal SB070B Screw 5,000 Clinical notes with Procedure / under LA planned line of Operation notes, treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 131 SB071 Implant Removal SB071A Nail 15,000 Clinical notes with Procedure / under RA / GA planned line of Operation notes, treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary 132 SB071 Implant Removal SB071B Plate 15,000 Clinical notes with Procedure / under RA / GA planned line of Operation notes, treatment Post procedure X- including planned ray films with line of treatment, reports, Detailed X-ray films with Discharge reports Summary
16. Otorhinolaryngology (ENT)
• Total number of packages: 35 • Total number of procedures: 78 • Additional cross specialty procedures: 12 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Nil
S. Packa AB PM - Procedure AB PM - JAY Packag Stratification Implant Mandatory Documents Mandatory Documents - Claim 228 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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N ge JAY Code Procedure e Price - Pre Authorization Processing o. Code Package HBP 2.0 Name HBP Name 2.0 1 SL001 Pinna SL001A Pinna surgery 8,600 History, Pre-op Clinical Histopath report, Post surgery for for tumour photograph and Biopsy procedure clinical photograph tumour / of affected part, detailed trauma Procedure / Operative Notes, detailed discharge summary 2 SL001 Pinna SL001B Pinna surgery 8,600 History, Pre-op Clinical Post procedure clinical surgery for for trauma photograph photograph of affected part, tumour / detailed Procedure / Operative trauma Notes, detailed discharge summary 3 SL002 Tympanopl SL002A Tympanoplas Partial Ossicular Clinical notes and Intra procedure clinical asty ty 12,900 Replacement Prosthesis Audiogram/ photograph, Post procedure - Indian Titanium (Max Tympanometry (or clinical photograph of affected 1) impedence audiometry) part, detailed Procedure / 7,000 as justification of Operative Notes. Detailed surgery discharge summary Invoice of graft used 4 SL003 Stapedecto SL003A Stapedectom Piston for Stapedectomy Clinical notes and Intra procedure microscope my / y 13,000 / Tympanotomy (Max 1) audiometry confirming clinical photograph; detailed tympanoto 5,000 conductive deafness Procedure / Operative Notes, my detailed discharge summary 5 SL003 Stapedecto SL003B Tympanotom Piston for Stapedectomy Clinical notes and Intra procedure microscope my / y 13,000 / Tympanotomy (Max 1) audiometry confirming clinical photograph; detailed tympanoto 5,000 conductive deafness Procedure / Operative Notes, my detailed discharge summary 6 SL004 Mastoidect SL004A Simple Clinical notes confirming Scar photo, Post procedure omy 28,000 the indication for the clinical photograph, Detailed procedure with imaging Procedure / Operative Notes, (X-ray/ CT) Evidence, Detailed discharge summary, Audiometry Histopath 7 SL004 Mastoidect SL004B Radical Clinical notes confirming Scar photo, Post procedure omy 28,000 the indication for the clinical photograph, Detailed procedure with imaging Procedure / Operative Notes, (X-ray/ CT) Evidence, Detailed discharge summary, Audiometry Histopath 8 SL005 Myringoto SL005A Unilateral 5,000 Local Clinical notes and Photograph of patient while my with or Anesthesia/Gen Audiogram justifying undergoing the procedure, 229 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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without eral Anesthesia surgery. detailed Procedure / Operative Grommet None/ "+5000" Notes, detailed discharge summary 9 SL005 Myringoto SL005B Bilateral 5,000 Local Clinical notes and Photograph of patient while my with or Anesthesia/Gen Audiogram justifying undergoing the procedure, without eral Anesthesia surgery. detailed Procedure / Operative Grommet None/ "+5000" Notes, detailed discharge summary 10 SL006 Endoscopic SL006A Endoscopic Clinical notes and Endoscopic still images, DCR DCR 19,300 endoscopy findings, Detailed discharge summary, Clinical photograph Post procedure clinical photograph of affected part, detailed Procedure / Operative Notes. 11 SL007 Epistaxis SL007A Epistaxis 1,800 Routine Ward Clinical notes with Clinical photograph, Detailed treatment - treatment - None planned line of Discharge Summary packing packing treatment 12 SL008 Functional SL008A Functional Clinical notes Indication Post procedure clinical septo septo 21,800 for this surgery with photograph of affected part; rhinoplasty rhinoplasty supporting medical Detailed Procedure / Operative records, X-ray, MLC/FIR Notes; Detailed discharge for traumatic injuries summary and circumstances of the incident which led to disfigurement, Clinical picture 13 SL009 Septoplasty SL009A Septoplasty Local Indication for this Post procedure clinical 12,000 Anesthesia/Gen surgery with supporting photograph of affected part, eral Anesthesia medical records, Detailed Procedure / Operative None/ "+6000" MLC/FIR for traumatic Notes. Detailed discharge injuries, Endoscopic summary picture/ Clinical picture 14 SL010 Fracture - SL010A Fracture - 8,000 Local MLC/FIR for traumatic Post procedure X-ray, Post setting setting nasal Anesthesia/Gen injuries and procedure clinical photograph nasal bone bone eral Anesthesia circumstances of the of affected part, detailed None/"+4000" incident which led to Procedure / Operative Notes. fracture, X Ray/CT Detailed discharge summary 15 SL011 Inferior SL011A Inferior 5,700 Clinical notes and Intraoperative Stills, Post turbinate turbinate EXAMINATION procedure clinical photograph reduction reduction FINDINGS, of affected part, Detailed under GA under GA nasoendoscopy findings discharge summary Detailed 230 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Procedure / Operative Notes 16 SL012 Open sinus SL012A Open sinus Clinical notes detailing Post procedure Imaging, Post surgery surgery 15,000 chronicity of sinusitis . procedure clinical photograph indications for surgery of affected part. with supporting CTpre- Histopathology,, detailed procedure photograph Procedure / Operative Notes. Intra procedure clinical photograph 17 SL013 Functional SL013A Functional Clinical notes and CT Stills of procedure being done, Endoscopic Endoscopic 11,000 confirming the diagnosis post procedure clinical Sinus (FESS) Sinus (FESS) photograph , Detailed Procedure / Operative Notes, detailed discharge summary 18 SL014 Ant. SL014A Ant. Indications of this Intraoperative photograph, X- Ethmoidal / Ethmoidal 15,000 surgery with clinical ray of clips used, post sphenopala artery evidence (CT) procedure clinical photograph tine artery ligation - of affected part. Detailed ligation Open Procedure / Operative Notes and discharge summary. 19 SL014 Ant. SL014B Ant. Indications of this Intraoperative photograph, X- Ethmoidal / Ethmoidal 15,000 surgery with clinical ray of clips used, post sphenopala artery evidence (CT) procedure clinical photograph tine artery ligation - of affected part. Detailed ligation Endoscopic Procedure / Operative Notes and discharge summary. 20 SL014 Ant. SL014C Sphenopalati Indications of this Intraoperative photograph, X- Ethmoidal / ne artery 15,000 surgery with clinical ray of clips used, post sphenopala ligation - evidence (CT) procedure clinical photograph tine artery Open of affected part. Detailed ligation Procedure / Operative Notes and discharge summary. 21 SL014 Ant. SL014D Sphenopalati Indications of this Intraoperative photograph, X- Ethmoidal / ne artery 15,000 surgery with clinical ray of clips used, post sphenopala ligation - evidence (CT) procedure clinical photograph tine artery Endoscopic of affected part. Detailed ligation Procedure / Operative Notes and discharge summary. 22 SL015 Adenoidect SL015A Adenoidecto 5,000 Clinical notes with Histopathology report, post omy my supporting investigation procedure clinical photograph reports,X Ray Adenoids, of affected part, detailed Clinical Photograph Procedure / Operative Notes. 231 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Detailed discharge summary 23 SL016 Tonsillecto SL016A Tonsillectom 7,500 Indication for surgery Histopathology report, post my y - U/L from treating doctor procedure clinical photograph with supporting case of affected part, detailed history, physical Procedure / Operative Notes examination findings, supporting investigation reports, Clinical Photograph 24 SL016 Tonsillecto SL016B Tonsillectom 7,500 Indication for surgery Histopathology report, post my y - B/L from treating doctor procedure clinical photograph with supporting case of affected part, detailed history, physical Procedure / Operative Notes examination findings, supporting investigation reports, Clinical Photograph 25 SL017 Peritonsillar SL017A Peritonsillar 5,800 Doctor's notes with C/S of pus, post procedure abscess abscess presenting complaints, clinical photograph of affected drainage / drainage duration and physicial part, detailed Procedure / intraoral examination findings of Operative Notes; detailed calculus oral cavity and tonsils, discharge summary removal clinical photograph if possible 26 SL017 Peritonsillar SL017B Intraoral 5,800 Doctor's notes with C/S of pus, post procedure abscess calculus presenting complaints, clinical photograph of affected drainage / removal duration and physicial part, detailed Procedure / intraoral examination findings of Operative Notes; detailed calculus oral cavity and tonsils, discharge summary removal clinical photograph if possible 27 SL018 Thyroglossa SL018A Thyroglossal Clinical notes and pre- Histopathology report, post l / Branchial cyst excision 15,300 operative clincial procedure clinical photograph cyst / sinus photograph of affected part, detailed / fistula Procedure / Operative Notes. excision Detailed discharge summary 28 SL018 Thyroglossa SL018B Thyroglossal Clinical notes and pre- Histopathology report, post l / Branchial sinus excision 15,300 operative clincial procedure clinical photograph cyst / sinus photograph of affected part, detailed / fistula Procedure / Operative Notes. excision Detailed discharge summary 232 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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29 SL018 Thyroglossa SL018C Thyroglossal Clinical notes and pre- Histopathology report, post l / Branchial fistula 15,300 operative clincial procedure clinical photograph cyst / sinus excision photograph of affected part, detailed / fistula Procedure / Operative Notes. excision Detailed discharge summary 30 SL018 Thyroglossa SL018D Branchial Clinical notes and pre- Histopathology report, post l / Branchial sinus excision 15,300 operative clincial procedure clinical photograph cyst / sinus photograph of affected part, detailed / fistula Procedure / Operative Notes. excision Detailed discharge summary 31 SL018 Thyroglossa SL018E Branchial Clinical notes and pre- Histopathology report, post l / Branchial fistula 15,300 operative clincial procedure clinical photograph cyst / sinus excision photograph of affected part, detailed / fistula Procedure / Operative Notes. excision Detailed discharge summary 32 SL019 Uvulopalato SL019A Uvulopalatop Clinical notes and Post procedure clinical pharyngopl haryngoplast 18,600 Polysomnography photograph of affected part, asty (UPPP) y (UPPP) (Sleep Study) + CT/MRI detailed Procedure / Operative Notes; detailed discharge summary 33 SL020 Excision of SL020A Excision of Implant for Excision of CT Scan, Biopsy, Clinical Procedure / Operative tumour of tumour of 10,000 tumour of oral cavity / notes with planned line Notes,Post Procedure oral cavity / oral cavity / paranasal sinus / of treatment, Pre Photograph of affected part, paranasal paranasal laryngopharynx (Max 1) operative Clinical Histopathology report sinus / sinus / 20,000 Photograph of affected laryngophar laryngophary part ynx with or nx without without reconstructio reconstructi n on 34 SL020 Excision of SL020B Excision of CT Scan, Biopsy, Clinical Procedure / Operative tumour of tumour of 36,500 Photograph of affected Notes,Post Procedure oral cavity / oral cavity / part Photograph of affected part, paranasal paranasal Histopathology report sinus / sinus / laryngophar laryngophary ynx with or nx with without pedicled flap reconstructi reconstructio on n 35 SL020 Excision of SL020C Excision of Implant for Excision of CT Scan, Biopsy, Clinical Procedure / Operative 233 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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tumour of tumour of 25,000 tumour of oral cavity / Photograph of affected Notes,Post Procedure oral cavity / oral cavity / paranasal sinus / part Photograph of affected part, paranasal paranasal laryngopharynx (Max 1) Histopathology report sinus / sinus / 20,000 laryngophar laryngophary ynx with or nx with free without flap reconstructi reconstructio on n 36 SL021 Parotidecto SL021A Total CT Scan and FNAC, Histopathology report, post my Parotidectom 28,200 Clinical Photograph of procedure clinical photograph y affected part of affected part, detailed Procedure / Operative Notes and detailed discharge summary. 37 SL021 Parotidecto SL021B Superficial CT Scan, FNAC, Clinical Histopathology report, post my Parotidectom 23,800 Photograph of affected procedure clinical photograph y part of affected part, detailed Procedure / Operative Notes and detailed discharge summary. 38 SL022 Removal of SL022A Removal of 9,000 Local Clinical notes to Histopathology report, post Submandib Submandibul Anesthesia/Gen establigh indication; procedure clinical photograph ular Salivary ar Salivary eral Anesthesia Biopsy if tumour, of affected part, detailed gland gland None/ "+6000" Clinical Photograph of Procedure / Operative Notes; affected part detailed discharge summary 39 SL022 Removal of SL022B Removal of 9,000 Local Clinical notes and Histopathology report, post Submandib Ranula Anesthesia/Gen Clinical photograph, procedure clinical photograph ular Salivary eral Anesthesia MLC/FIR for traumatic of affected part, detailed gland None/ "+6000" injuries and Procedure / Operative Notes; circumstances of the detailed discharge summary incident which led to rupture of salivary duct 40 SL022 Removal of SL022C Removal of 9,000 Local Clinical notes to Histopathology report, post Submandib Submandibul Anesthesia/Gen establigh indication; procedure clinical photograph ular Salivary ar Lymph eral Anesthesia Biopsy if tumour, of affected part, detailed gland node None/ "+6000" Clinical Photograph of operative notes; detailed affected part discharge summary 41 SL023 Rigid SL023A Rigid 7,000 Local Clinical notes with Procedure / Operative laryngoscop laryngoscopy Anesthesia/Gen planned line of Notes,Post Procedure y / - Diagnostic + eral Anesthesia treatment Photograph of affected part, 234 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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bronchosco / - biopsy None/ "+5000" Histopathology report py / oesophagos copy - Diagnostic + / - biopsy 42 SL023 Rigid SL023B Rigid 7,000 Local Clinical notes with Procedure / Operative laryngoscop bronchoscop Anesthesia/Gen planned line of Notes,Post Procedure y / y - eral Anesthesia treatment Photograph of affected part, bronchosco Diagnostic + None/ "+5000" Histopathology report py / / - biopsy oesophagos copy - Diagnostic + / - biopsy 43 SL023 Rigid SL023C Rigid 7,000 Local Clinical notes with Procedure / Operative laryngoscop oesophagosc Anesthesia/Gen planned line of Notes,Post Procedure y / opy - eral Anesthesia treatment Photograph of affected part, bronchosco Diagnostic + None/ "+5000" Histopathology report py / / - biopsy oesophagos copy - Diagnostic + / - biopsy 44 SL024 Microlaryng SL024A Microlarynge Indication for surgery Procedure / Operative eal surgery al surgery 17,000 with supporting Notes,Post Procedure with or with or investigation reports, Photograph of affected part, without without laser laryngoscopy findings Histopathology report laser +/- Laryngeal electromyography 45 SL025 Open SL025A Open 5,000 Implant for Open Clinical notes to Histopathology report in case laryngeal laryngeal laryngeal framework establish indication and of tumours, post procedure framework framework surgery / Thyroplasty justification of surgery; clinical photograph of affected surgery / surgery / (Keel / Stent) (Max 1) Evidence through CT/ part, detailed Procedure / Thyroplasty Thyroplasty 15,000 MRI/ Biopsy, Clinical Operative Notes; Detailed Photograph discharge summary 46 SL026 Tracheosto SL026A Tracheostom 6,000 Local Clinical notes with Procedure / Operative my / y Anesthesia/Gen planned line of Notes,Post Procedure Tracheotom eral Anesthesia treatment justifying Photograph of affected part, y None/ "+4000" indication Histopathology report 47 SL026 Tracheosto SL026B Tracheotomy 6,000 Local Clinical notes with Procedure / Operative 235 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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my / Anesthesia/Gen planned line of Notes,Post Procedure Tracheotom eral Anesthesia treatment justifying Photograph of affected part, y None/ "+4000" indication Histopathology report 48 SL027 Neck SL027A Selective Indication for surgery Histopathology report, Post dissection Benign neck 18,800 with supporting procedure Imaging, post tumour investigation reports (X- procedure clinical photograph excision ray/ CT/MRI), FNAC / of affected part, detailed Biospy in case of Procedure / Operative Notes; tumours, Clinical detailed discharge summary Photograph 49 SL027 Neck SL027B Comprehensi Indication for surgery Histopathology report, Post dissection ve Benign 18,800 with supporting procedure Imaging, post neck tumour investigation reports (X- procedure clinical photograph excision ray/ CT/MRI), FNAC / of affected part, detailed Biospy in case of Procedure / Operative Notes; tumours, Clinical detailed discharge summary Photograph 50 SL027 Neck SL027C Selective Indication for surgery Histopathology report, Post dissection Pharyngeal 18,800 with supporting procedure Imaging, post diverticulum investigation reports (X- procedure clinical photograph excision ray/ CT/MRI), FNAC / of affected part, detailed Biospy in case of Procedure / Operative Notes; tumours, Clinical detailed discharge summary Photograph 51 SL027 Neck SL027D Comprehensi Indication for surgery Histopathology report, Post dissection ve 18,800 with supporting procedure Imaging, post Pharyngeal investigation reports (X- procedure clinical photograph diverticulum ray/ CT/MRI), FNAC / of affected part, detailed excision Biospy in case of Procedure / Operative Notes; tumours, Clinical detailed discharge summary Photograph 52 SL028 Deep neck SL028A Deep neck Clinical notes and C/S of pus, post procedure abscess abscess 16,800 clinical photgraph/ clinical photograph of affected drainage/ drainage investigation supporting part, detailed Procedure / Post trauma diagnosis, CT Operative Notes; detailed neck discharge summary exploration 53 SL028 Deep neck SL028B Post trauma Clinical notes and C/S of pus, post procedure abscess neck 16,800 clinical photgraph/ clinical photograph of affected drainage/ exploration investigation supporting part, detailed Procedure / Post trauma diagnosis, CT Operative Notes; detailed 236 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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neck discharge summary exploration 54 SL029 Anterior SL029A Endoscopic Fibrin Glue (Max 1) Clinical notes with Procedure / Operative skull base CSF 26,000 9,000 planned line of Notes,Post Procedure surgery Rhinorrhea treatment detailing Photograph of affected part Repair aetiology; MLC/ FIR if traumatic. CT to confirm need of surgery 55 SL029 Anterior SL029B Optic nerve Fibrin Glue (Max 1) Clinical notes with Procedure / Operative skull base decompressi 25,500 9,000 planned line of Notes,Post Procedure surgery on treatment detailing Photograph of affected part aetiology; MLC/ FIR if traumatic. CT to confirm need of surgery 56 SL029 Anterior SL029C Orbital Fibrin Glue (Max 1) Clinical notes with Procedure / Operative skull base decompressi 25,500 9,000 planned line of Notes,Post Procedure surgery on treatment detailing Photograph of affected part aetiology; MLC/ FIR if traumatic. CT to confirm need of surgery 57 SL029 Anterior SL029D Craniofacial Fibrin Glue (Max 1) Clinical notes with Procedure / Operative skull base resection 25,500 9,000 planned line of Notes,Post Procedure surgery treatment detailing Photograph of affected part, aetiology; MLC/ FIR if Histopathology report traumatic. CT to confirm need of surgery 58 SL029 Anterior SL029E Maxillary Fibrin Glue (Max 1) Clinical notes with Procedure / Operative skull base swing 25,500 9,000 planned line of Notes,Post Procedure surgery treatment detailing Photograph of affected part aetiology; MLC/ FIR if traumatic. CT to confirm need of surgery 59 SL030 Advanced SL030A Endoscopic Fibrin Glue (Max 1) Clinical notes with Procedure / Operative anterior Hypophysect 39,800 9,000 planned line of Notes,Post Procedure skull base omy treatment and Coronal Photograph of affected part, surgery CT/MRI establishing Histopathology report diagnosis and establishing need of surgery 60 SL030 Advanced SL030B Clival tumour Fibrin Glue (Max 1) Clinical notes with Procedure / Operative anterior excision 39,800 9,000 planned line of Notes,Post Procedure 237 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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skull base treatment and Coronal Photograph of affected part, surgery CT/MRI establishing Histopathology report diagnosis and establishing need of surgery 61 SL031 Lateral skull SL031A Subtotal Fibrin Glue (Max 1) Clinical notes with Procedure / Operative base petrosectom 24,700 9,000 planned line of Notes,Post Procedure procedures y treatment and CT/MRI/ Photograph of affected part, biopsy to establish the Histopathology report indication and justify the surgery. 62 SL031 Lateral skull SL031B Post- Fibrin Glue (Max 1) Clinical notes with Procedure / Operative base traumatic 24,700 9,000 planned line of Notes,Post Procedure procedures facial nerve treatment and CT/MRI/ Photograph of affected part, decompressi biopsy to establish the Histopathology report on indication and justify the surgery. 63 SL031 Lateral skull SL031C CSF Fibrin Glue (Max 1) Clinical notes with Procedure / Operative base Otorrhoea 24,700 9,000 planned line of Notes,Post Procedure procedures repair treatment and CT/MRI/ Photograph of affected part, biopsy to establish the Histopathology report indication and justify the surgery. 64 SL032 Advanced SL032A Fisch Fibrin Glue (Max 1) Clinical notes with Procedure / Operative lateral skull approach 39,900 9,000 planned line of Notes,Post Procedure base treatment and Photograph of affected part, surgery Audiogram report Histopathology report justfying surgery +/- CT- TEMPORAL BONE of affected side /X-RAY BOTH MASTOIDS 65 SL032 Advanced SL032B Translabyrint Fibrin Glue (Max 1) Clinical notes with Procedure / Operative lateral skull hine 39,900 9,000 planned line of Notes,Post Procedure base approach treatment and Photograph of affected part, surgery Audiogram report Histopathology report justfying surgery +/- CT- TEMPORAL BONE of affected side /X-RAY BOTH MASTOIDS 66 SL032 Advanced SL032C Transcochlea Fibrin Glue (Max 1) Clinical notes with Procedure / Operative lateral skull r approach 39,900 9,000 planned line of Notes,Post Procedure 238 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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base treatment and Photograph of affected part, surgery Audiogram report Histopathology report justfying surgery +/- CT- TEMPORAL BONE of affected side /X-RAY BOTH MASTOIDS 67 SL032 Advanced SL032D Temporal Fibrin Glue (Max 1) Clinical notes with Procedure / Operative lateral skull Bone 39,900 9,000 planned line of Notes,Post Procedure base resection treatment and Photograph of affected part, surgery Audiogram report Histopathology report justfying surgery +/- CT- TEMPORAL BONE of affected side /X-RAY BOTH MASTOIDS 68 SL033 Closed SL033A Closed 9,200 MLC/FIR for traumatic Procedure / Operative reduction / reduction for injuries and Notes,Post Procedure intermaxilla fracture of circumstances of the Photograph of affected part, ry fixation maxilla incident which led to Histopathology report for fracture fracture, X Ray/CT of maxilla / mandible / zygoma 69 SL033 Closed SL033B Closed 9,200 MLC/FIR for traumatic Procedure / Operative reduction / reduction for injuries and Notes,Post Procedure intermaxilla fracture of circumstances of the Photograph of affected part, ry fixation mandible incident which led to Histopathology report for fracture fracture, X Ray/CT of maxilla / mandible / zygoma 70 SL033 Closed SL033C Closed 9,200 MLC/FIR for traumatic Procedure / Operative reduction / reduction for injuries and Notes,Post Procedure intermaxilla fracture of circumstances of the Photograph of affected part, ry fixation zygoma incident which led to Histopathology report for fracture fracture, X Ray/CT of maxilla / mandible / zygoma 71 SL033 Closed SL033D Closed 9,200 MLC/FIR for traumatic Procedure / Operative reduction / reduction injuries and Notes,Post Procedure intermaxilla and circumstances of the Photograph of affected part, 239 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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ry fixation Intermaxillar incident which led to Histopathology report for fracture y fixation for fracture, X Ray/CT of maxilla / fracture of mandible / mandible zygoma 72 SL034 Open SL034A Open Single/Multiple Implant for Open MLC/FIR for traumatic Procedure / Operative reduction reduction 18,000 None/"7000" reduction and internal injuries and Notes,Post Procedure and internal and internal fixation of maxilla / circumstances of the Photograph of affected part, fixation of fixation of mandible / zygoma incident which led to Histopathology report maxilla / maxilla (Max 1) fracture, X Ray/CT mandible / 4,000 zygoma 73 SL034 Open SL034B Open Single/Multiple Implant for Open MLC/FIR for traumatic Procedure / Operative reduction reduction 18,000 None/"7000" reduction and internal injuries and Notes,Post Procedure and internal and internal fixation of maxilla / circumstances of the Photograph of affected part, fixation of fixation of mandible / zygoma incident which led to Histopathology report maxilla / mandible (Max 1) fracture, X Ray/CT mandible / 4,000 zygoma 74 SL034 Open SL034C Open Single/Multiple Implant for Open MLC/FIR for traumatic Procedure / Operative reduction reduction 18,000 None/"7000" reduction and internal injuries and Notes,Post Procedure and internal and internal fixation of maxilla / circumstances of the Photograph of affected part, fixation of fixation of mandible / zygoma incident which led to Histopathology report maxilla / zygoma (Max 1) fracture, X Ray/CT mandible / 4,000 zygoma 75 SL035 Clinic based SL035A Turbinate 1,200 Clinical notes with Procedure / Operative therapeutic reduction planned line of Notes,Post Procedure interventio treatment and Photograph of affected part, ns of ENT EXAMINATION Histopathology report FINDINGS, nasoendoscopy findings 76 SL035 Clinic based SL035B Biopsy 1,200 Clinical notes with Procedure / Operative therapeutic planned line of Notes,Post Procedure interventio treatment and Photograph of affected part, ns of ENT EXAMINATION Histopathology report FINDINGS, nasoendoscopy findings 77 SL035 Clinic based SL035C Intratympani 1,200 Clinical notes with Procedure / Operative therapeutic c injections planned line of Notes,Post Procedure interventio treatment and Photograph of affected part, 240 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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ns of ENT EXAMINATION Histopathology report FINDINGS, nasoendoscopy findings 78 SL035 Clinic based SL035D Wide bore 1,200 Clinical notes with Procedure / Operative therapeutic aspiration planned line of Notes,Post Procedure interventio treatment and Photograph of affected part, ns of ENT EXAMINATION Histopathology report FINDINGS, nasoendoscopy findings
17. Pediatric Medical Management
• Total number of packages: 46 • Total number of procedures: 65 • Additional cross specialty procedures: 89 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages for progressive extension of treatment/ hospital stay • Pre-authorization remarks: Prior approval must be taken for all medical conditions/ packages under this domain for progressive extension of therapeutic treatments (i.e. for extending stay at 1,5,10 days stay and beyond) • All clinical test reports, diagnosis, TPR charting, case sheet/ clinical notes and discharge summary need to be submitted for extension of packages and during claims submission • Separate package for high end radiological diagnostic (CT, MRI, Imaging including nuclear imaging,) relevant to the illness only (no standalone diagnostics allowed) - subject to pre- authorization with a cap of Rs 5000 per family per annum within overall sum insured. • Separate package for high end histopathology (Biopsies) and advanced serology investigations relevant to the illness only after preauthorization with a cap of Rs 5000 per family per annum within overall sum insured. • Blood or Blood components transfusion if required, payable separately subject to pre- authorization. Blood can be procured only through licensed blood banks as per National Blood Transfusion Council Guidelines. • If a medical condition requiring hospitalization has not been envisaged under this list then a pre- authorization can be sought as “Unspecified Medical” S. Package AB PM - JAY Procedure AB PM - JAY Package Stratification Mandatory Documents - Mandatory Documents No. Code Package Name Code Procedure Name Price Pre Authorization - Claim Processing HBP 2.0 HBP 2.0
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1 MP001 Febrile seizures / MP001A Febrile seizures 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, other seizures Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All 1st seizure or past history investigations reports. 2 MP001 Febrile seizures / MP001B Flury of seizures 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, other seizures Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All 1st seizure or past history investigations reports. 3 MP001 Febrile seizures / MP001C Neurocysticercosis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, other seizures Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All 1st seizure or past history investigations reports. 4 MP001 Febrile seizures / MP001D Epilepsy 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, other seizures Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All 1st seizure or past history investigations reports. 5 MP002 Epileptic MP002A Epileptic 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalopathy encephalopathy Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All past h/o epilpesy investigations reports. 6 MP003 Acute encephalitis MP003A Infectious - 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, uncomplicated Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 7 MP003 Acute encephalitis MP003B Immune-mediated - 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, uncomplicated Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 242 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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8 MP004 Acute encephalitis MP004A Acute encephalitis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, syndrome syndrome Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 9 MP005 Acute meningo MP005A Acute meningo 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalitis / aseptic encephalitis Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic encephalopathy / brain abcess 10 MP005 Acute meningo MP005B Aseptic meningitis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalitis / aseptic Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic encephalopathy / brain abcess 11 MP005 Acute meningo MP005C Febrile 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalitis / aseptic encephalopathy Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic encephalopathy / brain abcess 12 MP005 Acute meningo MP005D Hypertensive 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, 243 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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encephalitis / aseptic encehalopathy Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic encephalopathy / brain abcess 13 MP005 Acute meningo MP005E Metabolic 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalitis / aseptic encephalopathy Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic encephalopathy / brain abcess 14 MP005 Acute meningo MP005F Hepatic 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalitis / aseptic encephalopathy Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic encephalopathy / brain abcess 15 MP005 Acute meningo MP005G Brain abcess 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, encephalitis / aseptic Without Ventilator/ICU - history and Admission Treatment details, meningitis / febrile With Ventilator notes showing vitals and detailed discharge encephalopathy / None/2700/3600/4500 examination findings; any summary, All hypertensive investigations done; investigations reports. encehalopathy / planned line of metabolic management encephalopathy / hepatic 244 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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encephalopathy / brain abcess 16 MP006 Meningitis MP006A Chronic meningitis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 17 MP006 Meningitis MP006B Partially treated 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, pyogenic meningitis Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 18 MP006 Meningitis MP006C Neuro tuberculosis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 19 MP006 Meningitis MP006D Complicated bacterial 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, meningitis Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 20 MP006 Meningitis MP006E Acute meningitis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of 245 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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management 21 MP007 Optic neuritis MP007A Optic neuritis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 fundus findings & summary, All photograph; planned line investigations reports. management; 22 MP008 Medical Management MP008A After Decompressive 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, for Raised intracranial craniotomy / Without Ventilator/ICU - history and Admission Treatment details, pressure After Shunt With Ventilator notes showing vitals and detailed discharge procedure / None/2700/3600/4500 examination findings (incl summary, All After other neurological examination); investigations reports. emergency neuro any investigations done; surgical procedures / planned line of For ICP monitoring management 23 MP009 Intracranial MP009A Intracranial 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, hemorrhage hemorrhage Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 24 MP010 Intracranial space MP010A Intracranial space 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, occupying lesion occupying lesion Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 25 MP011 Intracranial ring MP011A Intracranial ring 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, enhancing lesion with enhancing lesion with Without Ventilator/ICU - history and Admission Treatment details, complication complication With Ventilator notes showing vitals and detailed discharge (tuberculoma) (tuberculoma) None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 26 MP012 Cerebral herniation MP012A Cerebral herniation 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge 246 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 27 MP013 Acute MP013A Acute 1,800 Routine Ward/HDU/ICU - Clinical notes with planned Detailed ICPs (daily neuroregression / neuroregression / Without Ventilator/ICU - line of treatment (incl birth Treatment details), Acute worsening in Acute worsening in With Ventilator & past history), Procedure / Operative neuro metabolic and neuro metabolic and None/2700/3600/4500 Investigation Reports Notes (if applicable), neurodegenerative neurodegenerative supporting diagnosis Detailed Discharge conditions conditions (including CT head), Summary, All Planned line of treatment investigations reports. 28 MP014 Acute demyelinating MP014A Acute demyelinating 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, myelopathy myelopathy Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 29 MP015 Juvenile myasthenia MP015A Juvenile myasthenia 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 30 MP016 Acute ataxia MP016A Acute ataxia 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 31 MP017 Acute ischemic stroke MP017A Acute ischemic stroke 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 247 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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32 MP018 Wheezing MP018A Wheezing 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management summary, All investigations reports. 33 MP019 Chronic cough MP019A Chronic cough 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and earlier Treatment details, With Ventilator Treatment done and detailed discharge None/2700/3600/4500 Admission notes showing summary, All vitals; planned line investigations reports. management 34 MP020 Acute urticaria / MP020A Acute urticaria 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Anaphylaxis acute Without Ventilator/ICU - history and Admission Treatment details, asthma With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All specify the trigger investigations reports. 35 MP020 Acute urticaria / MP020B Anaphylaxis acute 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Anaphylaxis acute asthma Without Ventilator/ICU - history and Admission Treatment details, asthma With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All specify the trigger investigations reports. 36 MP021 Acute abdomen MP021A Acute abdomen 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 37 MP022 Celiac disease MP022A Celiac disease 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 38 MP023 Unexplained MP023A Unexplained 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, hepatosplenomegaly hepatosplenomegaly Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of 248 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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management 39 MP024 Infantile cholestasis MP024A Infantile cholestasis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 40 MP025 Acute MP025A Acute 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, glomerulonephritis glomerulonephritis Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals; detailed discharge None/2700/3600/4500 planned line management; summary, All investigations done investigations reports. 41 MP026 Nephrotic syndrome MP026A Nephrotic syndrome 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, with peritonitis with peritonitis Without Ventilator/ICU - history including past Treatment details, With Ventilator history, examination detailed discharge None/2700/3600/4500 findindgs, investigations summary, All done and Admission notes investigations reports. showing vitals; planned line management 42 MP027 Haemolytic uremic MP027A Haemolytic uremic 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, syndrome syndrome Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 43 MP028 CRRT MP028A CRRT 8,000 Clinical notes detailing Detailed ICPs, history and Admission Treatment details, notes showing vitals and detailed discharge examination findings; any summary, All investigations done; investigations reports. planned line of management 44 MP029 Global developmental MP029A Global developmental 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, delay / Intellectual delay Without Ventilator/ICU - birth and subsequent Treatment details, disability of unknown With Ventilator history and Admission detailed discharge etiology None/2700/3600/4500 notes showing vitals; summary, All planned line management investigations reports. 45 MP029 Global developmental MP029B Intellectual disability 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, delay / Intellectual of unknown etiology Without Ventilator/ICU - birth and subsequent Treatment details, 249 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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disability of unknown With Ventilator history and Admission detailed discharge etiology None/2700/3600/4500 notes showing vitals; summary, All planned line management investigations reports. 46 MP030 Rickets - requiring MP030A Rickets - requiring 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, admission for Work admission for Work Without Ventilator/ICU - history, investigations done Treatment details, Up Up With Ventilator and Admission notes detailed discharge None/2700/3600/4500 showing vitals; planned line summary, All management investigations reports. 47 MP031 Acute severe MP031A Acute severe 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, malnutrition malnutrition Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 48 MP032 Developmental and MP032A Developmental and 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, behavioral disorders behavioral disorders Without Ventilator/ICU - history and examination Treatment details, With Ventilator findings. Admission notes detailed discharge None/2700/3600/4500 showing neurological summary, All examination; any investigations reports. investigations done, planned line management 49 MP033 Short stature MP033A Short stature 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - histor, parent's height and Treatment details, With Ventilator Admission notes showing detailed discharge None/2700/3600/4500 vitals; planned line summary, All management investigations reports. 50 MP034 Dysmorphic children MP034A Dysmorphic children 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history, investigations done Treatment details, With Ventilator and Admission notes detailed discharge None/2700/3600/4500 showing vitals; planned line summary, All management investigations reports. 51 MP035 Floppy infant MP035A Floppy infant 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management 52 MP036 Inborn errors of MP036A Inborn errors of 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, 250 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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metabolism metabolism Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 53 MP037 Wilson’s disease MP037A Wilson’s disease 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 54 MP038 Rheumatoid arthritis MP038A Rheumatoid arthritis 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 55 MP039 Rheumatic fever MP039A Rheumatic fever 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 56 MP040 Cyanotic spells MP040A Cyanotic spells 1,800 Routine Ward/HDU/ICU - Clinical notes with planned Detailed ICPs (daily Without Ventilator/ICU - line of treatment (incl birth Treatment details), With Ventilator & past history), Detailed Discharge None/2700/3600/4500 Investigation Reports Summary, All supporting diagnosis investigations reports. (including ABG), Planned line of treatment 57 MP040 Cyanotic spells MP040B Cyanotic spells with 1,800 Routine Ward/HDU/ICU - Clinical notes with planned Detailed ICPs (daily CHD Without Ventilator/ICU - line of treatment (incl birth Treatment details), With Ventilator & past history), Detailed Discharge None/2700/3600/4500 Investigation Reports Summary, All supporting diagnosis investigations reports (including ECHO, ABG), (including 2D echo). Planned line of treatment 251 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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58 MP040 Cyanotic spells MP040C Cyanotic spells with 1,800 Routine Ward/HDU/ICU - Clinical notes with planned Detailed ICPs (daily Chest infection Without Ventilator/ICU - line of treatment (incl birth Treatment details), Post With Ventilator & past history) treatment CBC and X- None/2700/3600/4500 Investigation Reports ray chest, Detailed supporting diagnosis Discharge summary (including CBC, X-ray chest), Planned line of treatment 59 MP040 Cyanotic spells MP040D Cyanotic spells with 1,800 Routine Ward/HDU/ICU - Clinical notes with planned Detailed ICPs (daily Sepsis Without Ventilator/ICU - line of treatment (incl birth Treatment details), Post With Ventilator & past history), treatment CBC, and None/2700/3600/4500 Investigation Reports Radiological supporting diagnosis investigations, Detailed (including CBC, ABG, Discharge summary Radiological investigations), Planned line of treatment 60 MP041 Immune haemolytic MP041A Immune haemolytic 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, anemia anemia Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 61 MP042 Idiopathic MP042A Idiopathic 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Thrombocytopenic Thrombocytopenic Without Ventilator/ICU - history and Admission Treatment details, Purpura Purpura With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 62 MP043 Kawasaki Disease MP043A Kawasaki Disease 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history and Admission Treatment details, With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings; any summary, All investigations done; investigations reports. planned line of management 63 MP044 Steven Johnson MP044A Steven Johnson 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, syndrome syndrome Without Ventilator/ICU - history (incl drug intake Treatment details, With Ventilator history) and Admission detailed discharge None/2700/3600/4500 notes showing vitals and summary, All 252 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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examination findings; any investigations reports. investigations done; planned line of management 64 MP045 Trauma MP045A Trauma 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, Without Ventilator/ICU - history / examination Treatment details, With Ventilator findings describing trauma; detailed discharge None/2700/3600/4500 MLC/ FIR; and Admission summary, All notes showing vitals; investigations reports. planned line management 65 MP046 Ketogenic diet MP046A Ketogenic diet 1,800 Routine Ward/HDU/ICU - Clinical notes detailing Detailed ICPs, initiation in refractory initiation in refractory Without Ventilator/ICU - history and Admission Treatment details, epilepsy epilepsy With Ventilator notes showing vitals and detailed discharge None/2700/3600/4500 examination findings (incl summary, All neurological examination); investigations reports. any investigations done; planned line of management
18. Radiation Oncology
• Total number of packages: 14 • Total number of procedures: 35 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Prior approval must be taken for all treatments/ malignancies • The type and duration of treatment is different for all cancers. It is very important to complete the entire treatment which may in some cases last longer than a year. Relapse/recurrence may sometimes occur • Cancer care treatments are advised to go through a clinical treatment approval process before initiating the best suitable treatment. A clinical treatment approval process is mandated for cancer care, since it involves a multi-modal approach covering surgical, chemotherapy and radiation treatments and appropriate supportive care that could assess to determine the best course of patient management for such conditions • There should be pre-authorization at each step for cancer care 253 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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• It is advised that decision regarding appropriate patient care for cancer care treatments would need to be taken by a multidisciplinary tumor board (if available within the treating hospital or if not then it could be sent to the nearest regional cancer center (RCC) for approval) that should include a highly trained team of Surgical, Radiation and Medical Oncologist in order to ensure the most appropriate treatment for the patient. A detailed Oncology Treatment Plan could prove to be very vital, such as implications on the financial cover and to avoid unnecessary treatments S. Package AB PM - JAY Procedure AB PM - JAY Package Implant Mandatory Documents - Mandatory Documents - No. Code Package Name Code Procedure Price Pre Authorization Claim Processing HBP 2.0 HBP 2.0 Name 1 MR001 2D External Beam MR001A Radical Additional fraction for 2D HPE report, Clinical notes Detailed Discahrge Radiotherapy (6 11,000 External Beam with planned line of Summary (with RT Fractions) (Inclusive of Radiotherapy (Max 18) treatment (documents treatment and doses Simulation & Planning 500 confirming the Procedure given) Cost) indicated and details of RT treatment plan). 2 MR001 2D External Beam MR001B Adjuvant Additional fraction for 2D HPE report, Clinical notes Detailed Discahrge Radiotherapy (6 11,000 External Beam with planned line of Summary (with RT Fractions) (Inclusive of Radiotherapy (Max 18) treatment (documents treatment and doses Simulation & Planning 500 confirming the Procedure given) Cost) indicated and details of RT treatment plan). 3 MR001 2D External Beam MR001C Neoadjuvant Additional fraction for 2D HPE report, Clinical notes Detailed Discahrge Radiotherapy (6 11,000 External Beam with planned line of Summary (with RT Fractions) (Inclusive of Radiotherapy (Max 18) treatment (documents treatment and doses Simulation & Planning 500 confirming the Procedure given) Cost) indicated and details of RT treatment plan). 4 MR002 2D External Beam MR002A Palliative HPE report, Clinical notes Detailed Discahrge Radiotherapy - Palliative 10,000 with planned line of Summary (with RT (Upto 10 Fractions) treatment (documents treatment and doses (Inclusive of Simulation confirming the Procedure given) & Planning Cost) indicated and details of RT treatment plan). 5 MR003 2D External Beam MR003A Radical Additional fraction for 2D HPE report, Clinical notes Detailed Discahrge Radiotherapy (25 20,000 External Beam with planned line of Summary (with RT Fractions) (Inclusive of Radiotherapy (Max 10) treatment (documents treatment and doses Simulation & Planning 500 confirming the Procedure given) Cost) indicated and details of RT treatment plan). 6 MR003 2D External Beam MR003B Adjuvant Additional fraction for 2D HPE report, Clinical notes Detailed Discahrge Radiotherapy (25 20,000 External Beam with planned line of Summary (with RT 254 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Fractions) (Inclusive of Radiotherapy (Max 10) treatment (documents treatment and doses Simulation & Planning 500 confirming the Procedure given) Cost) indicated and details of RT treatment plan). 7 MR003 2D External Beam MR003C Neoadjuvant Additional fraction for 2D HPE report, Clinical notes Detailed Discahrge Radiotherapy (25 20,000 External Beam with planned line of Summary (with RT Fractions) (Inclusive of Radiotherapy (Max 10) treatment (documents treatment and doses Simulation & Planning 500 confirming the Procedure given) Cost) indicated and details of RT treatment plan). 8 MR004 Linear Accelerator, MR004A Radical Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 21,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy 3D CRT (6 Beam Radiotherapy 3D CRT treatment (documents treatment and doses Fractions) (Max 18) confirming the Procedure given) (Inclusive of Simulation 1,000 indicated and details of RT & Planning Cost) treatment plan). 9 MR004 Linear Accelerator, MR004B Adjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 21,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy 3D CRT (6 Beam Radiotherapy 3D CRT treatment (documents treatment and doses Fractions) (Max 18) confirming the Procedure given) (Inclusive of Simulation 1,000 indicated and details of RT & Planning Cost) treatment plan). 10 MR004 Linear Accelerator, MR004C Neoadjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 21,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy 3D CRT (6 Beam Radiotherapy 3D CRT treatment (documents treatment and doses Fractions) (Max 18) confirming the Procedure given) (Inclusive of Simulation 1,000 indicated and details of RT & Planning Cost) treatment plan). 11 MR005 Linear Accelerator, MR005A Radical Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 40,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy 3D CRT Beam Radiotherapy 3D CRT treatment (documents treatment and doses (25 Fractions) (Max 10) confirming the Procedure given) (Inclusive of Simulation 1,000 indicated and details of RT & Planning Cost) treatment plan). 12 MR005 Linear Accelerator, MR005B Adjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 40,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy 3D CRT Beam Radiotherapy 3D CRT treatment (documents treatment and doses (25 Fractions) (Max 10) confirming the Procedure given) (Inclusive of Simulation 1,000 indicated and details of RT & Planning Cost) treatment plan). 13 MR005 Linear Accelerator, MR005C Neoadjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge 255 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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External Beam 40,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy 3D CRT Beam Radiotherapy 3D CRT treatment (documents treatment and doses (25 Fractions) (Max 10) confirming the Procedure given) (Inclusive of Simulation 1,000 indicated and details of RT & Planning Cost) treatment plan). 14 MR006 Linear Accelerator, MR006A Radical Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 70,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy IMRT Beam Radiotherapy IMRT treatment (documents treatment and doses (Intensity Modulated (Max 15) confirming the Procedure given) Radiotherapy) 2,000 indicated and details of RT (20 Fractions) treatment plan). (Inclusive of Simulation & Planning Cost) 15 MR006 Linear Accelerator, MR006B Adjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 70,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy IMRT Beam Radiotherapy IMRT treatment (documents treatment and doses (Intensity Modulated (Max 15) confirming the Procedure given) Radiotherapy) 2,000 indicated and details of RT (20 Fractions) treatment plan). (Inclusive of Simulation & Planning Cost) 16 MR006 Linear Accelerator, MR006C Neoadjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 70,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy IMRT Beam Radiotherapy IMRT treatment (documents treatment and doses (Intensity Modulated (Max 15) confirming the Procedure given) Radiotherapy) 2,000 indicated and details of RT (20 Fractions) treatment plan). (Inclusive of Simulation & Planning Cost) 17 MR007 Linear Accelerator, MR007A Radical Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 42,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy IMRT Beam Radiotherapy IMRT treatment (documents treatment and doses (Intensity Modulated (Max 18) confirming the Procedure given) Radiotherapy) 2,000 indicated and details of RT (6 Fractions) treatment plan). (Inclusive of Simulation & Planning Cost) 18 MR007 Linear Accelerator, MR007B Adjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 42,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy IMRT Beam Radiotherapy IMRT treatment (documents treatment and doses (Intensity Modulated (Max 18) confirming the Procedure given) 256 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Radiotherapy) 2,000 indicated and details of RT (6 Fractions) treatment plan). (Inclusive of Simulation & Planning Cost) 19 MR007 Linear Accelerator, MR007C Neoadjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 42,000 Linear Accelerator, External with planned line of Summary (with RT Radiotherapy IMRT Beam Radiotherapy IMRT treatment (documents treatment and doses (Intensity Modulated (Max 18) confirming the Procedure given) Radiotherapy) 2,000 indicated and details of RT (6 Fractions) treatment plan). (Inclusive of Simulation & Planning Cost) 20 MR008 Linear Accelerator MR008A Radical Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 90,000 Linear Accelerator External with planned line of Summary (with RT Radiotherapy IGRT Beam Radiotherapy IGRT treatment (documents treatment and doses (Image Guided with 3D CRT or IMRT (Max confirming the Procedure given) radiotherapy) with 3D 15) indicated and details of RT CRT or IMRT 2,500 treatment plan). (20 Fractions) (Inclusive of Simulation & Planning Cost) 21 MR008 Linear Accelerator MR008B Adjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 90,000 Linear Accelerator External with planned line of Summary (with RT Radiotherapy IGRT Beam Radiotherapy IGRT treatment (documents treatment and doses (Image Guided with 3D CRT or IMRT (Max confirming the Procedure given) radiotherapy) with 3D 15) indicated and details of RT CRT or IMRT 2,500 treatment plan). (20 Fractions) (Inclusive of Simulation & Planning Cost) 22 MR008 Linear Accelerator MR008C Neoadjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 90,000 Linear Accelerator External with planned line of Summary (with RT Radiotherapy IGRT Beam Radiotherapy IGRT treatment (documents treatment and doses (Image Guided with 3D CRT or IMRT (Max confirming the Procedure given) radiotherapy) with 3D 15) indicated and details of RT CRT or IMRT 2,500 treatment plan). (20 Fractions) (Inclusive of Simulation & Planning Cost) 23 MR009 Linear Accelerator MR009A Radical Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 55,000 Linear Accelerator External with planned line of Summary (with RT 257 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Radiotherapy IGRT Beam Radiotherapy IGRT treatment (documents treatment and doses (Image Guided with 3D CRT or IMRT (Max confirming the Procedure given) radiotherapy) with 3D 18) indicated and details of RT CRT or IMRT 2,500 treatment plan). (6 Fractions) (Inclusive of Simulation & Planning Cost) 24 MR009 Linear Accelerator MR009B Adjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 55,000 Linear Accelerator External with planned line of Summary (with RT Radiotherapy IGRT Beam Radiotherapy IGRT treatment (documents treatment and doses (Image Guided with 3D CRT or IMRT (Max confirming the Procedure given) radiotherapy) with 3D 18) indicated and details of RT CRT or IMRT 2,500 treatment plan). (6 Fractions) (Inclusive of Simulation & Planning Cost) 25 MR009 Linear Accelerator MR009C Neoadjuvant Additional Fraction for HPE report, Clinical notes Detailed Discahrge External Beam 55,000 Linear Accelerator External with planned line of Summary (with RT Radiotherapy IGRT Beam Radiotherapy IGRT treatment (documents treatment and doses (Image Guided with 3D CRT or IMRT (Max confirming the Procedure given) radiotherapy) with 3D 18) indicated and details of RT CRT or IMRT 2,500 treatment plan). (6 Fractions) (Inclusive of Simulation & Planning Cost) 26 MR010 SRT / SBRT with IGRT MR010A SRT / SBRT Additional Fraction for SRT/ HPE report, Clinical notes Detailed Discahrge (Stereotacatic with IGRT 82,000 SBRT with IGRT (Max 4) with planned line of Summary (with RT radiotherapy) (Stereotacatic 11,000 treatment (documents treatment and doses (4 Fractions) radiotherapy) confirming the Procedure given) (Inclusive of Simulation indicated and details of RT & Planning Cost) treatment plan). 27 MR011 SRS with IGRT MR011A SRS with IGRT Biopsy/ HPE report of Detailed Discahrge (Stereotacatic (Stereotacatic 70,000 malignancy; justification of Summary (with RT radiotherapy) radiotherapy) SRS? treatment and doses (Inclusive of Simulation given) & Planning Cost) 28 MR012 Respiratory Gating MR012A Respiratory Additional Fraction for Clinical notes and Detailed Discahrge along with Linear Gating along 65,000 Respiratory Gating along Documentary evidence Summary (with RT Accelerator planning (5 with Linear with Linear Accelerator confirming the need of treatment and doses Fractions) Accelerator planning (Max 10) Respiratory-gated given) (Inclusive of Simulation planning 3,500 radiotherapy (tumours that 258 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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& Planning Cost) move with respiration during radiotherapy (lung, breast and upper abdominal tumpurs) 29 MR013 Brachytherapy High MR013A Intracavitory HPE report, Clinical notes Detailed Discahrge Dose Radiation 3,500 with planned line of Summary (with RT treatment (documents treatment and doses confirming the Procedure given) indicated and details of RT treatment plan). 30 MR013 Brachytherapy High MR013B Intraluminal HPE report, Clinical notes Detailed Discahrge Dose Radiation 3,500 with planned line of Summary (with RT treatment (documents treatment and doses confirming the Procedure given) indicated and details of RT treatment plan). 31 MR013 Brachytherapy High MR013C Endobiliary HPE report, Clinical notes Detailed Discahrge Dose Radiation 3,500 with planned line of Summary (with RT treatment (documents treatment and doses confirming the Procedure given) indicated and details of RT treatment plan). 32 MR013 Brachytherapy High MR013D Endobronchial HPE report, Clinical notes Detailed Discahrge Dose Radiation 3,500 with planned line of Summary (with RT treatment (documents treatment and doses confirming the Procedure given) indicated and details of RT treatment plan). 33 MR013 Brachytherapy High MR013E CVS HPE report, Clinical notes Detailed Discahrge Dose Radiation 3,500 with planned line of Summary (with RT treatment (documents treatment and doses confirming the Procedure given) indicated and details of RT treatment plan). 34 MR014 Brachytherapy High MR014A Interstitial Additional Fraction for HPE report, Clinical notes Detailed Discahrge Dose Radiation (5 42,000 Brachytherapy High Dose with planned line of Summary (with RT doses) Radiation (Max 15) treatment (documents treatment and doses (Inclusive of Simulation, 1,250 confirming the Procedure given) Planning Cost, OT & indicated and details of RT other charges ) treatment plan). 35 MR014 Brachytherapy High MR014B Surface Mould Additional Fraction for HPE report, Clinical notes Detailed Discahrge 259 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Dose Radiation (5 42,000 Brachytherapy High Dose with planned line of Summary (with RT doses) Radiation (Max 15) treatment (documents treatment and doses (Inclusive of Simulation, 1,250 confirming the Procedure given) Planning Cost, OT & indicated and details of RT other charges ) treatment plan).
19. Surgical Oncology
• Total number of packages: 76 • Total number of procedures: 120 • Additional cross specialty procedures: 109 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Prior approval must be taken for all treatments/ malignancies • The type and duration of treatment is different for all cancers. It is very important to complete the entire treatment which may in some cases last longer than a year. Relapse/recurrence may sometimes occur
• Cancer care treatments are advised to go through a clinical treatment approval process before initiating the best suitable treatment. A clinical treatment approval process is mandated for cancer care, since it involves a multi-modal approach covering surgical, chemotherapy and radiation treatments and appropriate supportive care that could assess to determine the best course of patient management for such conditions • There should be pre-authorization at each step for cancer care • It is advised that decision regarding appropriate patient care for cancer care treatments would need to be taken by a multidisciplinary tumor board (if available within the treating hospital or if not then it could be sent to the nearest regional cancer center (RCC) for approval) that should include a highly trained team of Surgical, Radiation and Medical Oncologist in order to ensure the most appropriate treatment for the patient. A detailed Oncology Treatment Plan could prove to be very vital, such as implications on the financial cover and to avoid unnecessary treatments S. No. Package AB PM - JAY Procedur AB PM - JAY Package Implant Mandatory Documents - Pre Mandatory Documents - Claim Code Package Name e Code Procedure Name Price Authorization Processing HBP 2.0 HBP 2.0 1 SC001 Glossectomy SC001A Hemiglossectomy 24,000 Clinical notes with planned line Procedure / Operative Notes, of treatment and FNAC/ Post Procedure Photographs of BIOPSY, CECT surgical site, HPE report, 260 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Detailed Discharge Summary 2 SC001 Glossectomy SC001B Total Glossectomy 30,000 Clinical notes with planned line Procedure / Operative Notes, of treatment and FNAC/ Post Procedure Photographs of BIOPSY, CECT surgical site, HPE report, Detailed Discharge Summary 3 SC002 Palatectomy SC002A Soft palate 20,000 Clinical notes, Biopsy and detailed Procedure / Operative clinical photograph +/- CT/ Notes, Clinical photgraph MRI showing scar, detailed discharge summary, HPE 4 SC002 Palatectomy SC002B Hard palate 20,000 Clinical notes, Biopsy and detailed Procedure / Operative clinical photograph +/- CT/ Notes, Clinical photgraph MRI showing scar, detailed discharge summary, HPE 5 SC003 Maxillectomy SC003A Partial 27,000 Clinical notes and Biopsy, CECT detailed Procedure / Operative Notes, Clinical Photograph showing scar, HPE report, Detailed discharge summary 6 SC003 Maxillectomy SC003B Radical 33,000 Clinical notes and Biopsy, CECT detailed Procedure / Operative Notes, Clinical Photograph showing scar, HPE report, Detailed Discharge summary 7 SC003 Maxillectomy SC003C Total 30,000 Clinical notes and Biopsy, CECT detailed Procedure / Operative Notes, Clinical Photograph showing scar, HPE report, Detailed Discharge summary 8 SC004 Composite SC004A Composite 40,000 Clinical notes, Biopsy, CT detailed Procedure / Operative resection (Oral resection (Oral reports and clinical Notes, Clinical Photograph Cavity) Cavity) photograph showing scar, HPE report, detailed discharge summary 9 SC005 Oesophageal / SC005A Oesophageal 45,000 Oesophageal Clinical notes and CECT, OGD Barcode of Stent; Detailed Tracheal stenting stenting stent (Max 1) Scopy Procedure / Operative Notes, Detailed Discharge summary. 10 SC005 Oesophageal / SC005B Tracheal stenting 45,000 Tracheal stent Clinical notes and CECT, OGD Barcode of Stent; Detailed Tracheal stenting (Max 1) Scopy Procedure / Operative Notes,Detailed Discharge summary 11 SC006 Transthoracic SC006A Open 60,000 Clinical notes with planned line Procedure / Operative Notes, esophagectomy: 2F of treatment and FNAC/ Post Procedure Photographs of / 3F BIOPSY, CECT surgical site, HPE report, Detailed Discharge Summary
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12 SC006 Transthoracic SC006B MIS 60,000 Clinical notes with planned line Procedure / Operative Notes, esophagectomy: 2F of treatment and FNAC/ Post Procedure Photographs of / 3F BIOPSY, CECT surgical site, HPE report, Detailed Discharge Summary 13 SC007 Gastric pull-up / SC007A Gastric pull-up / 36,000 Clinical notes with planned line Procedure / Operative Notes, Jejunal Graft Jejunal Graft of treatment and FNAC/ Post Procedure Photographs of BIOPSY, CECT surgical site, HPE report, Detailed Discharge Summary 14 SC008 Radical Small Bowel SC008A Open 33,000 Clinical notes with planned line Procedure / Operative Notes, Resection of treatment and FNAC/ Post Procedure Photographs of BIOPSY, CECT surgical site, HPE report, Detailed Discharge Summary 15 SC008 Radical Small Bowel SC008B Lap. 33,000 Clinical notes with planned line Procedure / Operative Notes, Resection of treatment and FNAC/ Post Procedure Photographs of BIOPSY, CECT surgical site, HPE report, Detailed Discharge Summary 16 SC009 Intersphincteric SC009A Open 40,200 Clinical notes with planned line Procedure / Operative Notes, resection of treatment and FNAC/ HPE report, Detailed Discharge BIOPSY, CECT Summary 17 SC009 Intersphincteric SC009B Lap. 40,200 Clinical notes with planned line Procedure / Operative Notes, resection of treatment and FNAC/ HPE report, Detailed Discharge BIOPSY, CECT Summary 18 SC010 Surgery for SC010A Abdominal wall 25,000 Clinical notes and CT abdomen detailed Procedure / Operative Abdominal wall tumour resection reports; biopsy Notes, Clinical Photograph tumour showing scar, HPE report; detailed discharge summary 19 SC010 Surgery for SC010B Abdominal wall 39,000 Clinical notes and CT abdomen detailed Procedure / Operative Abdominal wall tumour resection reports; biopsy Notes, Clinical Photograph tumour with reconstruction showing scar, HPE report; detailed discharge summary 20 SC011 Exploratory SC011A Exploratory 30,000 Clinical notes with planned line Procedure / Operative Notes, laparotomy f / b laparotomy f / b of treatment, CECT Post Procedure Photographs of diversion stoma / diversion stoma surgical site, HPE report, bypass Detailed Discharge Summary 21 SC011 Exploratory SC011B Exploratory 30,000 Clinical notes with planned line Procedure / Operative Notes, laparotomy f / b laparotomy f / b of treatment, CECT Post Procedure Photographs of diversion stoma / diversion bypass surgical site, HPE report, bypass Detailed Discharge Summary 22 SC012 Abdominoperineal SC012A Open 39,600 Clinical notes with planned line Procedure / Operative Notes, resection of treatment, HPE HPE report, Detailed Discharge
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Summary 23 SC012 Abdominoperineal SC012B Lap. 39,600 Clinical notes with planned line Procedure / Operative Notes, resection of treatment, HPE HPE report, Detailed Discharge Summary 24 SC013 Omentectomy SC013A Omentectomy 21,000 Clinical notes with planned line Procedure / Operative Notes, of treatment, HPE Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 25 SC014 Procedures SC014A Procedures 35,000 Clinical notes with planned line Procedure / Operative Notes, Requiring Bypass Requiring Bypass of treatment, HPE Post Procedure Photographs of Techniques Techniques surgical site, HPE report, Detailed Discharge Summary 26 SC015 Segmentectomy - SC015A Segmentectomy - 50,000 Clinical notes and Biopsy, detailed Procedure / Operative hepatobiliary hepatobiliary CECT/ MRI Notes, Clinical Photograph system system showing scar, HPE report; detailed discharge summary 27 SC016 Radical / Revision SC016A Radical 39,600 Clinical notes and CECT/MRI detailed Procedure / Operative Cholecystectomy reports; biopsy Notes, Clinical Photograph showing scar, HPE report; detailed discharge summary 28 SC016 Radical / Revision SC016B Revision 39,600 Clinical notes and CECT/MRI detailed Procedure / Operative Cholecystectomy reports; biopsy Notes, Clinical Photograph showing scar, HPE report; detailed discharge summary 29 SC017 Enucleation of SC017A Enucleation of 39,600 Clinical notes and CECT/ MRI & detailed Procedure / Operative pancreatic pancreatic biopsy and IHC report Notes, Clinical Photograph neoplasm neoplasm showing scar, HPE report, detailed discharge summary 30 SC018 Hepatoblastoma SC018A Hepatoblastoma 52,200 Clinical notes with planned line Procedure / Operative Notes, Excision Excision of treatment, HPE, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 31 SC019 Hemipelvectomy - SC019A Hemipelvectomy - 54,000 Clinical notes with planned line Procedure / Operative Notes, Internal Internal of treatment, HPE, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 32 SC020 Pelvic Exenteration SC020A Anterior - Open 58,800 Clinical notes with planned line Procedure / Operative Notes, of treatment, HPE, CT HPE report, Detailed Discharge Summary 33 SC020 Pelvic Exenteration SC020B Anterior - Lap. 58,800 Clinical notes with planned line Procedure / Operative Notes,
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of treatment, HPE, CT HPE report, Detailed Discharge Summary 34 SC020 Pelvic Exenteration SC020C Total - Open 58,800 Clinical notes with planned line Procedure / Operative Notes, of treatment, HPE, CT HPE report, Detailed Discharge Summary 35 SC020 Pelvic Exenteration SC020D Total - Lap. 58,800 Clinical notes with planned line Procedure / Operative Notes, of treatment, HPE, CT HPE report, Detailed Discharge Summary 36 SC021 Wilms tumors: SC021A Wilms tumors: 33,000 Clinical notes with planned line Procedure / Operative Notes, surgery surgery of treatment, Biopsy/HPE, CT Post Procedure Photographs of abdomen surgical site, HPE report, Detailed Discharge Summary 37 SC022 Ureteric end to end SC022A Ureteric end to end 24,000 CT KUB, Clinical notes with Procedure / Operative Notes, anastomosis anastomosis planned line of treatment Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 38 SC023 Distal ureterectomy SC023A Distal 30,000 CT KUB, Clinical notes with Procedure / Operative Notes, with reimplantation ureterectomy with planned line of treatment Post Procedure Photographs of reimplantation surgical site, HPE report, Detailed Discharge Summary 39 SC024 Radical cystectomy SC024A With continent 98,000 HPE, Clinical notes with Procedure / Operative Notes, diversion - Open planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 40 SC024 Radical cystectomy SC024B With Ileal Conduit - 88,000 HPE, Clinical notes with Procedure / Operative Notes, Open planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 41 SC024 Radical cystectomy SC024C With Ileal Conduit - 88,000 HPE, Clinical notes with Procedure / Operative Notes, Lap. planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 42 SC024 Radical cystectomy SC024D With neobladder - 98,000 HPE, Clinical notes with Procedure / Operative Notes, Open planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 43 SC024 Radical cystectomy SC024E With neobladder - 98,000 HPE, Clinical notes with Procedure / Operative Notes, Lap planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary
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44 SC024 Radical cystectomy SC024F With 75,000 HPE, Clinical notes with Procedure / Operative Notes, ureterosigmoidosto planned line of treatment, CT Post Procedure Photographs of my - Open surgical site, HPE report, Detailed Discharge Summary 45 SC024 Radical cystectomy SC024G With 75,000 HPE, Clinical notes with Procedure / Operative Notes, ureterosigmoidosto planned line of treatment, CT Post Procedure Photographs of my - Lap surgical site, HPE report, Detailed Discharge Summary 46 SC024 Radical cystectomy SC024H With ureterostomy 70,000 HPE, Clinical notes with Procedure / Operative Notes, -Open planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 47 SC024 Radical cystectomy SC024I With ureterostomy 70,000 HPE, Clinical notes with Procedure / Operative Notes, -Lap. planned line of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 48 SC025 Channel TURP SC025A Channel TURP 22,800 Clinical notes with planned line Procedure / Operative Notes, of treatment, PSA, USG- HPE report, Detailed Discharge prostate Summary 49 SC026 Radical SC026A Radical 30,000 CT KUB, Clinical notes with Procedure / Operative Notes, Urethrectomy Urethrectomy planned line of treatment Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 50 SC027 Penile preserving SC027A Penile preserving 25,000 HPE, Clinical notes with Procedure / Operative Notes, surgery surgery planned line of treatment HPE report, Detailed Discharge (WLE, Glansectomy, (WLE, Summary Laser) Glansectomy, Laser) 51 SC028 Excision of SC028A Excision of 24,000 CT, Clinical notes with planned Procedure / Operative Notes, undescended undescended line of treatment HPE report, Detailed Discharge testicular mass testicular mass Summary 52 SC029 Germ Cell Tumour SC029A Germ Cell Tumour 30,000 Beta HCG, AFP, USG, CT, Procedure / Operative Notes, Excision Excision Clinical notes with planned line HPE report, Detailed Discharge of treatment Summary 53 SC030 Bilateral SC030A Open 21,000 Clinical notes with planned line Procedure / Operative Notes, salpingoophorecto of treatment, HPE Post Procedure Photographs of my surgical site, HPE report, Detailed Discharge Summary 54 SC030 Bilateral SC030B Lap. 21,000 Clinical notes with planned line Procedure / Operative Notes, salpingoophorecto of treatment, HPE Post Procedure Photographs of
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my surgical site, HPE report, Detailed Discharge Summary 55 SC031 Leiomyoma SC031A Open 42,000 Clinical notes with planned line Procedure / Operative Notes, excision of treatment, USG Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 56 SC031 Leiomyoma SC031B MIS 42,000 Clinical notes with planned line Procedure / Operative Notes, excision of treatment, USG Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 57 SC032 Radical SC032A Class I radical 27,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy hysterectomy + of treatment and Biopsy, Post Procedure Photographs of bilateral CECT/ MRI surgical site, HPE report, salpingoophorecto Detailed Discharge Summary my + BPLND - Lap. 58 SC032 Radical SC032B Class I radical 27,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy hysterectomy + of treatment and Biopsy, Post Procedure Photographs of bilateral CECT/ MRI surgical site, HPE report, salpingoophorecto Detailed Discharge Summary my + BPLND - Open 59 SC032 Radical SC032C Class I radical 27,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy Hysterectomy +/- of treatment and Biopsy, Post Procedure Photographs of bilateral CECT/ MRI surgical site, HPE report, salpingoophorecto Detailed Discharge Summary my - Lap. 60 SC032 Radical SC032D Class I radical 27,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy Hysterectomy +/- of treatment and Biopsy, Post Procedure Photographs of bilateral CECT/ MRI surgical site, HPE report, salpingoophorecto Detailed Discharge Summary my - Open 61 SC032 Radical SC032E Class II radical 27,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy hysterctomy + of treatment and Biopsy, Post Procedure Photographs of BPLND CECT/ MRI surgical site, HPE report, Detailed Discharge Summary 62 SC032 Radical SC032F Class III radical 27,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy hysterctomy + of treatment and Biopsy, Post Procedure Photographs of BPLND CECT/ MRI surgical site, HPE report, Detailed Discharge Summary 63 SC032 Radical SC032G Hysterectomy + 34,000 Clinical notes with planned line Procedure / Operative Notes, Hysterectomy bilateral of treatment and Biopsy, Post Procedure Photographs of
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salpingoophorecto CECT/ MRI surgical site, HPE report, my + omentectomy Detailed Discharge Summary + peritonectomy and organ resections 64 SC033 Radical SC033A Radical 30,000 Clinical notes and CECT, biopsy HPE report, detailed Procedure vaginectomy vaginectomy / Operative Notes. Detailed discharge summary 65 SC034 Vulvectomy + SC034A Vulvectomy + 36,000 Clinical notes with planned line Procedure / Operative Notes, reconstruction reconstruction of treatment, Biopsy/HPE HPE report, Detailed Discharge procedures procedures Summary 66 SC035 Radical SC035A Radical 40,000 Clinical notes and CECT, biopsy HPE report, detailed Procedure Trachelectomy Trachelectomy / Operative Notes. Detailed discharge summary , Post procedure Clinical photgraph showing scar 67 SC036 Sacral Tumour SC036A Anterior + 60,000 Clinical notes with planned line Procedure / Operative Notes, Excision Posterior approach of treatment, HPE Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 68 SC036 Sacral Tumour SC036B Posterior approach 54,000 Clinical notes with planned line Procedure / Operative Notes, Excision of treatment, HPE Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 69 SC037 Resection of SC037A Resection of 40,000 Clinical notes and Biopsy of detailed Procedure / Operative nasopharyngeal nasopharyngeal primary, CECT/MRI Notes, Clinical Photograph tumour tumour showing scar, HPE report, detailed discharge summary 70 SC038 Total SC038A Total 36,000 Clinical notes with planned line Procedure / Operative Notes, Pharyngectomy Pharyngectomy of treatment, HPE, CT / MRI Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 71 SC039 Parapharyngeal SC039A Parapharyngeal 31,200 Clinical notes with planned line Procedure / Operative Notes, Tumour Excision Tumour Excision of treatment, HPE, CT / MRI Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 72 SC040 Laryngectomy SC040A Partial 39,000 Voice Clinical notes and Biopsy, CECT detailed Procedure / Operative laryngectomy prosthesis (Max film and report Notes, Clinical Photograph (voice preserving) 1) showing scar, HPE report, 30,000 Detailed Discharge summary
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73 SC040 Laryngectomy SC040B Total Laryngectomy 36,000 Clinical notes and Biopsy, CECT detailed Procedure / Operative film and report Notes, Clinical Photograph showing scar, HPE report 74 SC041 Tracheal resection SC041A Tracheal resection 36,000 Clinical notes and CECT/ Biopsy detailed Procedure / Operative confirming diagnosis Notes, Clinical Photograph showing scar, HPE report, Detailed discharge summary 75 SC042 Tracheal / Carinal SC042A Tracheal / Carinal 58,800 Clinical notes with planned line Procedure / Operative Notes, resection resection of treatment, HPE, CT / MRI Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 76 SC043 Tracheal Stenosis SC043A Tracheal Stenosis 36,000 Clinical notes with planned line Procedure / Operative Notes, (End to end (End to end of treatment, HPE, CT / MRI Post Procedure Photographs of Anastamosis) Anastamosis) surgical site, HPE report, (Throat) (Throat) Detailed Discharge Summary 77 SC044 Central airway SC044A Central airway 22,800 Clinical notes with planned line Procedure / Operative Notes, tumour debulking tumour debulking of treatment, HPE, CT / MRI Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 78 SC045 Diagnostic SC045A Diagnostic 15,000 Cinical notes, radiological Procedure / Operative Notes, thoracoscopy thoracoscopy evidence for indication Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 79 SC046 Sleeve resection of SC046A Sleeve resection of 70,000 Clinical notes and FNAC/ detailed Procedure / Operative lung cancer lung cancer BIOPSY, CECT Notes, Clinical Photograph showing scar, HPE report, detailed discharge summary 80 SC047 Mediastinoscopy SC047A Diagnostic 22,200 Cinical notes, radiological Procedure / Operative Notes, evidence for indication Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 81 SC047 Mediastinoscopy SC047B Staging 22,200 Cinical notes, radiological Procedure / Operative Notes, evidence for indication Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 82 SC048 Removal of Chest SC048A Chest Wall Tumour 36,000 Clinical notes with planned line Procedure / Operative Notes, Wall Tumour Excision of treatment and HPE, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 83 SC048 Removal of Chest SC048B Removal of chest 51,000 Clinical notes with planned line Procedure / Operative Notes,
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Wall Tumour wall tumour with of treatment and HPE, CT Post Procedure Photographs of reconstruction surgical site, HPE report, Detailed Discharge Summary 84 SC049 Pleurectomy SC049A Pleurectomy 39,000 Clinical notes with planned line Procedure / Operative Notes, Decortication Decortication of treatment and HPE, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 85 SC050 Chamberlain SC050A Chamberlain 22,200 Clinical notes with planned line Procedure / Operative Notes, procedure procedure of treatment and CT Thorax Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 86 SC051 Extrapleural SC051A Extrapleural 66,000 Clinical notes with planned line Procedure / Operative Notes, pneumonectomy pneumonectomy of treatment, HPE, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 87 SC052 Pneumonectomy SC052A Pneumonectomy 54,000 Clinical notes with planned line Procedure / Operative Notes, of treatment and CT Thorax, Post Procedure Photographs of biopsy surgical site, HPE report, Detailed Discharge Summary 88 SC053 Lung metastectomy SC053A Open 30,000 Clinical notes and FNAC/ detailed Procedure / Operative BIOPSY, CECT Notes, Clinical Photograph showing scar, HPE report, detailed discharge summary 89 SC053 Lung metastectomy SC053B VATS 30,000 Clinical notes and FNAC/ detailed Procedure / Operative BIOPSY, CECT Notes, Clinical Photograph showing scar, HPE report, detailed discharge summary 90 SC054 Thoracostomy SC054A Thoracostomy 19,800 Clinical notes with planned line Procedure / Operative Notes, of treatment, clinical Post Procedure Photographs of photograph surgical site, HPE report, Detailed Discharge Summary 91 SC055 Mediastinal SC055A Open 36,000 Clinical notes with planned line Procedure / Operative Notes, lymphadenectomy of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 92 SC055 Mediastinal SC055B Video - assisted 36,000 Clinical notes with planned line Procedure / Operative Notes, lymphadenectomy of treatment, CT Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 93 SC056 Mediastinal mass SC056A Mediastinal mass 60,000 Clinical notes with planned line Procedure / Operative Notes,
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excision with lung excision with lung of treatment and CT Thorax, Post Procedure Photographs of resection resection biopsy surgical site, HPE report, Detailed Discharge Summary 94 SC057 Segmental SC057A Open 42,000 Clinical notes with planned line Procedure / Operative Notes, resection of lung of treatment and CT Thorax, Post Procedure Photographs of biopsy surgical site, HPE report, Detailed Discharge Summary 95 SC057 Segmental SC057B Thoracoscopic 42,000 Clinical notes with planned line Procedure / Operative Notes, resection of lung of treatment and CT Thorax, Post Procedure Photographs of biopsy surgical site, HPE report, Detailed Discharge Summary 96 SC058 Wedge resection SC058A Open 36,000 Clinical notes with planned line Procedure / Operative Notes, lung of treatment and CT Thorax, Post Procedure Photographs of biopsy surgical site, HPE report, Detailed Discharge Summary 97 SC058 Wedge resection SC058B Thoracoscopic 36,000 Clinical notes with planned line Procedure / Operative Notes, lung of treatment and CT Thorax, Post Procedure Photographs of biopsy surgical site, HPE report, Detailed Discharge Summary 98 SC059 Breast conserving SC059A Breast conserving 22,800 Clinical notes and detailed Procedure / Operative surgery surgery Mammography, FNAC/ Notes, HPE report; detailed (lumpectomy + BIOPSY; CT/ MRI discharge summary axillary surgery) 99 SC059 Breast conserving SC059B Breast conserving 24,600 Clinical notes and detailed Procedure / Operative surgery surgery with Mammography, FNAC/ Notes, HPE report; detailed Oncoplasty BIOPSY; CT/ MRI discharge summary 100 SC060 Axillary Sampling / SC060A Axillary Sampling / 16,200 FNAC, Clinical notes with Procedure / Operative Notes, Sentinel Node Sentinel Node planned line of treatment Post Procedure Photographs of Biopsy Biopsy surgical site, HPE report, Detailed Discharge Summary 101 SC061 Axillary dissection SC061A Axillary dissection 19,800 Clinical notes and FNAC/ detailed Procedure / Operative BIOPSY, CECT/ Chest X-ray Notes, Clinical Photograph showing scar, HPE report; detailed discharge summary 102 SC062 Scalp tumour SC062A Scalp tumour 30,000 HPE, Clinical notes with Procedure / Operative Notes, excision with skull excision with skull planned line of treatment, Post Procedure Photographs of bone excision bone excision surgical site, HPE report, Detailed Discharge Summary 103 SC063 Neuroblastoma SC063A Neuroblastoma 60,000 HPE, Clinical notes with Procedure / Operative Notes, Excision Excision planned line of treatment Post Procedure Photographs of
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surgical site, HPE report, Detailed Discharge Summary 104 SC064 Excision of Pinna SC064A Growth - 21,600 HPE, Clinical notes with Procedure / Operative Notes, for Growths / Squamous planned line of treatment Post Procedure Photographs of Injuries - Total surgical site, HPE report, Amputation & Detailed Discharge Summary Excision of External Auditory Meatus 105 SC064 Excision of Pinna SC064B Growth - Basal 21,600 HPE, Clinical notes with Procedure / Operative Notes, for Growths / planned line of treatment Post Procedure Photographs of Injuries - Total surgical site, HPE report, Amputation & Detailed Discharge Summary Excision of External Auditory Meatus 106 SC064 Excision of Pinna SC064C Injury 21,600 Clinical notes with planned line Procedure / Operative Notes, for Growths / of treatment, Clinical Post Procedure Photographs of Injuries - Total photograph surgical site, HPE report, Amputation & Detailed Discharge Summary Excision of External Auditory Meatus 107 SC065 Neck dissection - SC065A Neck dissection - 16,000 Clinical notes, USG/ CT neck detailed Procedure / Operative comprehensive comprehensive and Biopsy/FNAC Notes, Clinical Photograph showing scar, HPE report, detailed discharge summary 108 SC066 Benign Soft Tissue SC066A Benign Soft Tissue 12,000 HPE, Clinical notes with Procedure / Operative Notes, Tumour - Excision Tumour - Excision planned line of treatment Post Procedure Photographs of surgical site, HPE report, Detailed Discharge Summary 109 SC067 Malignant Soft SC067A Malignant Soft 24,000 HPE, Clinical notes with Procedure / Operative Notes, Tissue Tumour - Tissue Tumour - planned line of treatment Post Procedure Photographs of Excision Excision surgical site, HPE report, Detailed Discharge Summary 110 SC068 Regional flap SC068A Myocutaneous flap 30,600 Clinical notes and Biopsy of detailed Procedure / Operative primary Notes, Clinical photgraph showing scar, detailed discharge summary 111 SC068 Regional flap SC068B Fasciocutaneous 30,600 Clinical notes and Biopsy of detailed Procedure / Operative flap primary Notes, Clinical photgraph showing scar, detailed discharge summary
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112 SC069 Rotationplasty SC069A Rotationplasty 45,000 Clinical notes with planned line Procedure / Operative Notes, of treatment Post Procedure Photographs of surgical site, Detailed Discharge Summary 113 SC070 Bone tumors / soft SC070A Bone tumors / soft 30,000 HPE, Clinical notes with Procedure / Operative Notes, tissue sarcomas: tissue sarcomas: planned line of treatment Post Procedure Photographs of surgery surgery surgical site, HPE report, Detailed Discharge Summary 114 SC071 Endoprosthesis SC071A Complete 39,000 Clinical notes with planned line Procedure / Operative Notes, Revision of treatment, radiological Post Procedure Photographs of evidence for indication surgical site, Detailed Discharge Summary 115 SC071 Endoprosthesis SC071B Partial 24,000 Clinical notes with planned line Procedure / Operative Notes, Revision of treatment, radiological Post Procedure Photographs of evidence for indication surgical site, Detailed Discharge Summary 116 SC072 Vertebral Tumour SC072A Vertebral Tumour 54,000 Clinical notes with planned line Procedure / Operative Notes, Excision and Excision and of treatment, radiological Post Procedure Photographs of Reconstruction Reconstruction evidence for indication surgical site, HPE report, Detailed Discharge Summary 117 SC073 Microvascular SC073A Microvascular 45,000 Implant for Clinical notes and Biopsy of detailed discharge summary, reconstruction (free reconstruction Microvascular primary with details of earlier detailed Procedure / Operative flaps) (free flaps) reconstruction surgery done and establishing Notes, Clinical Photograph (Max 1) need of microvascular showing scar 15,000 reconstruction 118 SC074 Vascular SC074A Vascular 57,600 Clincal notes Detailed Discharge Summary reconstruction reconstruction 119 SC075 Curopsy / SC075A Curopsy / 19,200 Clincal notes Detailed Discharge Summary Sclerotherapy Sclerotherapy 120 SC076 Chemo Port SC076A Chemo Port 18,000 Chemo Port – Clinical notes with planned line Procedure / Operative Notes, Insertion Insertion Adult (Max 1) of treatment discharge summary, Invoice of 15,000 Chemo port used
20. Urology
• Total number of packages: 94 • Total number of procedures: 142
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• Additional cross specialty procedures: 16 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Prior approval must be taken for surgeries requiring use of Deflux injection, Botox Injection, inflatable penile prosthesis, urinary sphincter and metallic stents • It is mandated to get approval for all non-surgical conditions (involving evaluation/ investigation/ therapeutic management / follow-up visits) as indicated • For any procedure whose charges are Rs. 15,000 or higher, extra costs (in the sense other packages) cannot be clubbed / claimed from the following: cystoscopy, ureteric catheterization, retrograde pyelogram, DJ stenting, nephrostomy – as they would form part of such packages costing Rs. 15,000 or higher as per the need
S. Pac AB PM - Procedu AB PM - JAY Package Stratification Implant Mandatory Documents - Pre Mandatory Documents No. kag JAY re Code Procedure Price Authorization - Claim Processing e Package HBP 2.0 Name Cod Name e HBP 2.0 1 SU0 Adrenalect SU001A Open 27,500 Unilateral/Bilateral Clinical notes confirming diagnosis Histopathology, 01 omy None/"5000" with Evidence of /CT/MRI +/- Detailed discharge FNAC/Biopsy, Sr. Cortisol, Sr. summary detailed electrolytes, 24 hr urinary Procedure / Operative catacholamine level / sr. or urinary Notes metanephrine normetanephrine, MIBG Scan/ DOTONOC scan 2 SU0 Adrenalect SU001B Lap. 27,500 Unilateral/Bilateral Clinical notes confirming diagnosis Histopathology, 01 omy None/"5000" with Evidence of /CT/MRI +/- Detailed discharge FNAC/Biopsy, Sr. Cortisol, Sr. summary detailed electrolytes, 24 hr urinary Procedure / Operative catacholamine level / sr. or urinary Notes metanephrine normetanephrine, MIBG Scan/ DOTONOC scan 3 SU0 Renal Cyst SU002A Open 25,000 Clinical notes and USG/CT scan Intra procedure still 02 deroofing confirming the renal cyst and photograph; detailed or justification of the surgery discharge summary; Marsupializ detailed Procedure / ation Operative Notes 4 SU0 Renal Cyst SU002B Lap. 25,000 Clinical notes and USG/CT scan Intra procedure still 273 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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02 deroofing confirming the renal cyst and photograph; detailed or justification of the surgery discharge summary; Marsupializ detailed Procedure / ation Operative Notes 5 SU0 Nephrecto SU003A For Benign 27,500 Clinical notes and USG/CT Histopathology, Intra 03 my pathology - confirming the need for surgery +/- operative photograph. Open FNAC/Biopsy, Detailed discharge summary, detailed Procedure / Operative Notes 6 SU0 Nephrecto SU003B For Benign 27,500 Clinical notes and USG/CT Histopathology, Intra 03 my pathology - confirming the need for surgery +/- operative photograph. Lap. FNAC/Biopsy, Detailed discharge summary, detailed Procedure / Operative Notes 7 SU0 Nephrecto SU003C Radical (Renal 27,500 Clinical notes and CT/MRI Histopathology, Intra 03 my tumor) - Open confirming the need for surgery +/- operative photograph/ FNAC/Biopsy, Post procedure X-ray. Detailed discharge summary, detailed Procedure / Operative Notes 8 SU0 Nephrecto SU003D Radical (Renal 27,500 Clinical notes and CT/MRI Histopathology, Intra 03 my tumor) - Lap. confirming the need for surgery +/- operative photograph/ FNAC/Biopsy, Post procedure X-ray. Detailed discharge summary, detailed Procedure / Operative Notes 9 SU0 Nephrecto SU004A Open 42,000 Clinical notes and CT/MRI Histopathology, Intra 04 my - Partial confirming the need for surgery, operative photograph. or Hemi Detailed discharge summary, detailed Procedure / Operative Notes 10 SU0 Nephrecto SU004B Lap. 42,000 Clinical notes and CT/MRI Histopathology, Intra 04 my - Partial confirming the need for surgery operative photograph. or Hemi Detailed discharge summary, detailed Procedure / Operative 274 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Notes 11 SU0 Nephrolitho SU005A Open 30,000 Clinical notes and IVP / NCCT+ CT- Post procedure Imaging 05 tomy IVP confirming the indication (X Ray/USG), showing stone removed; Detailed discharge summary, detailed Procedure / Operative Notes 12 SU0 Nephrolitho SU005B Anatrophic 30,000 Clinical notes and IVP / NCCT+ CT- Post procedure Imaging 05 tomy IVP confirming the indication (X Ray/USG), showing stone removed; Detailed discharge summary, detailed Procedure / Operative Notes 13 SU0 Open SU006A Open 1,000 Earlier Discharge Summary USG / Urine Routine, 06 Nephrolitho Nephrolithoto Drugs tomy - my - Follow Up Follow Up 14 SU0 PCNL SU007A PCNL 35,000 Unilateral/Bilateral Clinical notes and IVP / NCCT+ CT- Intra operative 07 (Percutane (Percutaneous None/"5000" IVP confirming the indication and photograph. Detailed ous Nephrolithoto need for PCNL discharge summary, Nephrolitho my) detailed Procedure / tomy) Operative Notes; Post procedure Imaging (X Ray/USG), 15 SU0 Nephrosto SU008A Nephrostomy - 14,000 Clinical notes and USG confirming Intra procedure clinical 08 my - Percutaneous the indication and need of photograph, detailed Percutaneo ultrasound procedure. discharge summary, us guided detailed Procedure / ultrasound Operative Notes guided 16 SU0 Nephrosto SU009A Nephrostomy 1,200 Earlier Discharge Summary USG / X-RAY KUB 09 my (PCN) - (PCN) - Follow Follow Up Up 17 SU0 Nephro SU010A Open 27,500 Clinical notes and CT/ CT-IVP/MRI Histopathology, Intra 10 ureterecto confirming the need for surgery, operative photograph. my (Benign) Detailed discharge summary, detailed Procedure / Operative Notes 275 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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18 SU0 Nephro SU010B Lap. 27,500 Clinical notes and /CT/ CT-IVP/MRI Histopathology, Intra 10 ureterecto confirming the need for surgery, operative photograph. my (Benign) Detailed discharge summary, detailed Procedure / Operative Notes 19 SU0 Nephro SU011A Open 27,500 Clinical notes and CT/ CT- Histopathology, Intra 11 ureterecto IVP/MRI/MRI Urogram confirming operative photograph. my with the need for surgery, Detailed discharge cuff of summary, detailed bladder Procedure / Operative Notes 20 SU0 Nephro SU011B Lap. 27,500 Clinical notes and CT/ CT- Histopathology, Intra 11 ureterecto IVP/MRI/MRI Urogram confirming operative photograph. my with the need for surgery, Detailed discharge cuff of summary, detailed bladder Procedure / Operative Notes 21 SU0 Perinephric SU013A Open 14,000 Clinical notes and USG/CT Intra procedure still 13 Abscess confirming the diagnosis of photograph; detailed drainage perinephric abscess. discharge summary; detailed Procedure / Operative Notes 22 SU0 Perinephric SU013B Percutaneous 14,000 Clinical notes and USG/CT Intra procedure still 13 Abscess confirming the diagnosis of photograph; detailed drainage perinephric abscess. discharge summary; detailed Procedure / Operative Notes 23 SU0 Ureterosco SU014A Lower Ureter 28,000 Unilateral/Bilateral Clinical notes and IVP / NCCT+ CT- Detailed discharge 14 py + Stone None/"+15000" IVP confirming the indication summary, Post removal procedure Imaging (X with Ray/USG), showing lithotripsy stone removed detailed Procedure / Operative Notes 24 SU0 Ureterosco SU014B Upper Ureter 28,000 Unilateral/Bilateral Clinical notes and IVP / NCCT+ CT- Detailed discharge 14 py + Stone None/"+15000" IVP confirming the indication summary, Post removal procedure Imaging (X with Ray/USG), showing lithotripsy stone removed detailed Procedure / Operative 276 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Notes 25 SU0 URSL / SU015A URSL / URSL - 1,000 Earlier Discharge Summary USG / Urine Routine, 15 URSL - Laser Laser - Follow Drugs - Follow Up Up 26 SU0 Extracopore SU016A Extracoporeal 18,500 DJ Stent (Max 1) Clinical notes and IVP / NCCT+ CT- Intra operative 16 al shock - shock - wave 200 IVP confirming the indication and photograph. Detailed wave Lithotripsy need for ESWL, Is EHCP registered discharge summary, Lithotripsy (ESWL) stone, for ESWL? detailed Procedure / (ESWL) with or without Operative Notes; stent (one side) 27 SU0 ESWL - SU017A ESWL - Follow 1,000 Earlier Discharge Summary USG / X-RAY KUB 17 Follow Up Up 28 SU0 Ureterolith SU018A Open 20,000 Clinical notes and IVP / NCCT+ CT- Detailed discharge 18 otomy IVP confirming the indication summary, detailed Procedure / Operative Notes,Post procedure Imaging (X Ray/USG), showing stone removed 29 SU0 Ureterolith SU018B Lap. 20,000 Clinical notes and IVP / NCCT+ CT- Detailed discharge 18 otomy IVP confirming the indication summary, Post procedure Imaging (X Ray/USG), showing stone removed detailed Procedure / Operative Notes 30 SU0 Lap SU019A Lap 1,000 Earlier Discharge Summary USG / Urine Routine, 19 Ureterolith Ureterolithoto Drugs otomy - my - Follow Up Follow Up 31 SU0 Open SU020A Open 1,000 Earlier Discharge Summary USG / Urine Routine, 20 Ureterolith Ureterolithoto Drugs otomy - my - Follow Up Follow Up 32 SU0 Pyeloplasty SU021A Pyeloplasty - 27,500 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 21 / Open DTPA renal scan, confirming photograph. Detailed Pyeloureter indication and the need for surgery discharge summary, ostomy / detailed Procedure / Pyelopyelos Operative Notes tomy
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33 SU0 Pyeloplasty SU021B Pyeloplasty - 27,500 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 21 / Laparoscopic DTPA renal scan, confirming photograph. Detailed Pyeloureter indication and the need for surgery discharge summary, ostomy / detailed Procedure / Pyelopyelos Operative Notes tomy 34 SU0 Pyeloplasty SU021C Pyeloureterost 27,500 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 21 / omy - Open DTPA renal scan, confirming photograph. Detailed Pyeloureter indication and the need for surgery discharge summary, ostomy / detailed Procedure / Pyelopyelos Operative Notes tomy 35 SU0 Pyeloplasty SU021D Pyeloureterost 27,500 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 21 / omy - DTPA renal scan, confirming photograph. Detailed Pyeloureter Laparoscopic indication and the need for surgery discharge summary, ostomy / detailed Procedure / Pyelopyelos Operative Notes tomy 36 SU0 Pyeloplasty SU021E Pyelopyelosto 27,500 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 21 / my - Open DTPA renal scan, confirming photograph. Detailed Pyeloureter indication and the need for surgery discharge summary, ostomy / detailed Procedure / Pyelopyelos Operative Notes tomy 37 SU0 Pyeloplasty SU021F Pyelopyelosto 27,500 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 21 / my - DTPA renal scan, confirming photograph. Detailed Pyeloureter Laparoscopic indication and the need for surgery discharge summary, ostomy / detailed Procedure / Pyelopyelos Operative Notes tomy 38 SU0 Pyeloplasty SU022A Pyeloplasty - 1,500 Earlier Discharge Summary USG / UFM / Urine 22 Follow Up Routine 39 SU0 Ureterocaly SU023A Ureterocalycost 25,000 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 23 costomy omy - Open DTPA renal scan photograph. Detailed discharge summary, detailed Procedure / Operative Notes 40 SU0 Ureterocaly SU023B Ureterocalycost 25,000 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 23 costomy omy - DTPA renal scan photograph. Detailed Laparoscopic discharge summary, detailed Procedure / 278 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Operative Notes 41 SU0 Pyelolithoto SU024A Open 28,000 Clinical notes and IVP / NCCT+ CT- Post procedure Imaging 24 my IVP confirming the indication (X Ray/USG), showing stone removed; Detailed discharge summary, detailed Procedure / Operative Notes 42 SU0 Pyelolithoto SU024B Lap. 28,000 Clinical notes and IVP / NCCT+ CT- Post procedure Imaging 24 my IVP confirming the indication (X Ray/USG), showing stone removed; Detailed discharge summary, detailed Procedure / Operative Notes 43 SU0 Internal SU025A Internal 10,000 Clinical notes and Investigation Endoscopic Intra 25 Ureterotom Ureterotomy reports confirming urethral stricture procedure still y including including (RGU+/- MCU) photograph, detailed cystoscopy cystoscopy as discharge summary, as an an independent Detailed Procedure / independen procedure Operative Notes t procedure 44 SU0 Ureterolysis SU026A Open 28,000 Clinical notes and CT-IVP/ MRI Intra procedure still 26 for Urogram confirming the diagnosis photograph,Detailed retroperito for which the surgery is done, discharge summary, neal fibrosis detailed Procedure / (with or Operative Notes without including details of omental omental wrapping if wrapping) done 45 SU0 Ureterolysis SU026B Lap. 28,000 Clinical notes and CT-IVP/ MRI Intra procedure still 26 for Urogram confirming the diagnosis photograph,Detailed retroperito for which the surgery is done, discharge summary, neal fibrosis detailed Procedure / (with or Operative Notes without including details of omental omental wrapping if wrapping) done 46 SU0 Ureterosto SU027A Ureterostomy 20,000 Clinical notes and CT/MRI Post Procedure Clinical 27 my (Cutaneous) confirming the diagnosis for Photograph stoma, ureterostomy and need for creating Detailed discharge 279 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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a stoma for ureter summary, detailed Procedure / Operative Notes 47 SU0 Uretero- SU028A Open 25,000 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 28 ureterosto DTPA renal scan photograph. Detailed my discharge summary, detailed Procedure / Operative Notes 48 SU0 Uretero- SU028B Lap. 25,000 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 28 ureterosto DTPA renal scan photograph. Detailed my discharge summary, detailed Procedure / Operative Notes 49 SU0 Uretero- SU029A Uretero - 25,000 Clinical notes and IVP/ CT-IVP + Intra procedure still 29 vaginal / vaginal fistula cystoscopy and vaginoscopy Scopy photograph,Detailed Uterine repair - Open confirming the diagnosis for which discharge summary, fistula the surgery is done, detailed Procedure / repair Operative Notes 50 SU0 Uretero- SU029B Uretero - 25,000 Clinical notes and IVP/ CT-IVP + Intra procedure still 29 vaginal / Uterine fistula cystoscopy and vaginoscopy Scopy photograph,Detailed Uterine repair - Open confirming the diagnosis for which discharge summary, fistula the surgery is done, detailed Procedure / repair Operative Notes 51 SU0 Uretero- SU029C Uretero - 25,000 Clinical notes and IVP/ CT-IVP + Intra procedure still 29 vaginal / vaginal fistula cystoscopy and vaginoscopy Scopy photograph,Detailed Uterine repair - confirming the diagnosis for which discharge summary, fistula Laparoscopic the surgery is done, detailed Procedure / repair Operative Notes 52 SU0 Uretero- SU029D Uretero - 25,000 Clinical notes and IVP/ CT-IVP + Intra procedure still 29 vaginal / Uterine fistula cystoscopy and vaginoscopy Scopy photograph,Detailed Uterine repair - confirming the diagnosis for which discharge summary, fistula Laparoscopic the surgery is done, detailed Procedure / repair Operative Notes 53 SU0 Ureteric SU030A Open 23,000 Unilateral/Bilateral Clinical notes and and CT-IVP/MRI Intra procedure clinical 30 reimplantat None/"+10000" Urogram + MCU confirming reflux photograph,Detailed ion and need of surgery. discharge summary, detailed Procedure / Operative Notes 54 SU0 Ureteric SU030B Lap. 23,000 Unilateral/Bilateral Clinical notes and and CT-IVP/MRI Intra procedure still 30 reimplantat None/"+10000" Urogram + MCU confirming reflux photograph,Detailed ion and need of surgery. discharge summary, 280 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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detailed Procedure / Operative Notes 55 SU0 Boari flap SU031A Open 30,000 Clinical notes and IVP/CT-IVP+/-MCU Intra procedure still 31 for ureteric confirming the stricture longer than photograph,Detailed stricture 5 cms for which the surgery is done discharge summary, detailed Procedure / Operative Notes including details of omental wrapping if done 56 SU0 Boari flap SU031B Lap. 30,000 Clinical notes and IVP/CT-IVP+/-MCU Intra procedure still 31 for ureteric confirming the stricture longer than photograph,Detailed stricture 5 cms for which the surgery is done discharge summary, detailed Procedure / Operative Notes including details of omental wrapping if done 57 SU0 Ileal SU032A Ileal 46,000 Clinical notes and IVP/CT-IVP+/-MCU Intra procedure still 32 replacemen replacement confirming the stricture longer than photograph,Detailed t for for ureteric 5 cms for which the surgery is done discharge summary, ureteric stricture detailed Procedure / stricture Operative Notes including details of omental wrapping if done 58 SU0 DJ stenting SU033A DJ stenting 9,800 DJ Stent (Max 1) Clinical notes and CT-IVP/ IVP Post Procedure x-ray 33 including including 200 confirming the diagnosis and the showing stent; detailed cystoscopy, cystoscopy, need of this surgery is done Procedure / Operative ureteric ureteric Notes detailing findings catheterizat catheterization, of cystoscopy/ ion, retrograde Retrogradepyelogram retrograde pyelogram and ureteric pyelogram catheterization; detailed discharge summary. 59 SU0 DJ Stent SU034A DJ Stent 5,000 Clinical notes with planned line of discharge summary 34 Removal Removal treatment including planned line of treatment, X-ray films with reports, Discharge Summary of DJ Stenting 60 SU0 Ureterocele SU035A Ureterocele 15,000 Clinical notes and IVP/CT-IVP Evidence of cystoscopy, 281 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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35 incision incision confirming the diagnosis for which ureteric including including the surgery is done, catheterization, cystoscopy, cystoscopy, retrograde pyelogram; ureteric ureteric Detailed discharge catheterizat catheterization, summary, detailed ion, retrograde Procedure / Operative retrograde pyelogram Notes pyelogram 61 SU0 Ureteric SU036A Ureteric 11,000 Clinical notes and Reports of all Evidence of cystoscopy, 36 sampling sampling previous work up done ureteric including including (Xray/USG/CT Scan), clinical catheterization, cystoscopy, cystoscopy, diagnosis suspected for this retrograde pyelogram ureteric ureteric procedure. and the diagnosis catheterizat catheterization, arrived at; Detailed ion, retrograde discharge summary, retrograde pyelogram detailed Procedure / pyelogram Operative Notes 62 SU0 Acute SU037A Acute 2,000 Routine Ward Clinical notes detailing the case Reports of all 37 manageme management of None history, circumstances that led to investigations done and nt of upper upper urinary trauma, presenting complaints, local consultation paper of urinary tract trauma – examination findings, injuries treating doctor tract conservative sustained as result of trauma, mentioning the final trauma – USG/CT Abdomen diagnosis and line of conservativ treatment, Detailed e discharge summary; 63 SU0 Endopyelot SU038A Retrograde 25,000 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 38 omy with laser / DTPA renal scan, is the hospital photograph. Detailed bugbee equipped with Laser? discharge summary, detailed Procedure / Operative Notes. If bugbee electrode is billed, insist on invoice/ barcode. 64 SU0 Endopyelot SU038B Antegrade with 25,000 Clinical notes and IVP/CT/ CT-IVP,+/- Intra operative 38 omy laser / bugbee DTPA renal scan, is the hospital photograph. Detailed equipped with Laser? discharge summary, detailed Procedure / Operative Notes. If bugbee electrode is billed, insist on invoice/ barcode. 282 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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65 SU0 Open SU039A Open 1,200 Earlier Discharge Summary USG / Urine Routine, 39 Pyelolithoto Pyelolithotomy Drugs my - Follow - Follow Up Up 66 SU0 Cystolithoto SU040A Open - 18,500 Clinical notes and X ray Detailed discharge 40 my - Open, including KUB/USG/IVP/NCCT confirming the summary , detailed including cystoscopy diagnosis of large bladder stone Procedure / Operative cystoscopy Notes 67 SU0 Cystolithotr SU041A Cystolithotripsy 18,500 Clinical notes and X ray Detailed discharge 41 ipsy / endoscopic, KUB/USG/IVP/NCCT confirming the summary, detailed Urethral including diagnosis of large bladder stone Procedure / Operative Stone cystoscopy Notes endoscopic, including cystoscopy 68 SU0 Cystolithotr SU041B Urethral Stone 18,500 Clinical notes and X ray Detailed discharge 41 ipsy / removal KUB/USG/IVP/NCCT confirming the summary, detailed Urethral endoscopic, diagnosis of large bladder stone Procedure / Operative Stone including Notes endoscopic, cystoscopy including cystoscopy 69 SU0 Diagnostic SU042A Diagnostic 6,500 Clinical notes and Reports of all Intra procedure still 42 Cystoscopy Cystoscopy work up done ( Xray/USG/CT photograph; Detailed Scan/MRI), suspected differential discharge summary diagnosis Detailed Procedure / Operative Notes 70 SU0 Partial SU043A Open 23,000 Clinical notes and CT/MRI Histopathology,Detaile 43 Cystectomy confirming the indication and need d discharge summary; of this surgery with supporting detailed Procedure / Evidence of the same (FNAC/Biopsy) Operative Notes 71 SU0 Partial SU043B Lap. 23,000 Clinical notes and CT/MRI Histopathology,Detaile 43 Cystectomy confirming the indication and need d discharge summary; of this surgery with supporting detailed Procedure / Evidence of the same (FNAC/Biopsy) Operative Notes 72 SU0 Partial SU044A Partial 1,000 Earlier Discharge Summary USG 44 Cystectomy Cystectomy - - Follow Up Follow Up 73 SU0 Augmentati SU045A Open 30,000 Clinical notes and IVP/CT IVP/MRI Intraoperative still 45 on +Cystogram+/- Cystoscopy/, images, Post procedure cystoplasty confirming the indication for which Imaging, Detailed 283 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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the surgery is done, discharge summary, detailed Procedure / Operative Notes 74 SU0 Augmentati SU045B Lap. 30,000 Clinical notes and IVP/CT IVP/MRI Intraoperative still 45 on +Cystogram+/- Cystoscopy/, images, Post procedure cystoplasty confirming the indication for which Imaging, Detailed the surgery is done, discharge summary, detailed Procedure / Operative Notes 75 SU0 Deflux for SU046A Deflux for VUR 1,200 Clinical notes with planned line of IVU 46 VUR treatment 76 SU0 Bladder SU047A Bladder 1,000 Earlier Discharge Summary USG 47 Diverticulec Diverticulectom tomy y - Follow Up 77 SU0 Open SU048A Open bladder 25,000 Clinical notes and USG/CT/MRI+/- Intra procedure clinical 48 bladder diverticulectom Cystoscopy confirming bladder photograph, Detailed diverticulec y with / diverticulum and need for surgery discharge summary, tomy with / without detailed Procedure / without ureteric re- Operative Notes ureteric re- implantation implantatio n 78 SU0 Bladder SU049A Bladder injury 23,000 Clinical notes and USG/CT/MRI+/- Detailed discharge 49 injury repair cystogram confirming the diagnosis summary; detailed repair (with or of bladder injury; MLC/ FIR if Procedure / Operative (with or without traumatic. Notes without urethral injury) urethral injury) 79 SU0 Bladder SU050A Bladder injury 27,500 Clinical notes and USG/CT/MRI+/- Detailed discharge 50 injury repair with cystogram confirming the diagnosis summary of both repair with colostomy of bladder injury; MLC/ FIR if surgeries; detailed colostomy (with or traumatic. Procedure / Operative (with or without Notes; Post procedue without urethral injury) pic of Colostomy urethral injury) 80 SU0 Extrophy SU051A Extrophy 65,000 Clinical notes and USG/CT/MRI Post Procedure Clinical 51 Bladder Bladder repair confirming the diagnosis of extrophy Photograph of affected repair including of bladder/ epispadias. Clinical part, detailed including osteotomy if Photograph of affected part Procedure / Operative 284 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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osteotomy needed + Notes if needed + epispadias epispadias repair + repair + ureteric ureteric reimplant reimplant 81 SU0 Neurogenic SU052A Neurogenic 14,300 Clinical notes detailing the case Evidence of all 52 bladder - bladder - history with previous work up / investigations done and Package for Package for initial diagnosis still images of RGU/ evaluation / evaluation / MCU done with patient investigatio investigation name & date n (catheter (catheter + + ultrasound + ultrasound culture + RGU/ + culture + MCU) for 1 RGU/ MCU) month for 1 month (medicines - (medicines - antibiotics) antibiotics) 82 SU0 Y V Plasty SU053A Y V Plasty of 23,000 Clinical notes and urethro Detailed Procedure / 53 of Bladder Bladder Neck / Cystoscopy +USG confirming the Operative Notes, Neck / Bladder Neck diagnosis detailed discharge Bladder Reconstruction summary. Neck Reconstruct ion 83 SU0 Bladder SU054A Bladder Neck 15,000 USG-KUB/PVR, Uroflometry Endoscopic picture 54 Neck incision - incision - Endoscopic Endoscopic 84 SU0 TURBT SU055A TURBT 27,500 Clinical notes and USG/CT/ MRI Histopathology, 55 (Transureth (Transurethral confirming the diagnosis bladder Detailed discharge ral Resection of tumour summary, detailed Resection the Bladder Procedure / Operative of the Tumor) Notes Bladder Tumor) 85 SU0 TURBT - SU056A TURBT - 18,000 Clinical notes and USG/CT/ MRI Intra procedure still 56 Restage Restage confirming the diagnosis bladder photograph tumour Histopathology, Detailed discharge 285 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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summary , detailed Procedure / Operative Notes 86 SU0 Post TURBT SU057A Post TURBT - 10,000 Clinical notes and Histopathology/ Intra procedure still 57 - Check Check biopsy confirming the diagnosis of photograph; detailed Cystoscopy Cystoscopy (Per bladder cancer discharge summary; (Per sitting) sitting) with detailed Procedure / with cold- cold-cup biopsy Operative Notes cup biopsy 87 SU0 Urachal SU058A Urachal Cyst 18,500 Clinical notes and USG/CT/MRI Histopathology, 58 Cyst excision - Open confirming the diagnosis of Urachus Detailed discharge excision summary , detailed Procedure / Operative Notes 88 SU0 Urachal SU058B Urachal Cyst 18,500 Clinical notes and USG/CT/MRI Histopathology, 58 Cyst excision - confirming the diagnosis of Urachus Detailed discharge excision Laparoscopic summary , detailed Procedure / Operative Notes 89 SU0 VVF Repair SU059A VVF Repair - 1,500 Earlier Discharge Summary USG / UFM / Urine 59 - Follow Up Follow Up Routine 90 SU0 Intravesical SU060A Induction 15,000 Clinical notes and Histopathology/ Detailed discharge 60 BCG / cycles biopsy confirming the diagnosis of summary, Detailed Mitomycin bladder cancer Procedure / Operative Notes, original bills of medicines administered 91 SU0 Intravesical SU060B Maintenance 30,000 Clinical notes and Histopathology/ Detailed discharge 60 BCG / biopsy confirming the diagnosis of summary, Detailed Mitomycin bladder cancer Procedure / Operative Notes, original bills of medicines administered 92 SU0 Suprapubic SU061A Suprapubic 5,000 Clinical notes and USG/CT Detailed Procedure / 61 Drainage - Drainage - confirming the diagnosis for which Operative Notes Closed / Closed / Trocar the surgery is done detailing how mcuh Trocar urine was drained, detailed discharge summary 93 SU0 Stress SU062A Stress 23,000 BIS standard sling Clinical notes and Cystoscopy/ USG/ Detailed Procedure / 62 incontinenc incontinence for women (Max Uro Dynamic study to Operative Notes; e surgery surgery - Open 1) confirm the dignosis. detailed discharge 5,000 summary 286 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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94 SU0 Repair of SU063A Repair of stress 1,000 Earlier Discharge Summary Clinical notes with 63 stress incontinence - planned line of incontinenc Follow Up treatment e - Follow Up 95 SU0 Emergency SU064A Emergency 2,000 Routine Ward Clinical notes detailing chroniciy and Evidence of simple 64 manageme management of None and USG proving retention of urine catheterization and nt of Acute Acute retention details of how much retention of of Urine urine drained. Detailed Urine discharge summary giving aetiology of retention 96 SU0 Meatotomy SU065A Meatotomy 3,500 Clinical notes and confirmed Detailed discharge 65 / diagnosis of meatal stenosis summary, detailed Meatoplast Procedure / Operative y Notes 97 SU0 Meatotomy SU065B Meatoplasty 3,500 Clinical notes and confirmed Detailed discharge 65 / diagnosis of meatal stenosis summary, detailed Meatoplast Procedure / Operative y Notes 98 SU0 Urethroplas SU066A Urethroplasty - 28,000 Clinical notes and ACU (Anterograde Intra procedure clinical 66 ty End to end urethrography)/micturating cysto- photograph, Detailed urethrogram (MCU) + Retrograde discharge summary, urethrography justifying the surgery. detailed Procedure / Operative Notes 99 SU0 Urethroplas SU066B Urethroplasty - 28,000 Clinical notes and ACU (Anterograde Intra procedure clinical 66 ty Substitution - urethrography)/micturating cysto- photograph, Detailed single stage urethrogram (MCU) + Retrograde discharge summary, urethrography justifying the surgery. detailed Procedure / Operative Notes 100 SU0 Urethroplas SU066C Urethroplasty - 41,500 Clinical notes and ACU (Anterograde Intra procedure clinical 66 ty Substitution - urethrography)/micturating cysto- photograph, Detailed two stage urethrogram (MCU) + Retrograde discharge summary, urethrography justifying the surgery. detailed Procedure / Operative Notes 101 SU0 Urethroplas SU066D Urethroplasty - 32,000 Clinical notes and ACU (Anterograde Intra procedure clinical 66 ty Transpubic urethrography)/micturating cysto- photograph, Detailed urethrogram (MCU) + Retrograde discharge summary, urethrography justifying the surgery. detailed Procedure / Operative Notes 102 SU0 Urethroplas SU067A Urethroplasty 1,000 Earlier Discharge Summary USG / UFM / Urine 287 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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67 ty Follow Follow Up Routine Up 103 SU0 Urethral SU068A Non endocopic 2,000 Clinical notes and Investigation Detailed discharge 68 Dilatation as an reports confirming urethral stricture summary, Detailed independent (RGU+/- MCU) Procedure / Operative procedure Notes detailing size of dilators used 104 SU0 Urethral SU068B Endocopic as 5,000 Clinical notes and Investigation Endoscopic Intra 68 Dilatation an independent reports confirming urethral stricture procedure still procedure (RGU+/- MCU) photograph, detailed discharge summary, Detailed Procedure / Operative Notes 105 SU0 Perineal SU069A Perineal 20,000 Clinical notes detailing the Intra procedure clinical 69 Urethrosto Urethrostomy pathology for which performed with photograph, Detailed my without without closure supporting Evidence of RGU discharge summary, closure (Retrograde urethrography) + MCU detailed Procedure / Operative Notes 106 SU0 Post. SU070A Post. Urethral 14,000 Clinical notes and confirmation of Intra procedure clinical 70 Urethral Valve stenosis of posterir urethral valve by photograph, Post Valve fulguration Voiding cystourethrogram procedure Imaging fulguration (preferred) + USG +/- uroflowmetry. (USG), Detailed discharge summary, detailed Procedure / Operative Notes 107 SU0 Hypospadia SU071A Single stage 28,000 Clinical notes and Clinical Post Procedure Clinical 71 s repair Photograph Photograph of affected part, detailed Procedure / Operative Notes; Detailed Procedure / Operative Notes 108 SU0 Hypospadia SU071B Two or more 12,000 Clinical notes and Clinical Post Procedure Clinical 71 s repair stage (First Photograph Photograph of affected Stage) part, detailed Procedure / Operative Notes 109 SU0 Hypospadia SU071C Two or more 2 Clinical notes and Clinical Post Procedure Clinical 71 s repair stage Photograph; evidence of stage 1 Photograph of affected (Intermediate (Discharge Summary) part, detailed Stage) Procedure / Operative 288 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Notes 110 SU0 Hypospadia SU071D Two or more 30,000 Clinical notes and Clinical Post Procedure Clinical 71 s repair stage (Final Photograph; evidence of stage 1 / 2 Photograph of affected Stage) (Discharge Summary) part, detailed Procedure / Operative Notes 111 SU0 Hypospadia SU072A Hypospadias 1,000 Discharge Summary USG / UFM / Urine 72 s Repair - Repair - Follow Routine Follow Up Up 112 SU0 Emergency SU073A Emergency 2,000 Routine Ward Clinical notes detailing the Evidence of 73 manageme management of None hematuria with urine report investigations done nt of Hematuria showing frank or microscopic? treatment given; Hematuria detailed discharge summary 113 SU0 Excision of SU074A Excision of 5,000 Clinical notes and confirmed Histopathology, 74 Urethral Urethral diagnosis of urethral carunclule. Detailed discharge Caruncle Caruncle summary, detailed Procedure / Operative Notes 114 SU0 Urethrovagi SU075A Urethrovaginal 30,000 Clinical notes and urethro Detailed Procedure / 75 nal fistula fistula repair Cystoscopy +vaginoscopy +USG Operative Notes, repair confirming the diagnosis detailed discharge summary. 115 SU0 Urethrorect SU076A Urethrorectal 40,000 Clinical notes and confirmation of detailed Procedure / 76 al fistula fistula repair fistula and it's tract by Operative Notes, repair Cystoscopy+Sigmoidoscopy+/- Detailed discharge RGU+MCU summary 116 SU0 Open SU077A Open simple 27,500 Clinical notes and USG with prostate Histopathology, 77 simple prostatetctomy size and Post Void Volume +/- PSA, Detailed discharge prostatetct for BPH +/- uroflometry summary, detailed omy for Procedure / Operative BPH Notes 117 SU0 Radical SU078A Open 50,000 Clinical notes and MRI /CT prostrate Histopathology of 78 prostatecto + PSA+Biopsy; prostate, Detailed my discharge summary, detailed Procedure / Operative Notes with details of nodes removed. 118 SU0 Radical SU078B Lap. 50,000 Clinical notes and MRI /CT prostrate Histopathology of
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78 prostatecto + PSA+Biopsy; prostate, Detailed my discharge summary, detailed Procedure / Operative Notes with details of nodes removed. 119 SU0 Holmium SU079A Holmium Laser 40,000 Clinical notes and USG with prostate Histopathology, 79 Laser Prostatectomy size and Post Void Volume +/- PSA, Detailed discharge Prostatecto +/- uroflometry Is the hospital summary, detailed my registered for holmium laser? Procedure / Operative Notes 120 SU0 TURP- SU080A Monopolar 27,500 Clinical notes and USG with prostate Histopathology, 80 Transurethr size and Post Void Volume +/- PSA, Detailed discharge al Resection +/- uroflometry summary, detailed of the Procedure / Operative Prostate, Notes BPH 121 SU0 TURP- SU080B Bipolar 27,500 Clinical notes and USG with prostate Histopathology, 80 Transurethr size and Post Void Volume +/- PSA, Detailed discharge al Resection +/- uroflometry summary, detailed of the Procedure / Operative Prostate, Notes BPH 122 SU0 Transrectal SU081A Transrectal 10,000 Clinical notes and USG with prostate Histopathology 81 Ultrasound Ultrasound size and Post Void Volume showing reporting of guided guided prostate establishing suspicion of malignancy, minimum 12 core prostate biopsy +/- PSA samples of prostate, biopsy (minimum 12 Detailed discharge (minimum core) summary, detailed 12 core) Procedure / Operative Notes. 123 SU0 Penectomy SU082A Partial 15,000 Clinical notes and Biopsy findings Histopathology, 82 Penectomy Detailed discharge summary, detailed Procedure / Operative Notes 124 SU0 Penectomy SU082B Total 25,000 Clinical notes and Biopsy findings Histopathology, 82 Penectomy + Detailed discharge Perineal summary, detailed Urethrostomy Procedure / Operative Notes detailing 290 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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urethrostomy 125 SU0 Surgery for SU083A Aspiration 15,000 Color-flow penile Doppler imaging/ Detailed discharge 83 Priapism USG (patients with high-flow summary; detailed priapism) Procedure / Operative Notes 126 SU0 Surgery for SU083B Shunt 15,000 Color-flow penile Doppler imaging/ Detailed discharge 83 Priapism USG (patients with high-flow summary; detailed priapism) Procedure / Operative Notes 127 SU0 Surgery for SU084A Surgery for 1,000 Earlier Discharge Summary Clinical notes with 84 Priaprism - Priaprism - planned line of Follow Up Follow Up treatment 128 SU0 Penile SU085A Penile 35,000 Penile Prosthesis Clinical notes with Previous medical Detailed discharge 85 prosthesis prosthesis - Malleable - reports showing the panectomy and summary, detailed insertion insertion Indian Implant its indication Procedure / Operative (Max 1) Notes, Bar code of implant used 129 SU0 Orchiectom SU086A High inguinal 13,800 Clinical notes and USG/CT / Biopsy Histopathology, 86 y confirming testicular cancer Detailed discharge summary, detailed Procedure / Operative Notes 130 SU0 Orchiectom SU086B Simple 10,000 Clinical notes and USG/CT / Biopsy Histopathology, 86 y confirming testicular cancer Detailed discharge summary, detailed Procedure / Operative Notes 131 SU0 Bilateral SU087A Bilateral 10,000 Clinical notes and USG/CT / Biopsy Histopathology, 87 Orchidecto Orchidectomy confirming bilateral testicular cancer Detailed discharge my for for hormone summary, detailed hormone ablation Procedure / Operative ablation Notes 132 SU0 Orchiopexy SU088A Orchiopexy 30,000 Unilateral/Bilateral Clinical notes and USG confirming Post Procedure Clinical 88 with None/"5000" that laparoscopy is needed for Photograph of affected laparoscopy locating the testes. Clinical part, detailed Photograph of affected part Procedure / Operative Notes; Detailed discharge summary 133 SU0 Orchiopexy SU088B Orchiopexy 15,000 Clinical notes and USG confirming Post Procedure Clinical 88 without location of undescended testis, Photograph of affected
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laparoscopy - Clinical Photograph of affected part part, detailed U/L Procedure / Operative Notes; Detailed discharge summary 134 SU0 Orchiopexy SU088C Orchiopexy 15,000 Clinical notes and USG confirming Post Procedure Clinical 88 without location of undescended testis, Photograph of affected laparoscopy - Clinical Photograph of affected part part, detailed B/L Procedure / Operative Notes; Detailed discharge summary 135 SU0 Surgical SU089A Non 10,000 Unilateral/Bilateral Clinical notes and USG Scrotum Detailed discharge 89 Correction Microsurgical None/"5000" summary; detailed of Procedure / Operative Varicocele Notes 136 SU0 Surgical SU089B Microsurgical 15,000 Unilateral/Bilateral Clinical notes and USG Scrotum; is Detailed discharge 89 Correction None/"5000" the EHCP registred for summary; detailed of microsurgery? Procedure / Operative Varicocele Notes 137 SU0 Radical SU090A Open 36,500 Clinical notes and USG/CT / Biopsy Histopathology, 90 Retroperito confirming bilateral testicular cancer Detailed discharge neal lymph summary, detailed node Procedure / Operative dissection Notes 138 SU0 Radical SU090B Lap. 36,500 Clinical notes and USG/CT / Biopsy Histopathology, 90 Retroperito confirming bilateral testicular cancer Detailed discharge neal lymph summary, detailed node Procedure / Operative dissection Notes 139 SU0 Ilio-Inguinal SU091A Ilio-Inguinal 18,500 Unilateral/Bilateral Clinical notes and USG/CT/MRI / Histopathology, 91 lymphaden lymphadenecto None/"5000" Biopsy confirming the diagnosis for Detailed discharge ectomy my which the surgery is done. summary, detailed Procedure / Operative Notes 140 SU0 Hysterecto SU092A Hysterectomy 5,000 Clinical notes and Histopathology, 92 my as part as part of VVF / Cystoscopy+vaginoscopy+CT - Detailed Procedure / of VVF / uterovaginal IVP/IVP +/- cystogram confirming Operative Notes, uterovagina fistula repair the diagnosis detailed discharge l fistula summary. repair 141 SU0 PCNL - SU093A PCNL - Follow 1,200 Earlier Discharge Summary USG / Urine Routine, 93 Follow Up Up Drugs 292 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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142 SU0 Emergency SU094A Emergency 3,500 Clinical notes detailing the case Detailed reports of all 94 manageme management of history with previous work up / investigations done and nt of Ureteric stone - initial diagnosis with stills of ureteric consultation paper of Ureteric Package for stone and treatment done so far treating doctor; culture stone - evaluation / & ABS report and Package for investigation Evidence of 3 weeks evaluation / (ultrasound + medicines investigatio culture) for 3 n weeks (ultrasound (medicines). + culture) for 3 weeks (medicines) .
21. Neurosurgery
• Total number of packages: 54 • Total number of procedures: 82 • Additional cross specialty procedures: 23 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Specific Pre and Post-op Investigations such as pre/ post-op X-ray, neuro-diagnostic studies, post-operative clinical photographs showing scars etc. will need to be submitted/ uploaded for pre-authorization/ claims settlement purposes. The costs for such investigations will form part of the approved package cost. S. Packag AB PM - Procedur AB PM - JAY Package Stratification Implant Mandatory Mandatory Documents - Claim No. e Code JAY e Code Procedure Price Documents - Pre Processing HBP Package HBP 2.0 Name Authorization 2.0 Name 1 SN001 Depressed SN001A Depressed Clinical notes and CT Post procedure Imaging with film (CT), Fracture Fracture 40,000 confirming diagnosis Post procedure Clinical photgraph showing scar, detailed discharge summary, Detailed Procedure / Operative Notes. 2 SN002 CranioPlast SN002A CranioPlasty CT/MRI Post procedure Imaging wih film 293 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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y with 20,000 (CT/Xray), Post procedure Clinical Endogenous photgraph , Detailed Procedure / graft Operative Notes. 3 SN002 CranioPlast SN002B CranioPlasty Implant for CT/MRI Post procedure Imaging wih film y with Exogenous 20,000 "CranioPlasty (CT/Xray), Post procedure Clinical graft with Exogenous photgraph , Detailed Procedure / graft" (Max 1) Operative Notes.
4 SN003 Twist Drill SN003A Twist Drill Clinical notes and CT Post procedure Imaging with film Craniostom Craniostomy 15,000 (CT/MRI), Post procedure Clinical y photgraph showing scar, Detailed Procedure / Operative Notes. Discharge summary 5 SN004 Craniosteno SN004A Craniostenosis Clinical notes and CT/ Post procedure Imaging with film (CT), sis 28,000 MRI establishing Post procedure Clinical photgraph need of surgery showing Post procedure Clinical photgraph showing scar; detailed discharge summary, Detailed Procedure / Operative Notes. 6 SN005 Meningocel SN005A Anterior Clinical notes and Post procedure Imaging with film (CT), e 36,000 CT/MRI establishing Post procedure Clinical photgraph need of surgery showing scar, Detailed discharge summary Detailed Procedure / Operative Notes. 7 SN005 Meningocel SN005B Lumbar Clinical notes and Post procedure Imaging with film (CT), e 36,000 CT/MRI establishing Post procedure Clinical photgraph need of surgery showing scar, Detailed discharge summary Detailed Procedure / Operative Notes. 8 SN005 Meningocel SN005C Occipital Clinical notes and Post procedure Imaging with film (CT), e 50,000 CT/MRI establishing Post procedure Clinical photgraph need of surgery showing scar, Detailed discharge summary Detailed Procedure / Operative Notes. 9 SN006 Surgery for SN006A Gocussa Clinical notes and CT Histopathology, Post procedure Imaging tumour 50,000 supporting surgery with film (CT), Post procedure Clinical meninges photgraph showing scar , Detailed Procedure / Operative Notes. Detailed discharge summary 10 SN006 Surgery for SN006B Posterior Clinical notes and CT Histopathology, Post procedure Imaging tumour 50,000 supporting surgery with film (CT), Post procedure Clinical 294 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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meninges photgraph showing scar , Detailed Procedure / Operative Notes. Detailed discharge summary 11 SN007 Duroplasty SN007A Duroplasty with Clinical notes and CT/ Post procedure Imaging with film (CT), Endogenous 12,500 MRI establishing Post procedure Clinical photgraph graft need of surgery showing Post procedure Clinical photgraph showing scar; detailed discharge summary, Detailed Procedure / Operative Notes. 12 SN007 Duroplasty SN007B Duroplasty with Implant for Clinical notes and CT/ Post procedure Imaging with film (CT), Exogenous graft 12,500 "Duroplasty - MRI establishing Post procedure Clinical photgraph Exogenous" need of surgery showing Post procedure Clinical (Max 1) photgraph showing scar; detailed discharge summary, Detailed Procedure / Operative Notes. 13 SN008 Burr hole SN008A Burr hole Clinical notes and Post procedure Imaging with film (CT), surgery 7,000 CT/MRI establishing Post procedure Clinical photgraph need of surgery showing scar , Detailed discharge summary, Detailed Procedure / Operative Notes. 14 SN008 Burr hole SN008B Burr hole Clinical notes and Post procedure Imaging with film (CT), surgery surgery with 20,000 CT/MRI establishing Post procedure Clinical photgraph chronic Sub need of surgery showing scar , Detailed discharge Dural summary, Detailed Procedure / Haematoma Operative Notes. 15 SN009 Surgery for SN009A Head injuries Clinical notes and CT/ Post procedure Imaging with film (CT), Haematom 55,000 MRI establishing Post procedure Clinical photgraph a - need of surgery showing scar , Detailed Procedure / Intracranial Operative Notes. Detailed discharge summary 16 SN009 Surgery for SN009B Hypertensive Clinical notes and CT/ Post procedure Imaging with film (CT), Haematom 50,000 MRI establishing Post procedure Clinical photgraph a - need of surgery showing scar , Detailed Procedure / Intracranial Operative Notes. Detailed discharge summary 17 SN009 Surgery for SN009C Child - subdural Clinical notes and CT/ Post procedure Imaging with film (CT), Haematom 50,000 MRI establishing Post procedure Clinical photgraph a - need of surgery showing scar , Detailed Procedure / Intracranial Operative Notes. Detailed discharge summary 18 SN010 Excision of SN010A Excision of Brain Clinical notes and CT Pus C/s, Post procedure Imaging with 295 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Brain Abscess 36,000 film (CT), Post procedure Clinical Abscess photgraph showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes 19 SN011 Abscess SN011A Abscess Tapping Single/Multiple Clinical notes and CT Pus C/s, Post procedure Imaging with Tapping 20,000 None/"+10000 film (CT), Post procedure Clinical " photgraph showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes 20 SN012 Epilepsy SN012A Epilepsy Surgery Clinical notes and Post procedure Imaging with film (CT), Surgery 50,000 EEG, Neurologist Post procedure Clinical photgraph report, CT/MRI showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes. 21 SN013 Brain SN013A Brain Biopsy Clinical notes and Histopathology, Post procedure Clinical Biopsy 15,000 CT/MRI, suspected photgraph showing scar, Detailed differential diagnosis discharge summary, Detailed Procedure / Operative Notes. 22 SN014 Excision of SN014A Excision of Clinical notes and CT/ Post procedure Imaging with film (CT), Orbital Orbital Tumour 40,000 MRI report Post procedure Clinical photgraph Tumour showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes. HPE report 23 SN015 Excision of SN015A Parasagital Clinical notes and Histopathology, Post procedure Imaging Brain 50,000 CT/MRI with film (CT), Post procedure Clinical Tumor photgraph showing scar, Detailed Supratentor discharge summary, Detailed Procedure ial / Operative Notes. 24 SN015 Excision of SN015B Basal Clinical notes and Histopathology, Post procedure Imaging Brain 50,000 CT/MRI with film (CT), Post procedure Clinical Tumor photgraph showing scar, Detailed Supratentor discharge summary, Detailed Procedure ial / Operative Notes. 25 SN015 Excision of SN015C Brainstem Clinical notes and Histopathology, Post procedure Imaging Brain 50,000 CT/MRI with film (CT), Post procedure Clinical Tumor photgraph showing scar, Detailed Supratentor discharge summary, Detailed Procedure ial / Operative Notes. 26 SN015 Excision of SN015D C P Angle Clinical notes and Histopathology, Post procedure Imaging Brain 50,000 CT/MRI with film (CT), Post procedure Clinical Tumor photgraph showing scar, Detailed 296 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Supratentor discharge summary, Detailed Procedure ial / Operative Notes. 27 SN015 Excision of SN015E Supratentorial & Clinical notes and Histopathology, Post procedure Imaging Brain others 55,000 CT/MRI with film (CT), Post procedure Clinical Tumor photgraph showing scar, Detailed Supratentor discharge summary, Detailed Procedure ial / Operative Notes. 28 SN016 Stereotactic SN016A Stereotactic Clinical notes from Post procedure Imaging with film (CT), Lesioning Lesioning 60,000 neuorlogist/ Post procedure Clinical photgraph psychiatriat / MRI showing scar, Detailed Procedure / Operative Notes. Detailed discharge summary 29 SN017 Trans SN017A Trans Clinical notes and Histopathology, Post procedure Imaging Sphenoidal Sphenoidal 50,000 MRI supporting with film (MRI), Detailed Procedure / Surgery Surgery surgery Operative Notes. Detailed discharge summary. 30 SN018 Trans oral SN018A Trans oral X ray and MRI Spine Post procedure Imaging with film (X- Surgery Surgery 40,000 ray), Detailed discharge summary, Detailed Procedure / Operative Notes. HPE report 31 SN019 Transoral SN019A Transoral Implant for X ray and MRI Spine Post procedure Imaging with film (X- surgery surgery 55,000 "Transoral ray), Detailed discharge summary, (Anterior) (Anterior) and surgery Detailed Procedure / Operative Notes. and CV CV Junction (Anterior) and Junction (Posterior CV Junction (Posterior Sterilisation) (Posterior Sterilisation Sterlization)" ) (Max 1) 32 SN020 External SN020A External Clinical noteand CT Analysis/ C/S of pus/ fluid removed, Ventricular Ventricular 30,000 Post procedure Imaging with film (CT), Drainage Drainage (EVD) Post procedure Clinical photgraph (EVD) including showing scar , Detailed discharge including antibiotics summary, Detailed Procedure / antibiotics Operative Notes. 33 SN021 Ventricular SN021A Ventricular Clinical notes and CT Post procedure Imaging with film (CT), Puncture Puncture 15,000 justifying procedure Post procedure Clinical photgraph showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes. 34 SN022 Shunt SN022A Ventriculo - Clinical notes and Detailed discharge summary, Detailed Surgery peritoneal 30,000 CT/MRI Procedure / Operative Notes.Clinical 297 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Photograph 35 SN022 Shunt SN022B Ventriculo - Clinical notes and Detailed discharge summary, Detailed Surgery pleural 30,000 CT/MRI Procedure / Operative Notes.Clinical Photograph 36 SN022 Shunt SN022C Ventriculo - Clinical notes and Detailed discharge summary, Detailed Surgery atrial 30,000 CT/MRI Procedure / Operative Notes.Clinical Photograph 37 SN022 Shunt SN022D Theco - Clinical notes and Detailed discharge summary, Detailed Surgery peritoneal 30,000 CT/MRI Procedure / Operative Notes.Clinical Photograph 38 SN023 Aneurysm SN023A Aneurysm Clip for Clinical notes and CT- Post procedure Imaging with film (CT) Clipping Clipping 50,000 Aneurysm (Max angio/MRA/DSA showing clips, Post procedure Clinical including including 1) photgraph showing scar, Detailed angiogram angiogram 15,000 discharge summary, Detailed Procedure / Operative Notes., invoice of all the clip(s) used 39 SN024 Superficial SN024A Superficial Clinical notes and Post procedure Imaging with film (CT), Temporal Temporal Artery 60,000 MRA/ DSA report Post procedure Clinical photgraph Artery (STA): middle showing scar, Detailed discharge (STA): cerebral artery summary, Detailed Procedure / middle (MCA) or (other Operative Notes. cerebral EC - IC) Bypass artery procedure (MCA) or (other EC - IC) Bypass procedure 40 SN025 Arterio SN025A Intracranial Clinical notes and Post procedure Imaging with film (CT), venous 50,000 MRA/ DSA report Post procedure Clinical photgraph malformati showing Post procedure Clinical on (AVM) photgraph showing scar, Detailed excision discharge summary, Detailed Procedure / Operative Notes. 41 SN025 Arterio SN025B Intraspinal Clinical notes and Post procedure Imaging with film (CT), venous 50,000 MRA/ DSA report Post procedure Clinical photgraph malformati showing Post procedure Clinical on (AVM) photgraph showing scar, Detailed excision discharge summary, Detailed Procedure / Operative Notes. 42 SN025 Arterio SN025C Scalp Clinical notes and Post procedure Imaging with film (CT), venous 25,000 MRA/ DSA report Post procedure Clinical photgraph 298 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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malformati showing Post procedure Clinical on (AVM) photgraph showing scar, Detailed excision discharge summary, Detailed Procedure / Operative Notes. 43 SN026 Foramen SN026A Foramen Clinical notes and Post procedure Clinical photgraph Magnum Magnum 45,000 CT/MRI showing scar, detailed discharge Decompres Decompression summary, Detailed Procedure / sion Operative Notes. 44 SN027 Skull SN027A Skull Traction Clinical notes and Clinical photgraph with traction applied, Traction 8,000 Indication for skull Detailed Procedure / Operative Notes traction supporting detailing weights applied; Detailed radiological evdience discharge summary . (CT/MRI). 45 SN028 Posterior SN028A Posterior Clinical notes and Post procedure Clinical photgraph Cervical Cervical 30,000 MRI showing scar, Detailed discharge Discetomy Discetomy summary, Detailed Procedure / without without implant Operative Notes. implant 46 SN029 Posterior SN029A Posterior Implant for Clinical notes and Post procedure Clinical photgraph Cervical Cervical Fusion 50,000 "Posterior MRI showing scar, Detailed discharge Fusion with with implant Cervical Fusion summary, Detailed Procedure / implant (Lateral mass with implant Operative Notes. Cervical spine X-ray (Lateral fixation) (Lateral mass showing implant mass fixation)" (Max fixation) 1) 47 SN030 Cervical SN030A Cervical Disc Clinical notes and Post procedure Clinical photgraph Disc Multiple level 40,000 MRI showing scar, Detailed discharge Multiple without Fusion summary, Detailed Procedure / level Operative Notes. Cervical spine X-ray without Fusion 48 SN031 Excision of SN031A Excision of Unilateral/Bilat X-Ray chest/CT/MRI Post procedure Imaging with film (X Cervical Cervical Ribs 20,000 eral confirming Diagnosis. Ray) Detailed Procedure / Operative Ribs None/"+15000 Notes. Post procedure scar photo, " Detailed discharge summary 49 SN032 Thoracic / SN032A Thoracic Implant for Clinical notes and Post procedure Imaging with film (X ray) Lumbar Corpectomy 60,000 "Thoracic MRI showing the implants, Post procedure Corpectom with fusion Corpectomy Clinical photgraph showing scar, y with with fusion" Detailed discharge summary , Detailed fusion (Max 1) Procedure / Operative Notes 50 SN032 Thoracic / SN032B Lumbar Implant for Clinical notes and Post procedure Imaging with film (X ray) 299 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Lumbar Corpectomy 60,000 "Lumbar MRI showing the implants, Post procedure Corpectom with fusion Corpectomy Clinical photgraph showing scar, y with with fusion" Detailed discharge summary , Detailed fusion (Max 1) Procedure / Operative Notes 51 SN033 Lumbar SN033A Lumbar Clinical notes and Post op MRI, Post procedure Clinical Discectomy Discectomy 30,000 MRI establishing photgraph showing scar, Detailed need of surgery discharge summary Detailed Procedure / Operative Notes. 52 SN034 Laminecto SN034A Laminectomy Clinical notes and Post procedure X-ray showing fixation & my with Fusion 40,000 MRI establishing fusion, Post procedure Clinical need of surgery photgraph showing scar, Detailed discharge summary Detailed Procedure / Operative Notes. 53 SN034 Laminecto SN034B Laminectomy Implant for Clinical notes and Post procedure X-ray showing fixation & my with Fusion and 40,000 Laminectomy MRI establishing fusion, Post procedure Clinical fixation with Fusion and need of surgery photgraph showing scar, Detailed fixation (Max 1) discharge summary Detailed Procedure 10,000 / Operative Notes. 54 SN035 Neurectom SN035A Neurectomy Clinical notes Post procedure Clinical photgraph y 16,000 justifying the surgery, showing scar, detailed discharge summary Detailed Procedure / Operative Notes. 55 SN035 Neurectom SN035B Neurectomy - Clinical notes Post procedure Clinical photgraph y Trigeminal 16,500 justifying the surgery, showing scar, detailed discharge summary Detailed Procedure / Operative Notes. 56 SN036 Micro SN036A Cervical Clinical notes and Intra procedure still photograph Post discectomy 40,000 MRI procedure Clinical photgraph showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes. 57 SN036 Micro SN036B Lumbar Clinical notes and Intra procedure still photograph Post discectomy 40,000 MRI procedure Clinical photgraph showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes. 58 SN037 Surgery for SN037A Surgery for Clinical notes and Post op X-ray with film; Detailed Spinal Canal Spinal Canal 40,000 MRI supporting discharge summary; Detailed Procedure Stenosis Stenosis surgery / Operative Notes; 59 SN038 Spine - SN038A Spine - Clinical notes and Post op X-ray with film showing fusion; Decompres Decompression 40,000 MRI supporting Detailed discharge summary; Detailed sion & & Fusion surgery Procedure / Operative Notes;
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Fusion 60 SN038 Spine - SN038B Spine - Implant for Clinical notes and Post op X-ray with film showing fusion; Decompres Decompression 40,000 Spine - MRI supporting Detailed discharge summary; Detailed sion & & Fusion with Decompression surgery Procedure / Operative Notes; Fusion fixation & Fusion with fixation (Max 1) 10,000 61 SN039 Spine - SN039A Spine - Clinical notes and Post procedure Clinical photgraph Extradural Extradural 30,000 MRI supporting showing scar, detailed discharge Haematom Haematoma surgery summary, Detailed Procedure / a Operative Notes 62 SN039 Spine - SN039B Spine - Implant for Clinical notes and Post procedure Clinical photgraph Extradural Extradural 30,000 Spine - MRI supporting showing scar, detailed discharge Haematom Haematoma Extradural surgery summary, Detailed Procedure / a with fixation Haematoma Operative Notes with fixation (Max 1) 10,000 63 SN040 Spine - SN040A Spine - Clinical notes and Post procedure Clinical photgraph Intradural Intradural 40,000 MRI supporting showing scar, detailed discharge Haematom Haematoma surgery summary, Detailed Procedure / a Operative Notes 64 SN040 Spine - SN040B Spine - Implant for Clinical notes and Post procedure Clinical photgraph Intradural Intradural 40,000 Spine - MRI supporting showing scar, detailed discharge Haematom Haematoma Intradural surgery summary, Detailed Procedure / a with fixation Haematoma Operative Notes with fixation (Max 1) 10,000 65 SN041 Spine - SN041A Spine - Clinical notes and Histopathology/ Biopsy report, Post Extradural Extradural 30,000 MRI supporting procedure Clinical photgraph showing Tumour Tumour surgery scar, Detailed discharge summary Detailed Procedure / Operative Notes. 66 SN041 Spine - SN041B Spine - Implant for Clinical notes and Histopathology/ Biopsy report, Post Extradural Extradural 30,000 Spine - MRI supporting procedure Clinical photgraph showing Tumour Tumour with Extradural surgery scar, Detailed discharge summary fixation Tumour with Detailed Procedure / Operative Notes. fixation (Max 1) 10,000 67 SN042 Spine - SN042A Spine - Clinical notes and Biopsy & HPE report; Post procedure Intradural Intradural 40,000 MRI supporting Clinical photgraph showing scar, 301 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Tumour Tumour surgery detailed discharge summary, Detailed Procedure / Operative Notes 68 SN042 Spine - SN042B Spine - Implant for Clinical notes and Biopsy & HPE report; Post procedure Intradural Intradural 40,000 Spine - MRI supporting Clinical photgraph showing scar, Tumour Tumour with Intradural surgery detailed discharge summary, Detailed fixation Tumour with Procedure / Operative Notes fixation (Max 1) 10,000 69 SN043 Spine - SN043A Spine - Clinical notes and Histopathology, Post procedure Imaging Intramedull Intramedullar 50,000 MRI supporting with film (X-ray/ CT), Post procedure ar Tumour Tumour surgery Clinical photgraph showing scar, Detailed Procedure / Operative Notes. Detailed discharge summary 70 SN043 Spine - SN043B Spine - Implant for Clinical notes and Histopathology, Post procedure Imaging Intramedull Intramedullar 50,000 Spine - MRI supporting with film (X-ray/ CT), Post procedure ar Tumour Tumour with Intramedullar surgery Clinical photgraph showing scar, fixation Tumour with Detailed Procedure / Operative Notes. fixation (Max 1) Detailed discharge summary 10,000 71 SN044 R. F. SN044A R. F. Lesioning Clinical notes Intra procedure clinical CD/ series of still Lesioning for Trigeminal 16,500 establishing diagnosis photographs; Detailed Procedure / for Neuralgia of Trigeminal Operative Notes, detailed discharge Trigeminal neuralgia and summary; invoice of RF probe Neuralgia justification of local neurectomy with MRI / CT 72 SN045 Brachial SN045A Brachial Plexus – Clinical notes and Detailed discharge summary, Post Plexus – Repair 27,000 MRI report procedure Clinical photgraph showing Repair scar, Detailed Procedure / Operative Notes. 73 SN046 Carpal SN046A Carpal Tunnel Clinical history, MRI, Post procedure Clinical photgraph Tunnel Release 10,000 NCV showing scar, Detailed discharge Release summary , Detailed Procedure / Operative Notes & MRI Report 74 SN047 Nerve SN047A Nerve Clinical notes and Detailed discharge summary, Post Decompres Decompression 16,000 NCV procedure Clinical photgraph showing sion scar, Detailed Procedure / Operative Notes. 75 SN048 Cranial SN048A Cranial Nerve Clinical notes and Post procedure Imaging with film (CT), Nerve Anastomosis 32,000 MRI justifying Post procedure Clinical photgraph Anastomosi surgery showing scar, detailed discharge 302 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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s summary, Detailed Procedure / Operative Notes. 76 SN049 Peripheral SN049A Minor Clinical notes and Detailed discharge summary, Post Nerve 15,000 Nerve Conduction procedure Clinical photgraph showing Surgery Velocity (NCV) and scar, Detailed Procedure / Operative Electromyography Notes. (EMG) reports 77 SN049 Peripheral SN049B Major Clinical notes and Detailed discharge summary, Post Nerve 30,000 Nerve Conduction procedure Clinical photgraph showing Surgery Velocity (NCV) and scar, Detailed Procedure / Operative Electromyography Notes. (EMG) reports 78 SN050 Nerve SN050A Nerve Biopsy Clinical notes and HPE Report of Nerve Biopsy: Detailed Biopsy excluding 7,000 Reports of previous Proedure notes; detailed discharge excluding Hensens investigations and summary Hensens treatment taken ruling out Hensen's, differentials suspected, need for Nerve Biopsy 79 SN051 Muscle SN051A Muscle Biopsy Clinical notes and Histopathology, Post procedure Clinical Biopsy with with report 7,000 Electromyography photgraph showing scar Detailed report (EMG) reports discharge summary,, Detailed Procedure / Operative Notes. 80 SN052 Anterior SN052A Anterior Clinical notes and Post procedure Imaging with film (CT), Encephaloc Encephalocele 50,000 CT/MRI as Evidence Post procedure Clinical photgraph ele showing scar, Detailed discharge summary Detailed Procedure / Operative Notes. 81 SN053 Spina Bifida SN053A Spina Bifida Clinical notes and CT Post procedure Clinical photgraph Surgery Surgery 36,000 showing scar, Detailed discharge summary, Detailed Procedure / Operative Notes. 82 SN054 Gamma SN054A Gamma Knife Clinical notes and CT/ Intra procedure clinical photograph, Knife radiosurgery 75,000 MRI report; Is the treating doctor's consultation paper radiosurger (GKRS) / SRS for EHCP equipped with showing planning for RT treatment and y (GKRS) / tumours / Gamma Knife? the RT chart, detailed discharge SRS for Arteriovenous summary tumours / malformation Arterioveno (AVM) us 303 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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malformati on (AVM)
22. Oral & Maxillofacial Surgery
• Total number of packages: 7 • Total number of procedures: 9 • Additional cross specialty procedures: 6 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Nil S. No. Package AB PM - JAY Procedure AB PM - JAY Package Mandatory Documents - Pre Mandatory Documents - Claim LOS Code Package Name Code Procedure Name Price Authorization Processing HBP 2.0 HBP 2.0 1 SM001 Extraction of SM001A Extraction of impacted 500 Dental X-ray / OPG Post procedure X-ray, extracted NA impacted tooth tooth under LA (Orthopantomogram) showing tooth, Detailed Procedure / under LA impacted tooth Clinical Operative Notes, Photograph 2 SM002 Sequestrectomy SM002A Sequestrectomy 1,500 OPG showing necrosed tissue Post procedure clinical 7 photograph; detailed discharge summary, Detailed Procedure / Operative Notes, HPE 3 SM003 TM joint ankylosis of SM003A TM joint ankylosis of 15,000 Clinical Photograph, X-Ray of Post procedure clinical 3 both jaws - under both jaws - under GA affected area, CT; photograph with mouth open, GA X Ray, detailed discharge summary Detailed Procedure / Operative Notes 4 SM004 Fixation of fracture SM004A Closed reduction (1 5,000 Circumstances that led to fracture, Detailed Discharge Summary, 1 of jaw jaw) using wires - MLC copy with number, Clinical detailed Procedure / Operative under LA Photograph, X Ray Mandible, Notes, Post procedure X ray mandible showing wires used 5 SM004 Fixation of fracture SM004B Open reduction (1 jaw) 12,000 Circumstances that led to fracture, Detailed Discharge Summary, 2 of jaw and fixing of plates / MLC copy with number, Clinical detailed Procedure / Operative wire – under GA Photograph, X Ray Mandible, Notes, Post procedure X ray mandible showing wires used
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6 SM005 Surgery for Cyst & SM005A Enucleation / excision / 2,500 OPG/ CT Scan confirming the detailed discharge summary, 1 tumour of Maxilla / marsupialization for diagnosis; Biopsy/FNAC if tumour, Detailed Procedure / Operative Mandible cyst & tumour of Clinical Photograph Notes, Histopath, Post Maxilla under LA procedure clinical photograph; HPE 7 SM005 Surgery for Cyst & SM005B Enucleation / excision / 2,500 OPG/ CT Scan confirming the detailed discharge summary, 1 tumour of Maxilla / marsupialization for diagnosis; Biopsy/FNAC if tumour, Detailed Procedure / Operative Mandible cyst & tumour of Clinical Photograph Notes, Histopath, Post Mandible under LA procedure clinical photograph; HPE 8 SM006 Mandible Tumour SM006A Mandible Tumour 6,000 OPG/ CT Scan confirming the detailed discharge summary, 2 Resection and Resection and diagnosis; Biopsy/FNAC if tumour, Detailed Procedure / Operative reconstruction / reconstruction / Cancer Clinical Photograph Notes, Histopath, Post Cancer surgery surgery procedure clinical photograph; HPE 9 SM007 Release of fibrous SM007A Release of fibrous 3,000 Clinical notes and Oral Biopsy Detailed Procedure / Operative 1 bands & grafting - in bands & grafting - in confirming the diagnosis, Clinical Notes detailing grafting, (OSMF) treatment (OSMF) treatment Photograph detailed discharge summary, under GA under GA Post procedure clinical photograph
23. Pediatric Surgery
• Total number of packages: 19 • Total number of procedures: 35 • Additional cross specialty procedures: 179 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Nil S. No. Package AB PM - JAY Procedure AB PM - JAY Package Mandatory Documents - Pre Mandatory Documents - Claim LOS Code Package Name Code Procedure Name Price Authorization Processing HBP 2.0 HBP 2.0 1 SS001 Cleft Lip and Palate SS001A Cleft Lip and Palate 15,000 Clinical notes and Clinical Detailed discharge summary, detailed 3 Surgery (per stage) Surgery (per stage) Photograph Procedure / Operative Notes, Post procedure clinical photograph 2 SS002 Ankyloglossia SS002A Ankyloglossia Minor 5,000 Clinical notes and pre-op Detailed discharge summary, detailed 1
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photograph Procedure / Operative Notes, post procedure clinical photograph 3 SS002 Ankyloglossia SS002B Ankyloglossia Major 15,000 Clinical notes and pre-op Detailed discharge summary, detailed 3 photograph Procedure / Operative Notes, post procedure clinical photograph 4 SS003 Anti GERD Surgery SS003A Anti GERD Surgery 10,000 Clinical notes and UGI Intra procedure clinical photograph, 2 Endoscopy report detailed Procedure / Operative Notes, detailed discharge summary 5 SS004 Gastrostomy + SS004A Gastrostomy + 20,000 USG/CT Abd, Endoscopy, detailed Procedure / Operative Notes, 5 Esophagoscopy + Esophagoscopy + Biopsy Post procedure clinical photograph Threading Threading 6 SS005 Ladds Procedure SS005A Ladds Procedure 30,000 X Ray/ CT Scan Abdomen/ Histopathology, detailed Procedure / 7 UGI contrast study Operative Notes, Post procedure clinical confirming the malrotation photograph of the operated region 7 SS006 Duplication Cyst SS006A Duplication Cyst 20,000 Clinical notes and USG/CT Histopathology, detailed Procedure / 5 Excision Excision Abd, +/- Endoscopic USG Operative Notes, Intra procedure clinical photograph, detailed discharge summary 8 SS007 Intussusception SS007A Non – Operative 20,000 Clinical notes and stills of: X- Detailed Procedure / Operative Notes,, 3 Reduction in infants ray Abdomen/USG Abdomen Detailed discharge summary , Post procedure X Ray Abdomen. 9 SS007 Intussusception SS007B Operative in infants 25,000 Clinical notes and stills of: X- Detailed Procedure / Operative Notes,, 5 ray Abdomen/USG Abdomen Detailed discharge summary , Post procedure X Ray Abdomen. 10 SS008 Surgery for SS008A Myectomy 25,000 Clinical notes and USG/ Dye Histopathology, detailed Procedure / 5 Hirschsprung’s test Operative Notes, detailed discharge Disease summary 11 SS008 Surgery for SS008B Pull Through 20,000 Clinical notes and USG/ Dye Histopathology, detailed Procedure / 5 Hirschsprung’s test Operative Notes, detailed discharge Disease summary 12 SS008 Surgery for SS008C Rectal Biopsy - Punch 10,000 Clinical notes and USG/ Dye Histopathology, detailed Procedure / 1 Hirschsprung’s test Operative Notes, detailed discharge Disease summary 13 SS008 Surgery for SS008D Rectal Biopsy – Open 10,000 Clinical notes and USG/ Dye Histopathology, detailed Procedure / 2 Hirschsprung’s test Operative Notes, detailed discharge Disease summary 14 SS008 Surgery for SS008E Sphinecterotomy 15,000 Clinical notes and USG/ Dye Histopathology, detailed Procedure / 3 Hirschsprung’s test Operative Notes, detailed discharge Disease summary 15 SS009 Rectal Polypectomy SS009A Rectal Polypectomy - 8,000 Clinical notes and Histopathology, detailed Procedure / 2 - Sigmoiescopic Sigmoiescopic Under sigmoidoscopy confirming Operative Notes, Intra procedure clinical
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Under GA GA polyp photograph 16 SS010 Ano Rectal SS010A Abd - Perineal PSARP 20,000 Clinical notes and Clinical detailed Procedure / Operative Notes, 5 Malformation Photograph, Distal Post procedure clinical Cologram/ CT, USG photograph, detailed discharge summary Abdomen, Xray Lumbosacral spine (inverted position) 17 SS010 Ano Rectal SS010B Anoplasty 20,000 Clinical notes and Clinical detailed Procedure / Operative Notes, 5 Malformation Photograph, Distal Post procedure clinical Cologram/ CT, USG photograph, detailed discharge summary Abdomen, Xray Lumbosacral spine (inverted position) 18 SS010 Ano Rectal SS010C Cutback 20,000 Clinical notes and Clinical detailed Procedure / Operative Notes, 5 Malformation Photograph, Distal Post procedure clinical Cologram/ CT, USG photograph, detailed discharge summary Abdomen, Xray Lumbosacral spine (inverted position) 19 SS010 Ano Rectal SS010D PSARP 20,000 Clinical notes and Clinical detailed Procedure / Operative Notes, 5 Malformation Photograph, Distal Post procedure clinical Cologram/ CT, USG photograph, detailed discharge summary Abdomen, Xray Lumbosacral spine (inverted position) 20 SS010 Ano Rectal SS010E Redo - Pullthrough 15,000 Clinical notes and Clinical detailed Procedure / Operative Notes, 5 Malformation Photograph, Distal Post procedure clinical Cologram/ CT, USG photograph, detailed discharge summary Abdomen, Xray Lumbosacral spine (inverted position) 21 SS010 Ano Rectal SS010F Transposition 15,000 Clinical notes and Clinical detailed Procedure / Operative Notes, 5 Malformation Photograph, Distal Post procedure clinical Cologram/ CT, USG photograph, detailed discharge summary Abdomen, Xray Lumbosacral spine (inverted position) 22 SS011 Fecal Fistula Closure SS011A Fecal Fistula Closure 25,000 Clinical notes and USG / CT Intra procedure clinical photograph, 3 abdomen and pelvis detailed Procedure / Operative Notes, delineating fistula tract. Detailed discharge summary 23 SS012 GI Tumor Excision SS012A GI Tumor Excision 30,000 Clinical notes and USG/ CT / HPR, detailed Procedure / Operative 7 biopsy Notes, Intra procedure clinical photograph, Detailed Procedure / Operative Notes, detailed discharge summary 24 SS013 Congenital SS013A Congenital 25,000 Clinical notes and Chest X-ray Detailed Procedure / Operative Notes, 5 Diaphragmatic Diaphragmatic Hernia AP/Lat, USG/CT scan stills detailed discharge summary, Foetal 307 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Hernia Cardiogram, Xray Chest AP/Lat stills 25 SS014 Exomphalos / SS014A Exomphalos 25,000 Clinical notes and Clinical Detailed discharge summary, detailed 5 Gastroschisis Photograph Procedure / Operative Notes, Post procedure clinical photograph 26 SS014 Exomphalos / SS014B Gastroschisis 25,000 Clinical notes and Clinical Detailed discharge summary, detailed 5 Gastroschisis Photograph Procedure / Operative Notes, Post procedure clinical photograph 27 SS015 Hernia & Hydrocele SS015A Hernia & Hydrocele 20,000 Clinical notes and USG, detailed Procedure / Operative Notes, 5 Clinical Photograph Post procedure clinical photograph showing scar, detailed Procedure / Operative Notes, 28 SS016 Retro - Peritoneal SS016A Retro - Peritoneal 25,000 Clinical notes and USG/MRI Histopathology, detailed Procedure / 5 Lymphangioma Lymphangioma Abd Operative Notes, Intra procedure clinical Excision Excision photograph, Detailed discharge summary 29 SS017 Surgery for SS017A Surgery for 20,000 Clinical notes and CT/MRI Histopathology, detailed Procedure / 5 Sacrococcygeal Sacrococcygeal confirming the diagnosis, Operative Notes, Post procedure clinical Teratoma Teratoma Biopsy photograph showing scar 30 SS018 Surgery for SS018A Surgery for 25,000 Clinical notes and X Ray/CT detailed Procedure / Operative Notes, 7 Congenital Lobar Congenital Lobar Scan stills confirming the Post procedure X-ray stills, detailed Emphysema Emphysema diagnosis discharge summary 31 SS019 Undescended Testis SS019A Bilateral - Palpable + 15,000 Clinical notes and USG, detailed Procedure / Operative Notes, 4 Nonpalpable Clinical Photograph Post procedure clinical photograph showing scar, detailed Procedure / Operative Notes, 32 SS019 Undescended Testis SS019B Bilateral Palpable 15,000 Clinical notes and USG, detailed Procedure / Operative Notes, 4 Clinical Photograph Post procedure clinical photograph showing scar, detailed Procedure / Operative Notes, Detailed Discharge summary 33 SS019 Undescended Testis SS019C Bilateral Non - 20,000 Clinical notes and USG, detailed Procedure / Operative Notes, 4 Palpable Clinical Photograph Post procedure clinical photograph showing scar, detailed Procedure / Operative Notes, Detailed Discharge summary 34 SS019 Undescended Testis SS019D Unilateral - Palpable 15,000 Clinical notes and USG, detailed Procedure / Operative Notes, 4 Clinical Photograph Post procedure clinical photograph showing scar, detailed Procedure / Operative Notes, Detailed Discharge summary 35 SS019 Undescended Testis SS019E Reexploration / 20,000 Clinical notes and USG, detailed Procedure / Operative Notes, 4
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Second Stage Clinical Photograph Post procedure clinical photograph showing scar, detailed Procedure / Operative Notes,
24. Plastic & Reconstructive Surgery
• Total number of packages: 8 • Total number of procedures: 12 • Additional cross specialty procedures: 17 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Specific Pre and Post-op Investigations such as clinical and/or relevant imaging photographs of the patient are essential. • In case of emergency/life-saving/ limb saving operative procedures, preauthorization may not be required. However, formal intimation should be done within 24 hours of admission. S. Package AB PM - JAY Procedure AB PM - JAY Package Implant Mandatory Documents - Mandatory Documents - LOS No. Code Package Name Code Procedure Name Price Pre Authorization Claim Processing HBP 2.0 HBP 2.0 1 SP001 Pressure Sore – SP001A Pressure Sore – 30,000 Clinical notes detailing Post procedure clinical 3 Surgery Surgery events that led to photograph; Detailed pressure sores; clinical Procedure / Operative Notes, photograph detailed discharge summary 2 SP002 Diabetic Foot – SP002A Diabetic Foot – 30,000 Clinical notes with Post procedure clinical 3 Surgery Surgery planned line of photograph; Detailed treatment detailing Operative notes, detailed diabetic foot extent of discharge summary damage; clinical photograph 3 SP003 Revascularization of SP003A Revascularization of 25,000 Clinical notes and Clinical Intra procedure clinical 5 limb / digit limb / digit photograph, Doppler; If photograph, Detailed traumatic then MLC/FIR discharge summary, Detailed report. Procedure / Operative Notes, 4 SP004 Ear Pinna SP004A Ear Pinna 30,000 Prosthesis for Ear Pinna Clinical notes and Clinical Clinical photograph of donor 5 Reconstruction with Reconstruction with Reconstruction (Max 1) photograph in case of and recipient sites, Intra costal cartilage / costal cartilage / injury, If traumatic then operative clinical photograph 309 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Prosthesis Prosthesis MLC/FIR report. Invoice of Prosthesis/ Implant (including the cost (including the cost Documents supporting if used. Detailed discharge of prosthesis / of prosthesis / indication is non- summary implants) implants) traumatic. 5 SP005 Scalp avulsion SP005A Scalp avulsion 50,000 Clinical notes detailing Intra procedure clinical 5 reconstruction reconstruction how avulsion occurred; photograph and Post Clinical Photograph, MLC procedure clinical copy with number since photograph, Detailed traumatic Procedure / Operative Notes, detailed discharge summary
6 SP006 Tissue Expander for SP006A Tissue Expander for 50,000 Tissue Expander / Detailed Clinical notes of Detailed discharge summary, 5 disfigurement disfigurement Implant for original clinical event Detailed Procedure / following burns / following burns disfigurement following having led to Operative Notes, Post trauma / congenital burns / trauma / disfigurement or procedure clinical deformity congenital deformity confirming details / photograph, Invoice of (including cost of (Max 1) invetsigations of expander/Implant used expander / implant) congenital event; Clinical Photograph, 7 SP006 Tissue Expander for SP006B Tissue Expander for 50,000 Tissue Expander / Detailed Clinical notes of Detailed discharge summary, 5 disfigurement disfigurement Implant for original clinical event Detailed Procedure / following burns / following trauma disfigurement following having led to Operative Notes, Post trauma / congenital burns / trauma / disfigurement or procedure clinical deformity congenital deformity confirming details / photograph, Invoice of (including cost of (Max 1) invetsigations of expander/Implant used expander / implant) congenital event; Clinical Photograph, 8 SP006 Tissue Expander for SP006C Tissue Expander for 50,000 Tissue Expander / Detailed Clinical notes of Detailed discharge summary, 5 disfigurement disfigurement Implant for original clinical event Detailed Procedure / following burns / following disfigurement following having led to Operative Notes, Post trauma / congenital congenital burns / trauma / disfigurement or procedure clinical deformity deformity congenital deformity confirming details / photograph, Invoice of (including cost of (Max 1) invetsigations of expander/Implant used expander / implant) congenital event; Clinical Photograph, 9 SP007 Hemangioma SP007A Sclerotherapy 35,000 Clinical notes and Clinical Post procedure clinical 3 under GA Photograph photograph, Invoice of sclerosing agent used. Detailed discharge summary,
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Detailed Procedure / Operative Notes. 10 SP007 Hemangioma SP007B Debulking 35,000 Clinical notes and Clinical Post procedure clinical 4 Photograph photograph, Invoice of sclerosing agent used. Detailed discharge summary, Detailed Procedure / Operative Notes. 11 SP007 Hemangioma SP007C Excision 35,000 Clinical notes and Clinical Post procedure clinical 4 Photograph photograph, Invoice of sclerosing agent used. Detailed discharge summary, Detailed Procedure / Operative Notes. 12 SP008 NPWT SP008A NPWT 2,000 Clinical notes detailing Post procedure clinical 3 events that led to photograph with tube and chronic/ non healing pump; detailed discharge woulds; clinical summary, Detailed Procedure photograph / Operative Notes,
25. Polytrauma
• Total number of packages: 10 • Total number of procedures: 21 • Additional cross specialty procedures: 0 • Number of procedures recommended for auto-approval: 0 • Pre-authorization: Mandatory for all packages • Pre-authorization remarks: Specific Pre and Post-op Investigations such as pre/ post-op X-ray, CT report, post-op scar photo, electro-diagnostic studies etc. will need to be submitted/ uploaded for pre-authorization/ claims settlement purposes. The costs for such investigations will form part of the approved package cost. • The minimum length of hospital stay admissible for polytrauma cases would be on a case-by-case depending on the nature, type and vitals (for e.g. coagulation parameters). However weekly submission of clinico-radiological vitals is desired.
S. Package AB PM - JAY Procedure AB PM - JAY Package Stratification Implant Mandatory Documents - Mandatory No. Code Package Name Code Procedure Price Pre Authorization Documents - 311 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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HBP 2.0 HBP 2.0 Name Claim Processing 1 ST001 Conservative ST001A Severe Routine Ward Clinical notes with planned Discharge Management of 1,000 None line of treatment summary Head Injury 2 ST001 Conservative ST001B Depressed Routine Ward Clinical notes with planned Discharge Management of Fracture 5,000 None line of treatment including summary Head Injury planned line of treatment, X-ray films with reports 3 ST002 Head injury ST002A Head injury Implant for Open Clinical notes detailing the Post- op Clinical with repair of with repair of 35,000 reduction and injury and need of surgery. Photograph Facio-Maxillary Facio-Maxillary internal fixation of MLC/ FIR with X-ray/ CT; showing implant Injury & Injury & maxilla / mandible / pre-op clinical photograph for fixation and fixations fixations zygoma (Max 1) repairs; detailed (including (including 4,000 discharge implants) implants) summary, Detailed operatives notes 4 ST003 Craniotomy and ST003A Subdural Clinical notes detailing the Post- op Clinical evacuation of hematoma 60,000 injury and need of surgery. Photograph & X- Haematoma along with MLC/ FIR with X-ray/ CT/ rays showing with fixation of fixation of MRI (of both head & craniotomy fracture of long fracture of affected long bone) evidence and bone single long bone implant for fixation; detailed discharge summary, Detailed operatives notes 5 ST003 Craniotomy and ST003B Extradural Clinical notes detailing the Post- op Clinical evacuation of hematoma 60,000 injury and need of surgery. Photograph & X- Haematoma along with MLC/ FIR with X-ray/ CT/ rays showing with fixation of fixation of MRI (of both head & craniotomy fracture of long fracture of affected long bone) evidence and bone single long bone implant for fixation; detailed discharge summary, Detailed operatives notes 6 ST003 Craniotomy and ST003C Subdural Clinical notes detailing the Post- op Clinical evacuation of hematoma 75,000 injury and need of surgery. Photograph & X- 312 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Haematoma along with MLC/ FIR with X-ray/ CT/ rays showing with fixation of fixation of MRI (of both head & craniotomy fracture of long fracture of 2 or affected long bone) evidence and bone more long implant for bone. fixation; detailed discharge summary, Detailed operatives notes 7 ST003 Craniotomy and ST003D Extradural Clinical notes detailing the Post- op Clinical evacuation of hematoma 75,000 injury and need of surgery. Photograph & X- Haematoma along with MLC/ FIR with X-ray/ CT/ rays showing with fixation of fixation of MRI (of both head & craniotomy fracture of long fracture of 2 or affected long bone) evidence and bone more long implant for bone. fixation; detailed discharge summary, Detailed operatives notes 8 ST004 Management of ST004A Management of Implant for "One Clinical notes detailing the Intra- op Clinical Chest injury Chest injury 35,000 fracture of long injury and need of surgery. Photograph & X- with fracture of with fixation of bone (with MLC/ FIR with X-ray/ CT/ rays showing Long bone Single Long implants)" (Max 1) MRI (of both chest & chest injury bone 5,000 affected long bone) repair and implant for fixation; detailed discharge summary, Detailed operatives notes 9 ST004 Management of ST004B Management of Clinical notes detailing the Intra- op Clinical Chest injury Chest injury 45,000 injury and need of surgery. Photograph & X- with fracture of with fixation of MLC/ FIR with X-ray/ CT/ rays showing Long bone 2 or more Long MRI (of both chest & chest injury bones affected long bone) repair and implant for fixation; detailed discharge summary, Detailed 313 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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operatives notes 10 ST005 Management of ST005A Surgical Clinical notes detailing the Intra- op Clinical Visceral injury intervention for 30,000 injury and need of surgery. Photograph & X- and fracture Visceral injury MLC/ FIR with X-ray/ CT/ rays showing long bone and fixation of MRI (of both affected visceral injury fracture of viscera & affected long repair and single long bone bone) implant for fixation; detailed discharge summary, Detailed operatives notes 11 ST005 Management of ST005B Surgical Clinical notes detailing the Intra- op Clinical Visceral injury intervention for 45,000 injury and need of surgery. Photograph & X- and fracture Visceral injury MLC/ FIR with X-ray/ CT/ rays showing long bone and fixation of MRI (of both affected visceral injury fracture of 2 or viscera & affected long repair and more long bone) implant for bones fixation; detailed discharge summary, Detailed operatives notes 12 ST006 Internal fixation ST006A Internal fixation Clinical notes detailing the Post- op Clinical of of 40,000 injury and need of surgery. Photograph Pelviacetabular Pelviacetabular MLC/ FIR with X-ray/ CT; showing implant fracture fracture for fixation; detailed discharge summary, Detailed operatives notes 13 ST007 Internal fixation ST007A Internal fixation Clinical notes and PRE OP Post- op Clinical with Flap cover with Flap cover 40,000 CLINICAL PICTURE Photograph Surgery for Surgery for +/- X-RAY/CT showing implant wound in wound in for fixation and compound compound flap cover; fracture fracture detailed discharge summary, Detailed 314 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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operatives notes 14 ST008 Emergency ST008A Emergency Clinical notes with planned Intra- op Clinical tendons repair tendons repair 30,000 line of treatment detailing Photograph ± Peripheral ± Peripheral the injury and need of showing tendon/ Nerve repair/ Nerve repair/ surgery. MLC/ FIR with X- nerve injury reconstructive reconstructive ray/ CT/ MRI (of both chest repair and surgery surgery & affected long bone) reconstruction; detailed discharge summary, Detailed operatives notes 15 ST009 Management of ST009A Nerve Plexus Clinical notes detailing the Intra operative Nerve Plexus / injury repair 50,000 injury and need of surgery. still photograph, Tendon injuries MLC/ FIR +/- Nerve detailed conduction velocity (NCV) discharge +/- MRI + /- summary, EMG(Electromyography) Detailed operatives notes 16 ST009 Management of ST009B Nerve Plexus Clinical notes detailing the Intra operative Nerve Plexus / injury 50,000 injury and need of surgery. still photograph, Tendon injuries reconstruction MLC/ FIR +/- Nerve detailed conduction velocity (NCV) discharge +/- MRI + /- summary, EMG(Electromyography) Detailed operatives notes 17 ST009 Management of ST009C Tendon injury Clinical notes detailing the Intra operative Nerve Plexus / repair 50,000 injury and need of surgery. still photograph, Tendon injuries MLC/ FIR +/- Nerve detailed conduction velocity (NCV) discharge +/- MRI + /- summary, EMG(Electromyography) Detailed operatives notes 18 ST009 Management of ST009D Tendon injury Clinical notes detailing the Intra operative Nerve Plexus / reconstruction 50,000 injury and need of surgery. still photograph, Tendon injuries MLC/ FIR +/- Nerve detailed conduction velocity (NCV) discharge +/- MRI + /- summary, EMG(Electromyography) Detailed operatives notes 19 ST009 Management of ST009E Tendon Clinical notes detailing the Intra operative 315 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Nerve Plexus / Transfer 50,000 injury and need of surgery. still photograph, Tendon injuries MLC/ FIR +/- Nerve detailed conduction velocity (NCV) discharge +/- MRI + /- summary, EMG(Electromyography) Detailed operatives notes 20 ST010 Plexus injury ST010A Plexus injury Clinical notes detailing the Intra operative along with along with 60,000 injury and need of surgery. still photograph, Vascular injury Vascular injury MLC/ FIR +/- Nerve detailed repair / graft repair conduction velocity (NCV) discharge + /- MRI + /- MRA + /- EMG summary, (Electromyography) Detailed operatives notes 21 ST010 Plexus injury ST010B Plexus injury Clinical notes detailing the Intra operative along with along with 60,000 injury and need of surgery. still photograph, Vascular injury Vascular injury MLC/ FIR +/- Nerve detailed repair / graft graft conduction velocity (NCV) discharge + /- MRI + /- MRA + /- EMG summary, (Electromyography) Detailed operatives notes
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Annex 2.4 Guidelines for Identification of Health scheme Beneficiary Family Units
The core principle for finalising the operational guidelines for proposed AB-PMJAY is to construct a broad framework as guiding posts for simplifying the implementation of the Mission under the ambit of the Benefit cover and the technology while providing requisite flexibility to the States to optimally chalk out the activities related to implementation in light of the peculiarities of their own State, as ownership of implementation of scheme lies with them. A. AB-PMJAY will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data, both rural and urban. Additionally, all such enrolled families under RSBY that do not feature in the targeted groups as per SECC data will be included as well.
B. States covering a much larger population than the AB-PMJAY beneficiary list will need to i) Provide a declaration that their eligibility criteria cover AB-PMJAY beneficiaries ii) Setup a process to ensure any family in AB-PMJAY list who may be missed under the State’s criteria is covered when they seek care. iii) Beneficiaries obtaining treatment should be tagged if they are AB-PMJAY beneficiaries. Reports to MoHFW/ NHA will need to be provided for these beneficiaries iv) Link all AB-PMJAY beneficiaries with the State’s Scheme ID and Aadhaar in a defined time period v) Beneficiaries Family Unit GEP (Government Employee and Pensioners) members which are Government Employees and Pensioners, Employees and Pensioners of Corporations/ Autonomous Bodies, Authorities, Universities and Institutions (receiving Grants in Aid from the State Government) who have paid member contribution. GEP beneficiaries will be provided medical facilities under SGHS. vi) Beneficiaries Family Unit RP (Remaining Population) members not covered in above two categories (AB-PMJAY and SGHS) and also do not avail benefits from similar schemes like ECHS (Employee Contributory Health Scheme), ESIC (Employee State Insurance Corporation), Central Government Employees and Pensioners. Databases of RP are NFSA Ration cards (2014-15), MSBY families and remaining SECC families not covered under AB-PMJAY. RP will be provided medical facilities under AAUY.
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C. State will be responsible for carrying out Information, Education and Communication (IEC) activities amongst targeted families such that they are aware of their entitlement, benefit cover, empanelled hospitals and process to avail the services under AB-PMJAY. This will include leveraging village health and nutrition days, making available beneficiary family list at Panchayat office, visit of ASHA workers to each target family and educating them about the scheme, Mass media, etc among other activities. The following 2 IEC activities are designed to aid in Beneficiary Identification
i) MoHFW in collaboration with Ministry of Rural Development (MoRD) will drive collection of Ration Card, Mobile Number for each AB-PMJAY household.
ii) Government of India will send a personalised letter via mass mail to each targeted family through postal department in states launching AB-NHPM. This letter will include details about the scheme, toll free helpline number and family details and their ID under AB-PMJAY
iii) States which are primarily covering AB-PM-JAY beneficiaries are encouraged to create multiple service locations where beneficiaries can check if they are covered. These include Contact points or kiosks set up at CSCs, PHCs, Gram Panchayat, etc Empaneled Hospital Self-check via mobile or web Or any other contact point as deemed fit by States
D. Beneficiary identification will include the following broad steps: I. The operator searches through the Health Schemes list to determine if the person is covered. II. Search can be performed by Name and Location, Ration Card No or Mobile number (collected during data drive) or ID printed on the letter sent to family, GEP Id or MSBY URN III. If the beneficiary’s name is found in the Health Schemes list, Aadhaar (or an alternative government ID) and Ration Card (or an alternative family ID) is collected against the Name / Family. IV. The operator sends the linked record for approval to the ISA / SHA V. If the health scheme data and provided documents information matched, the operator can issue the e-Card after approval from ISA/SHA and admit the patient for treatment if required. VI. The SHA will setup a Beneficiary approval team that works on fixed service level agreements on turnaround time. The Health schemes details and the information from the ID is presented to the verifier. The SHA can either approve or recommend a case for rejection with reason. VII. All cases recommended for rejection will be scrutinised by a State team that works on fixed service level agreements on turnaround time. The state team will either accept rejection or approve with reason.
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VIII. The e-card will be printed with the unique ID under health schemes and handed over to the beneficiary to serve as a proof for verification for future reference. IX. The beneficiary will also be provided with a booklet/ pamphlet with details about health schemes and process for availing services. X. Presentation of this e-card will not be mandatory for availing services. However, the e-card may serve as a tool for reinforcement of entitlement to the beneficiary and faster registration process at the hospital when needed. A. Addition of new family members will be allowed. This requires at least one other family member has been approved by the ISA/SHA. Proof of being part of the same family is required in the form of i. Name of the new member is in the family ration card or State defined family card. Or ii. A Marriage Certificate relating to marriage to a family member existing in the family. Or iii. A Birth Certificate relating to a birth to a family member existing in the family is available. B. For BIS in respect of GEP Beneficiaries, the Government Order No. 214/XXVIII-3-2020-04/2008 T.C dated 4th May 2020 and guidelines issued by SHA from time to time will also be applicable.
E. Addition of new family members will be allowed. This requires at least one other family member has been approved by the Trust. Proof of being part of the same family is required in the form of i) Name of the new member is in the family ration card or State defined family card ii) A marriage certificate relating to marriage to a family member existing in the family A birth certificate relating to a birth to a family member existing in the family is available.
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Annex 2.5 Guidelines for Empanelment of Health Care Providers and Other Related Issues
1.1. Basic Principles
For providing the benefits envisaged under the Mission, the State Health Authority (SHA) through State Empanelment Committee (SEC) will empanel or cause to empanel private and public health care service providers and facilities in their respective States as per these guidelines. The states are free to decide the mode of verification of empanelment application, conducting the physical verification either through District Empanelment Committee (DEC) or using the selected ISA, under the broad mandate of the instructions provided in these guidelines.
1.2. Institutional Set-Up for Empanelment
A. State Empanelment Committee (SEC) will constitute of following members: CEO, State Health Authority– Chairperson; Medical Officer not less than the level Director, preferably Director In Charge for Implementation of Clinical Establishment Regulation Act – Member; Two State government officials nominated by the Department – Members; ISA to nominate a representative not below Additional General Manager or equivalent;
The state government may invite other members to SEC as it may deem fit to assist the Committee in its activities. The State Government may also require the ISA to mandatorily provide a medical representative to assist the SEC in its activities.
Alternatively, the State/SHA may continue with any existing institution under the respective state schemes that may be vested with the powers and responsibilities of SEC as per these guidelines. The SHAs through State Empanelment Committee (SEC) shall ensure: Ensuring empanelment within the stipulated timeline for quick implementation of the programme; The empanelled provider meets the minimum criteria as defined by the guidelines for general or specialty care facilities; Empanelment and de-empanelment process transparency; Time-bound processing of all applications; and Time-bound escalation of appeals.
It is prescribed that at the district level, a similar committee, District Empanelment Committee (DEC) will be formed which will be responsible for hospital empanelment related
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The State Government may require the ISA to mandatorily provide a medical representative to assist the DEC in its activities.
The structure of SEC and DEC for the two options are recommended as below: S.No Institutional SEC Recommended DEC Recommended . Option Composition Composition 1. Approval of the Chair: CEO/Officer in Chair: CMO or Empanelment Charge of State Health equivalent application by the Authority At least 3 membered State At least 5 membered committee Committee At least one other doctor other than CMO 2. Verification of the Chair: CEO/Officer in DEC may have 1 Empanelment Charge of State Health representative from application by the Agency the ISA ISA and approval SEC may have 1 by State representative from the ISA
The DEC will be responsible for: Getting the field verification done along with the submission of the verification reports to the SEC through the online empanelment portal. The DEC will also be responsible for recommending, if applicable, any relaxation in empanelment criteria that may be required to ensure that sufficient numbers of empanelled facilities are available in the district. Final approval of relaxation will lie with SEC o The SEC will consider, among other things, the reports submitted by the DEC and recommendation approve or deny or return to the hospital the empanelment request. 321 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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1.3. Process of Empanelment
A. Empanelment requirements
i) All State will be permitted to empanel hospitals only in their own State. ii) In case State wants to empanel hospitals in another State, they can only do so till the time that State is not implementing AB-PMJAY. For such states where AB- PMJAY is not being implemented NHA may directly empanel CGHS empanelled hospitals. iii) All public facilities with capability of providing inpatient services (Community Health Centre level and above) are deemed empanelled under Health Scheme. The State Health Department shall ensure that the enabling infrastructure and guidelines are put in place to enable all public health facilities to provide services under Health Scheme. iv) Employee State Insurance Corporation (ESIC) hospitals will also be eligible for empanelment in Health Scheme, based on the approvals. v) For private providers and not for profit hospitals, a tiered approach to empanelment will be followed. Empanelment criteria are prepared for various types of hospitals / specialties catered by the hospitals and attached in Annex 1. vi) Private hospitals will be encouraged to provide ROHINI provided by Insurance Information Bureau (IIB). Similarly public hospitals will be encouraged to have NIN provided by MoHFW. vii) Hospitals will be encouraged to attain quality milestones by making NABH (National Accreditation Board of Health) pre entry level accreditation/ NQAS (National Quality Assurance Standards) for all the empaneled hospitals to be attained within 1 year with 2 extensions of one year each. viii) Hospitals with NABH/ NQAS accreditation will be given incentivised payment structures by the states within the flexibility provided by MoHFW/NHA. The hospital with NABH/ NQAS accreditation can be incentivized for higher package rates subject to Procedure and Costing Guidelines. ix) Hospitals in backwards/rural/naxal areas may be given incentivised payment structures by the states within the flexibility provided by MoHFW/NHA x) Criteria for empanelment has been divided into two broad categories as given below.
Category 1: General Criteria Category 2: Specialty Criteria
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All the hospitals empanelled under Hospitals would need to be empanelled Health Scheme for providing general separately for certain tertiary care packages care have to meet the minimum criteria authorized for one or more specialties (like established under the Mission detailed Cardiology, Oncology, Neurosurgery etc.). in Annex 1. No exceptions will be made This would only be applicable for those for any hospital at any cost. hospitals who meet the general criteria for the Health Scheme. Detailed empanelment criteria have been provided as Annex 1. State Governments will have the flexibility to revise/relax the empanelment criteria based, barring minimum requirements of Quality as highlighted in Annex 1, on their local context, availability of providers, and the need to balance quality and access; with prior approval from National Health Agency. The same will have to be incorporated in the web-portal for online empanelment of hospitals. Hospitals will undergo a renewal process for empanelment once every 3 years or till the expiry of validity of NABH/ NQAS certification whichever is earlier to determine compliance to minimum standards. National Health Agency may revise the empanelment criteria at any point during the programme, if required and the states will have to undertake any required re-assessments for the same.
1.4. Awareness Generation and Facilitation
The state government shall ensure that maximum number of eligible hospitals participate in the Health Scheme, and this need to be achieved through IEC campaigns, collaboration with and district, sub-district and block level workshops. The state and district administration should strive to encourage all eligible hospitals in their respective jurisdictions to apply for empanelment under Health Scheme. The SHA shall organise a district workshop to discuss the details of the Mission (including empanelment criteria, packages and processes) with the hospitals and address any query that they may have about the mission. Representatives of both public and private hospitals (both managerial and operational persons) including officials from ISA will be invited to participate in this workshop.
1.5. Online Empanelment
A. A web-based platform is being provided for empanelment of hospitals for Health Scheme. B. The hospitals can apply through this portal only, as a first step for getting empanelled in the programme. C. This web-based platform will be the interface for application for empanelment of hospitals under Health Scheme.
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D. Following the workshop, the hospitals will be encouraged to initiate the process of empanelment through the web portal. Every hospital willing to get empanelled will need to visit the web portal, www.pmjay.gov.in and create an account for themselves. E. Availability of PAN CARD number (not for public hospitals) and functional mobile number of the hospital will be mandatory for creation of this account / Login ID on the portal for the hospital. F. Once the login ID is created, hospital shall apply for empanelment through an online application on the web portal - www.pmjay.gov.in. G. Each hospital will have to create a primary and a secondary user ID at the time of registration. This will ensure that the application can be accessed from the secondary user ID, in case the primary user is not available for some reason. H. All the required information and documents will need to be uploaded and submitted by the hospital through the web portal. I. Hospital will be mandated to apply for all specialties for which requisite infrastructure and facilities are available with it. Hospitals will not be permitted to choose specific specialties it wants to apply for unless it is a single specialty hospital. J. After registering on the web-portal, the hospital user will be able to check the status of their application. At any point, the application shall fall into one of the following categories: i) Hospital registered but application submission pending ii) Application submitted but document verification pending iii) Application submitted with documents verified and under scrutiny by DEC/SEC iv) Application sent back to hospital for correction v) Application sent for field inspection vi) Inspection report submitted by DEC and decision pending at SEC level vii) Application approved and contract pending viii) Hospital empanelled ix) Application rejected x) Hospital de-empanelled xi) Hospital blacklisted (2 years)
1.6. Role of DEC A. After the empanelment request by a hospital is filed, the application should be scrutinized by the DEC and processed completely within 15 days of receipt of 324 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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application. B. A login account for a nodal officer from DEC will be created by SEC. This login ID will be used to download the application of hospitals and upload the inspection report. C. As a first step, the documents uploaded have to be correlated with physical - verification of original documents produced by the hospital. In case any documents are found wanting, the DEC may return the application to the hospital for rectifying any errors in the documents. D. After the verification of documents, the DEC will physically inspect the premises of the hospital and verify the physical presence of the details entered in the empanelment application, including but not limited to equipment, human resources, service standards and quality and submit a report in a said format through the portal along with supporting pictures/videos/document scans. E. DEC will ensure the visits are conducted for the physical verification of the hospital. The verification team will have at least one qualified medical doctor (minimum MBBS). F. The team will verify the information provided by the hospitals on the web-portal and will also verify that hospitals have applied for empanelment for all specialties as available in the hospital. G. In case during inspection, it is found that hospital has not applied for one or more specialties but the same facilities are available, then the hospital will be instructed to apply for the missing specialties within a stipulated a timeline (i.e. 7 days from the inspection date). i) In this case, the hospital will need to fill the application form again on the web portal. However, all the previously filled information by the hospital will be pre- populated and hospital will be expected to enter the new information. ii) If the hospital does not apply for the other specialties in the stipulated time, it will be disqualified from the empanelment process. H. In case during inspection, it is found that hospital has applied for multiple specialties, but all do not conform to minimum requirements under Health Scheme then the hospital will only be empanelled for specialties that conform to Health Scheme norms. I. The team will recommend whether hospital should be empanelled or not based on their field-based inspection/verification report. J. DEC team will submit its final inspection report to the state. The district nodal officer has to upload the reports through the portal login assigned to him/her. K. The DEC will then forward the application along with its recommendation to the SEC. 325 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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1.7. Role of SEC A. The SEC will consider, among other things, the reports submitted by the DEC and recommendation approve or deny or return back to the hospital the empanelment request. B. In case of refusal, the SEC will record in writing the reasons for refusal and either directs the hospital to remedy the deficiencies, or in case of egregious emissions from the empanelment request, either based on documentary or physical verification, direct the hospital to submit a fresh request for empanelment on the online portal. C. The SEC will also consider recommendations for relaxation of criteria of empanelment received from DEC or from the SHA and approve them to ensure that sufficient number and specialties of empanelled facilities are available in the states. D. Hospital will be intimated as soon as a decision is taken regarding its empanelment and the same will be updated on the Health Scheme web portal. The hospital will also be notified through SMS/email of the final decision. If the application is approved, the hospital will be assigned a unique national hospital registration number under Health Scheme. E. If the application is rejected, the hospital will be intimated of the reasons on the basis of which the application was not accepted and comments supporting the decision will be provided on the Health Scheme web portal. Such hospitals shall have the right to file a review against the rejection with the State Health Agency within 15 days of rejection through the portal. In case the request for empanelment is rejected by the SHA in review, the hospitals can approach the Grievance Redressal Mechanism for remedy. F. In case the hospital chooses to withdraw from Health Scheme, it will only be permitted to re-enter/ get re-empanelled under Health Scheme after a period of 6 months. G. If a hospital is blacklisted for a defined period due to fraud/abuse, after following due process by the State Empanelment Committee, it can be permitted to re-apply after cessation of the blacklisting period or revocation of the blacklisting order, whichever is earlier. H. There shall be no restriction on the number of hospitals that can be empanelled under AB-PMJAY in a district. I. Final decision on request of a Hospital for empanelment under Health Scheme shall be completed within 30 days of receiving such an application.
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1.8. Fast Track Approvals
A. In order to fast track the empanelment process, hospitals which are NABH/ NQAS accredited shall be auto-empaneled provided they have submitted the application on web portal and meet the minimum criteria. B. In order to fast track the empanelment process, the states may choose to auto- approve the already empanelled hospitals under an active RSBY scheme or any other state scheme; provided that they meet the minimum eligibility criteria prescribed under Health Scheme. C. If already empanelled, under this route, should the state allow the auto-approval mode, the hospital should submit their RSBY government empanelment ID or State empanelment ID during the application process on the web portal to facilitate on- boarding of such service providers. D. The SEC shall ensure that all hospitals provided empanelment under Fast Track Approval shall undergo the physical verification process within 3 months of approval. If a hospital is found to have wrongfully empanelled under Health Scheme under any category, such an empanelment shall be revoked to the extent necessary and disciplinary action shall be taken against such an errant medical facility.
1.9. Signing of Contract
A. Within 7 days of approval of empanelment request by SEC, the State Government will sign a contract with the empanelled hospitals as per the template defined in the tender document. B. If ISA is involved in implementing the scheme in the State, they will also be part of this agreement, i.e. tripartite agreement will be made between the ISA, SHA and the hospital. C. Each empanelled hospital will need to provide a name of a nodal officer who will be the focal point for the Health Scheme for administrative and medical purposes. D. Once the hospital is empanelled, a separate admin user for the hospital will be created to carry out transactions for providing treatment to the beneficiaries.
1.10. PROCESS FOR DISCIPLINARY PROCEEDINGS AND DE-EMPANELMENT DE-EMPANELMENT PROCEDURE
A. Introduction
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EHCP empaneled under the AB PMJAY scheme by SHA can be de-empaneled (the process may be initiated with the help of ISA ) if they fail to meet and uphold the necessary criteria agreed upon. The following steps are to be followed for de-empanelment of hospitals.
B. Definitions
1. IC means Insurance Company 2. Show Cause Notice refers to a notice to EHCP, seeking justification or explanation for the conduct in question 3. Suspension refers to temporary termination of operations under PMJAYEHCP as granted to it under the terms of contract. However, treatment of existing patients will continue as usual till they are treated and discharged from the EHCP. 4. De-empanelment refers to termination of contract of EHCP under PM-JAY and EHCP would not be allowed to provide services under PM-JAY any longer. 5. Term Evidence refers to it under Section 3 of the Evidence Act read with other provisions of the Act along with other applicable laws of India.
Process for Disciplinary Proceedings and De- Empanelment
Step 1 Investigation of suspect claims/ hospitals The State Health Agency (SHA) /Insurance Company (IC)/ NHA or any of their authorized representatives shall be conducting ongoing forensics and analytics to identify aberrant cases/ suspect EHCPs, followed by desk audits of suspect cases. Based on the data analysis of suspect cases or EHCPs visits or any authorized inspection or any complaint received about the EHCP from the patient or any third party or any complaint received /reported in the grievance cell the SHA or its representative can put that EHCP on watch list and serve a show cause notice for the observed deviations. The data of such EHCP shall be analyzed very closely for patterns, trends and anomalies. For certain high-risk suspect cases identified, field medical audit may be conducted to collect and analyze evidences. Investigation of the case including submission of report shall be done within 10 working days of flagging the case. All attempts shall be made to close the case within the above-mentioned period and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same.
Step 2 – Show-Cause Notice to the EHCP i. Based on the investigation report received, if the SHA/ Insurance Company/NHA observes that there is sufficient evidence/suspicion of EHCP indulging in malpractices, a show cause-notice shall be issued to the EHCP. All attempts shall be made to issue show cause notice within 7 working days from receipt of investigation report and in case of any delay, report must be submitted to CEO SHA, citing the reasons for the same ii. The Show-cause Notice shall be sent both to the EHCP’s registered email ID provided at the time of empanelment or the most current one available/updated with SHA and a hard copy will be sent via registered speed post or delivered by hand through district coordinator to the EHCP’s notified address. iii. The Show-Cause Notice shall clearly mention the email ID of the SHA where the response to the show- cause needs to be sent by the EHCP. The receipt of the registered speed post or acknowledgement of receipt by EHCP (in case delivered by hand) should be kept securely as proof by the SHA/IC. iv. The process of serving notice and acknowledgement of the same may also be achieved by way of an Alert in the system used by EHCP to login to PMJAY portal for day to day operations. v. EHCP shall respond to the Show-cause notice within 5 working days from the date of receipt of the show- cause notice. The response shall be sent to the SHA/IC at the email id provided in the show-cause letter or address specified for registered post along with supporting evidences collected as per the applicable laws of 328 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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India. In case, the response to the Show-Cause notice is not received within 5 working days, the EHCP may be suspended/ its operations will be ceased under PM-JAY, for a specified time frame not exceeding 6 months, so that no new pre- authorizations can be raised by it. Treatment of existing patients will continue as usual till they are discharged. The notification of suspension should be sent through email and registered speed post. All attempts shall be made to send the notification within 2 working days of the decision and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same vi. In case, the response received from EHCP to the show cause notice is not found to be satisfactory then further information or evidences may be requested through email. The EHCP shall provide the requested documents/information within 3 working days through email. If the requested documents/information is not received within 3 working days then the EHCP may be suspended for a specified time frame not exceeding 6 months, so that it shall not be allowed to conduct any new pre- authorizations. All admitted patients under the scheme will be provided continued treatment as usual till they are discharged. No fresh admission will be allowed to EHCP under the Scheme. The notification of suspension should be sent through email and registered speed post, all attempts shall be made to send this notification within 2 working days of the decision taken by SHA for suspension and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same vii. The EHCP shall not contact the beneficiaries in question after the show cause Notice is served nor shall it try to tamper and/or do any such act and/or omission which may lead to tampering of evidences, as per the applicable laws. In case any such tampering is found legal action may be taken accordingly.
If the above-mentioned timelines are not met, then either of the parties can approach Competent authority as per the Grievance Redressal Guidelines
Step 3 - Detailed Investigation of EHCP There shall be a detailed investigation into the activities of EHCP in the following conditions: a) For the EHCP which have been suspended. b) Receipt of complaint of a serious nature against EHCP c) The detailed investigation may include field visits to the EHCP, examination of case papers, talking with the beneficiaries (if needed), examination of hospital records etc. d) If the investigation reveals that the report/ complaint/ allegation against the hospital is not substantiated, suspension will be immediately revoked (in case it is suspended) the same will be informed to the concerned Hospital, district hospital and the process to receive claim from the hospital will be restarted. Procedure to be followed for detailed Investigation: i. Depending the nature and extent of suspicion/evidence of mischievous activities the SHA/IC may conduct a parallel detailed investigation, which would include investigation of the response submitted by EHCP to the Show Cause notice. ii. All attempts shall be made to complete the investigation and submit the report within 10 working days of show-cause being issued. In case of any delay report must be submitted to CEO SHA, citing the reasons for the same. The detailed investigation may include but not be limited to contacting or meeting beneficiaries to gather further evidence of malpractices and may include field visits to the EHCP to examine the in-door case papers, talking with admitted beneficiaries/treating doctor/other staff, examination of EHCPs records etc. iii. All statements of beneficiaries shall be recorded in writing in the language known to the Beneficiary and ensured that the said statement is read over to the beneficiary for confirmation and such statement is self- attested by the Beneficiary via signature or thumb impression for use as evidence later on. Wherever possible, video recording may be taken and if possible, a copy of photo identity proof of such beneficiary be maintained.
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Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand iv. If the investigation reveals that the original suspicion/alleged mischievous activities against the provider are not valid and no malpractices are detected, then – a) All attempts shall be made by SHA/ Insurance Company to revoke the show cause notice, within 5 working days of the investigation report being submitted. In case of any delay report must be submitted to CEO SHA, citing the reasons for the same b) All attempts shall be made by SHA/ Insurance Company to send an email/letter to this effect to the EHCP within 5 working days of the decision to revoke show-cause notice and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same v. If the investigation reveals that –
a) The suspicion/alleged malpractice on the part of EHCP are valid and further new cases are detected, the Insurance Company/SHA may recommend suspension for a specified time period, not exceeding 6 months b) The original cause of suspicion/alleged mischievous activities on the part of EHCP are not valid but additional malpractices are identified, a new Show Cause Notice will be issued to the EHCP. All attempts shall be made to issue above mentioned show cause notice within 7 working days of noticing such malpractices and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same. The EHCP shall be allowed 5 working days to respond and entire procedure for investigation will be followed as stated under these guidelines.
If the above-mentioned timelines are not met, then either of the parties can approach Competent authority as per the Grievance Redressal Guidelines.
Step 4 - Suspension of the EHCP I. An EHCP can be suspended in the following cases: A. Suspension after show cause notice For EHCPs where adequate evidence of malpractices is present and the EHCP is not able to provide satisfactory justification, the SHA may suspend the hospital for a specified time period, not exceeding a period 6 months, as per process outlined in Step 3.
B. No response to Show Cause Notice: I. In case, the EHCP does not provide any response to the Show-Cause notice within the stipulated time period as outlined in Step 3, the EHCP may be suspended for a specified time period, not exceeding 6 months. II. If the response is received during suspension period, the SHA may review the response, if found satisfactory then the suspension may be revoked, provided at least a period of 15 days suspension is served by the EHCP. C. Direct suspension along with Show Cause i) If the SHA/IC obtains irrefutable evidences that the actions of the EHCP have or may cause grievous harm to the patients’ health or life the SHA may immediately suspend the EHCP for a specified time period, not exceeding 6 months. The suspension must be accompanied with the Show-cause notice, allowing the EHCP time of 5 working days to respond to it. In such case SHA should share the notice along with detailed justification/reason for suspension with NHA and Secretary – Department of Health. ii) The SHA may also conduct a parallel investigation in such cases as outlined in Step 2 iii) All attempts shall be made by the Investigation team to submit its report to SHA, within 10 working days of the suspension, including its findings on the response submitted by the EHCP to the Show Cause notice. In case of any delay report must be submitted to CEO SHA, citing the reasons for the same D. If the EHCP fails to submit the penalty amount levied by the SHA
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If the penalty is levied on the EHCP for an offence and the EHCP fails to submit the penalty amount within the stipulated time the SHA may decide to suspend the EHCP till the amount is recovered.
In all cases outlined above, the notification of suspension should be sent through email and registered speed post. All attempts shall be made to send the notification within 3 working days of decision and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same
II. Following suspension: i. The EHCP may file an appeal against suspension, with the SHA to review the order along with submission of necessary evidences and an undertaking of not repeating similar instances of malpractices within 30 days of suspension. ii. The SHA may revoke the suspension after examining the evidence and undertaking submitted by EHCP. iii. In case the alleged malpractices on the part of the EHCP are serious in nature and EHCP is unable to refute the same with evidence, the SHA shall present the case to SEC to initiate the de-empanelment proceedings against the EHCP. If the above-mentioned timelines are not met, then either of the parties can approach Competent authority as per the Grievance Redressal Guidelines.
Step 5 –Presentation of case to the SEC and De- empanelment Presentation of case for de-empanelment may be initiated by SHA after conducting proper disciplinary proceedings (like Show Cause notice, suspension etc.) as outlined above.
If the Show Cause was not received by EHCP or adequate time was not allotted for response, then a fresh Show Cause Notice shall be served to the EHCP and it shall respond to within 3 working days from the date of receipt of the show-cause notice
In case the matter is referred to SEC, the following steps would be taken - i) The SEC would meet within 30 working days of the case being referred. ii) All relevant documents including the detailed investigation report should be submitted to the SEC either at the time of case filing or at least 10 days prior to the meeting. iii) The SEC must ensure that the EHCP has been issued a show-cause notice seeking an explanation for the alleged malpractice with adequate time to respond. iv) Both parties (SHA and EHCP) would be provided a fair opportunity to present their case with necessary evidence at the meeting conducted by SEC v) The SEC shall consider submissions made by the beneficiaries (through call center/written submissions/emails etc.), field audit reports/survey reports/feedback reports/ complaints filed with them or information from other sources to investigate a claim of fraud/abuse under PMJAY by an EHCP. vi) If the SEC finds that the complaint/allegation against the EHCP are valid, shall order de-empanelment of the EHCP along with additional disciplinary actions like penalties, FIR etc. as it may deem fit. vii) In case the SEC does not find adequate supporting evidence against the EHCP, it may revoke the suspension of the EHCP or reverse/modify any other disciplinary action taken by SHA against the EHCP, while making clear observations and reasons underlying the final decision. viii) All attempts shall be made to take the final decision within 30 days of 1st SEC meeting and in case of any delay report must be submitted to CEO SHA, citing the reasons for the same ix) All attempts shall be made to implement any disciplinary proceeding as decided by SEC within 30 days of the decision taken by SEC and in case of any delay report must be submitted to Secretary-Health and Family Welfare Department of the State, citing the reasons for the same. x) If either party is not satisfied by the decision of SEC, they can approach Competent authority as per the
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Grievance Redressal guidelines. If the above - mentioned timelines are not met, then either of the parties can approach Competent authority as per the Grievance Redressal Guidelines.
Step 6 - Actions to be taken after De- empanelment Once the hospital has been de-empaneled, following steps shall be taken:
i) A letter/email shall be sent to the EHCP regarding the decision at registered address /registered email ID/ of the EHCP within 3 working of the decision. ii) A decision may be taken by the SEC to ask the SHA/Insurance Company to either lodge an FIR in case there is suspicion of criminal activity or take such other permissible legal action under applicable laws of India. iii) This information shall be sent with other Insurance Companies, other regulatory bodies and to NHA. iv) A list of de-empaneled hospitals shall be displayed on NHA and SHA website. The list should be prominently displayed and easily accessible on the website to ensure beneficiary awareness. v) The SHA may notify in the local media about the entities where malpractice is confirmed and also about the action taken against the EHCP engaging in malpractices. vi) The period of de-empanelment would be for a period of 2 years., unless stated otherwise, vii) Once de-empaneled, the EHCP cannot seek for re-empanelment until completion of 1 year from the date of such de-empanelment. viii) In case SHA/SEC decides to re-empanel an EHCP within a period of 1 year, it shall notify NHA and Secretary-Health and Family Welfare Department of the concerned State, along with a detailed explanation/recorded reason for the same. ix) Based on the severity of the offence, SEC may de-empanel the EHCP for more than 2 years or may blacklist an EHCP. In such cases, the SHA/SEC should inform NHA and Secretary-Health and Family Welfare Department of the concerned State of its decision along with a detailed explanation/recorded reason for the same. x) In case of confirmed act of professional misconduct and violation of medical ethics, the appropriate Medical Council should be informed of the details of the case, the doctor and the hospital involved. The Medical Council and Sate Medical Council should take it up and take appropriate action as per the Code of Medical Ethics Regulation, 2002 and/or such necessary action as may be required as per the applicable laws
A. Gradation of Offences
On the basis of the investigation report/field audits, the following charges may be found to be reasonably proved and a gradation of penalties may be levied by the SEC. However, this tabulation is intended to be as guidelines rather than mandatory rules and the SEC may take a final call on the severity and quantum of punishment on a case to case basis. Penalties for Offences by the Hospital Case Issue First Offence Second Offence Third Offence Illegal cash Full Refund and In addition to actions as De- payments by compensation 3 times of mentioned for first offence, empanelment/ beneficiary illegal payment to the Rejection of claim for the black-listing
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beneficiary case Billing for Rejection of claim and Rejection of claim and De- services not penalty of 3 times the penalty of 8 times the empanelment provided amount claimed for amount claimed for services services not provided, to not provided, to ISA /State ISA /State Health Agency Health Agency Up coding/ Rejection of claim and Rejection of claim and De- Unbundling/ penalty of 8 times the penalty of 16 times the empanelment Unnecessary excess amount claimed excess amount claimed due Procedures due to up coding to up /unbundling/Unnecessary coding/unbundling/Unnecess Procedures, to ISA /State ary Procedures, to ISA /State Health Agency. For Health Agency unnecessary procedure: Wrongful Rejection of claim and Rejection of claim and De- beneficiary penalty of 3 times the penalty of 8 times the empanelment Identification amount claimed for amount claimed for wrongful wrongful beneficiary beneficiary identification to identification to ISA ISA /State Health Agency /State Health Agency A) In case of minor Non- i) Penalty of up to 5 times i) De- gaps- adherence to of all the approved empanelment i) Show Cause notice minimum claims related to gaps with compliance And penalty of criteria for observed. period of 2 weeks for up to 5 times empanelment, rectification And suspension until of all the quality and ii) And rejection of rectification of gaps and approved service claims related to gaps validation by SEC/ DEC claims related standards as B) In case major gaps laid under to the gaps and wilful PMJAY observed suppression/ misrepresentation of facts – i) Show Cause notice with compliance period of 2 weeks for rectification And rejection of claims related to gaps and penalty up to 3 times of all cases related to gaps
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observed
All these penalties are recommendatory and the SEC may inflict larger or smaller penalties depending on the severity/regularity/scale/intentionality on a case to case basis with reasons mentioned clearly in a speaking order. The penalties by the hospital will be paid to the SHA in all the cases.
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Annex 1: Detailed Empanelment Criteria
Category 1: Essential criteria:
A Hospital would be empanelled as a network private hospital with the approval of the respective State Health Agency1 if it adheres with the following minimum criteria: 1. Should have at least 10 inpatient beds with adequate spacing and supporting staff as per norms. i. Exemption may be given for single-specialty hospitals like Eye and ENT. ii. General ward - @80sq ft per bed, or more in a Room with Basic amenities- bed, mattress, linen, water, electricity, cleanliness, patient friendly common washroom etc. Non-AC but with fan/Cooler and heater in winter.
2. It should have adequate and qualified medical and nursing staff (doctors2 & nurses3), physically in charge round the clock; (necessary certificates to be produced during empanelment).
3. Fully equipped and engaged in providing Medical /Surgical services, commensurate to the scope of service/ available specialities and number of beds. i. Round-the-clock availability (or on-call) of a Surgeon and Anaesthetist where surgical services/ day care treatments are offered. ii. Round-the-clock availability (or on-call) of an Obstetrician, Paediatrician and Anaesthetist where maternity services are offered. iii. Round-the-clock availability of specialists (or on-call) in the concerned specialties having sufficient experience where such services are offered (e.g. Orthopaedics, ENT, Ophthalmology, Dental, general surgery (including endoscopy) etc.)
4. Round-the-clock support systems required for the above services like Pharmacy, Blood Bank, Laboratory, Dialysis unit, Endoscopy investigation support, Post op ICU care with ventilator support, X-ray facility (mandatory) etc., either ‘In-House’ or with ‘Outsourcing arrangements’, preferably with NABL accredited laboratories, with appropriate agreements and in nearby vicinity.
5. Round-the-clock Ambulance facilities (own or tie-up).
1 In order to facilitate the effective implementation of Ayushman Uttarakhand, State Governments shall set up the State Health Agency (SHA) or designate this function under any existing agency/ trust designated for this purpose, such as the state nodal agency or a trust set up for the state insurance program. 2 Qualified doctor is a MBBS approved as per the Clinical Establishment Act/ State government rules & regulations as applicable from time to time. 3 Qualified nurse per unit per shift shall be available as per requirement laid down by the Nursing Council/ Clinical Establishment Act/ State government rules & regulations as applicable from time to time. Norms vis a vis bed ratio may be spelt out.
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6. 24 hours emergency services managed by technically qualified staff wherever emergency services are offered i. Casualty should be equipped with Monitors, Defibrillator, Nebulizer with accessories, Crash Cart, Resuscitation equipment, Oxygen cylinders with flow meter/ tubing/catheter/face mask/nasal prongs, suction apparatus etc. and with attached toilet facility. 7. Mandatory for hospitals wherever surgical procedures are offered: i. Fully equipped Operation Theatre of its own with qualified nursing staff under its employment round the clock. ii. Post-op ward with ventilator and other required facilities. 8. Wherever intensive care services are offered it is mandatory to be equipped with an Intensive Care Unit (For medical/surgical ICU/HDU/Neonatal ICU) with requisite staff i. The unit is to be situated in close proximity of operation theatre, acute care medical, surgical ward units, labour room and maternity room as appropriate. ii. Suction, piped oxygen supply and compressed air should be provided for each ICU bed. iii. Further ICU- where such packages are mandated should have the following equipment: 1) Piped gases 2) Multi-sign Monitoring equipment 3) Infusion of ionotropic support 4) Equipment for maintenance of body temperature 5) Weighing scale 6) Manpower for 24x7 monitoring 7) Emergency cash cart 8) Defibrillator. 9) Equipment for ventilation. 10) In case there is common Paediatric ICU then Paediatric equipments, e.g.: paediatric ventilator, Paediatric probes, medicines and equipment for resuscitation to be available. iv. HDU (high dependency unit) should also be equipped with all the equipment and manpower as per HDU norms.
9. Records Maintenance: Maintain complete records as required on day-to-day basis and is able to provide necessary records of hospital / patients to the Society/Insurer or his representative as and when required. i. Wherever automated systems are used it should comply with MoHFW/ NHA EHR guidelines (as and when they are enforced) ii. All Health Scheme cases must have complete records maintained iii. Share data with designated authorities for information as mandated. 10. Legal requirements as applicable by the local/state health agency. 11. Adherence to Standard treatment guidelines/ Clinical Pathways for procedures as mandated by NHA from time to time. 12. Registration with the Income Tax Department. 13. NEFT enabled bank account 14. Telephone/Fax
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15. Safe drinking water facilities/Patient care waiting area 16. Uninterrupted (24 hour) supply of electricity and generator facility with required capacity suitable to the bed strength of the hospital. 17. Waste management support services (General and Bio Medical) – in compliance with the bio-medical waste management act. 18. Appropriate fire-safety measures. 19. Provide space for a separate kiosk for Health Scheme beneficiary management (AB- PMJAY non-medical4 coordinator) at the hospital reception. 20. Ensure a dedicated medical officer to work as a medical5 co-ordinator towards Health Scheme beneficiary management (including records for follow-up care as prescribed) 21. Ensure appropriate promotion of Health Scheme in and around the hospital (display banners, brochures etc.) towards effective publicity of the scheme in co-ordination with the SHA/ district level Health Scheme team. 22. IT Hardware requirements (desktop/laptop with internet, printer, webcam, scanner/ fax, bio-metric device etc.) as mandated by the NHA.
Category 2: Advanced criteria:
Over and above the essential criteria required to provide basic services under Health Scheme (as mentioned in Category 1) those facilities undertaking defined speciality packages (as indicated in the benefit package for specialities mandated to qualify for advanced criteria) should have the following: 1. These empanelled hospitals may provide specialized services such as Cardiology, Cardiothoracic surgery, Neurosurgery, Nephrology, Reconstructive surgery, Oncology, Paediatric Surgery, Neonatal intensive care etc. 2. A hospital could be empanelled for one or more specialities subject to it qualifying to the concerned speciality criteria for respective packages 3. Such hospitals should be fully equipped with ICCU/SICU/ NICU/ relevant Intensive Care Unit in addition to and in support of the OT facilities that they have. 4. Such facilities should be of adequate capacity and numbers so that they can handle all the patients operated in emergencies. i. The Hospital should have sufficient experienced specialists in the specific identified fields for which the Hospital is empanelled as per the requirements of professional and regulatory bodies/ as specified in the clinical establishment act/ State regulations. ii. The Hospital should have sufficient diagnostic equipment and support services in the specific identified fields for which the Hospital is empanelled
4 The non-medical coordinator will do a concierge and helpdesk role for the patients visiting the hospital, acting as a facilitator for beneficiaries and are the face of interaction for the beneficiaries. Their role will include helping in preauthorization, claim settlement, follow-up and Kiosk-management (including proper communication of the scheme). 5 The medical coordinator will be an identified doctor in the hospital who will facilitate submission of online pre-authorization and claims requests, follow up for meeting any deficiencies and coordinating necessary and appropriate treatment in the hospital.
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as per the requirements specified in the clinical establishment act/ State regulations. 5. Indicative domain specific criteria are as under: A. Specific criteria for Cardiology/ CTVS 1. CTVS theatre facility (Open Heart Tray, Gas pipelines Lung Machine with TCM, defibrillator, ABG Machine, ACT Machine, Hypothermia machine, IABP, cautery etc.) 2. Post-op with ventilator support 3. ICU Facility with cardiac monitoring and ventilator support 4. Hospital should facilitate round the clock cardiologist services. 5. Availability of support speciality of General Physician & Paediatrician 6. Fully equipped Catheterization Laboratory Unit with qualified and trained Paramedics. B. Specific criteria for Cancer Care 1. For empanelment of Cancer treatment, the facility should have a Tumour Board which decides a comprehensive plan towards multi-modal treatment of the patient or if not then appropriate linkage mechanisms need to be established to the nearest regional cancer centre (RCC). Tumor Board should consist of a qualified team of Surgical, Radiation and Medical /Paediatric Oncologist in order to ensure the most appropriate treatment for the patient. 2. Relapse/recurrence may sometimes occur during/ after treatment. Retreatment is often possible which may be undertaken after evaluation by a Medical/ Paediatric Oncologist/ Tumor Board with prior approval and pre-authorization of treatment. 3. For extending the treatment of chemotherapy and radiotherapy the hospital should have the requisite Pathology/ Haematology services/ infrastructure for radiotherapy treatment viz. for cobalt therapy, linear accelerator radiation treatment and brachytherapy available in-house. In case such facilities are not available in the empanelled hospital for radiotherapy treatment and even for chemotherapy, the hospital shall not perform the approved surgical procedure alone but refer the patients to other centres for follow-up treatments requiring chemotherapy and radiotherapy treatments. This should be indicated where appropriate in the treatment approval plan. 4. Further hospitals should have following infrastructure for providing certain specialized radiation treatment packages such as stereotactic radiosurgery/ therapy. i. Treatment machines which are capable of delivering SRS/SRT ii. Associated Treatment planning system iii. Associated Dosimetry systems C. Specific criteria for Neurosurgery 1. Well Equipped Theatre with qualified paramedical staff, C-Arm, Microscope, neurosurgery compatible OT table with head holding frame (horse shoe, may field / sugita or equivalent frame). 2. ICU facility 3. Post-op with ventilator support 4. Facilitation for round the clock MRI, CT and other support bio-chemical investigations. D. Specific criteria for Burns, Plastic & Reconstructive surgery 338 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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1. The Hospital should have full time / on - call services of qualified plastic surgeon and support staff with requisite infrastructure for corrective surgeries for post burn contractures. 2. Isolation ward having monitor, defibrillator, central oxygen line and all OT equipment. 3. Well Equipped Theatre 4. Intensive Care Unit. 5. Post-op with ventilator support 6. Trained Paramedics 7. Post-op rehab/ Physiotherapy support/ Phycology support. E. Specific criteria for /Paediatric Surgery 1. The Hospital should have full time/on call services of paediatric surgeons 2. Well-equipped theatre 3. ICU support 4. Support services of paediatrician 5. Availability of mother rooms and feeding area. 6. Availability of radiological/ fluoroscopy services (including IITV), Laboratory services and Blood bank. F. Specific criteria for specialized new born care. 1. The hospital should have well developed and equipped neonatal nursey/Neonatal ICU (NICU) appropriate for the packages for which empanelled, as per norms 2. Availability of radiant warmer/ incubator/ pulse oximeter/ photo therapy/ weighing scale/ infusion pump/ ventilators/ CPAP/ monitoring systems/ oxygen supply / suction / infusion pumps/ resuscitation equipment/ breast pumps/ bilimeter/ KMC (Kangaroo Mother Care) chairs and transport incubator - in enough numbers and in functional state; access to hematological, biochemistry tests, imaging and blood gases, using minimal sampling, as required for the service packages 3. For Advanced Care and Critical Care Packages, in addition to 2. above: parenteral nutrition, laminar flow bench, invasive monitoring, in-house USG. Ophthalmologist on call. 4. Trained nurses 24x7 as per norms 5. Trained Paediatrician(s) round the clock 6. Arrangement for 24x7 stay of the Mother – to enable her to provide supervised care, breastfeeding and KMC to the baby in the nursery/NICU and upon transfer therefrom; provision of bedside KMC chairs. 7. Provision for post-discharge follow up visits for counselling for feeding, growth / development assessment and early stimulation, ROP checks, hearing tests etc. G. Specific criteria for Polytrauma 1. Shall have Emergency Room Setup with round the clock dedicated duty doctors. 2. Shall have the full-time service availability of Orthopaedic Surgeon, General Surgeon, and anaesthetist services. 3. The Hospital shall provide round the clock services of Neurosurgeon, Orthopaedic Surgeon, CT Surgeon, General Surgeon, Vascular Surgeon and other support specialists as and when required based on the need. 4. Shall have dedicated round the clock Emergency theatre with C-Arm facility, Surgical ICU, Post-Op Setup with qualified staff. 339 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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5. Shall be able to provide necessary diagnostic support round the clock including specialized investigations such as CT, MRI, emergency biochemical investigations. H. Specific criteria for Nephrology and Urology Surgery 1. Dialysis unit 2. Well-equipped operation theatre with C-ARM 3. Endoscopy investigation support 4. Post op ICU care with ventilator support 5. Sew lithotripsy equipment
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Annex 2.6 Claims Management Guidelines including Portability
All Empanelled Health Care Providers (EHCP) will make use of IT system of Health Scheme to manage the claims related transactions. IT system of Health Scheme has been developed for online transactions and all stakeholders are advised to maintain online transactions preferably to ensure the claim reporting in real time. However, keeping in mind the connectivity constraints faced by some districts an offline arrangement has also been included in the IT system that has to be used only when absolute. The Health Scheme strives to make the entire claim management paperless that is at any stage of claim registration, intimation, payment, investigation by EHCP or by the Trust/Implementation Support Agency the need of submission of a physical paper shall not be required. This mean that this claim data will be sent electronically through IT system to the Central/ State server. The NHA, SHA, ISA, and EHCP shall be able to access this data with respect to their respective transaction data only.
Once a claim has been raised (has hit the Central/State server), the following will need to be adhered to by the Trust through the Implementation Support Agency regarding claim settlement:
1. Claim Payments and Turn-around Time The Trust through the Implementation Support Agency shall follow the following process regarding the processing of claims received from the EHCP: A. The Trust or the Implementation Support Agency agency (IRDAI compliant only) appointed by it shall decide on the acceptance or rejection of any claim received from an EHCP. Any rejection notice issued by the Trust/Implementation Support Agency to EHCP shall clearly state that rejection is subject to the EHCP’s right to appeal against rejection of the claim.
B. If a claim is not rejected, the Trust/Implementation Support Agency shall either make the payment (based on the applicable package rate) or shall conduct further investigation into the claim received from EHCP.
C. The process specified in clause A and B above (rejection or payment/investigation) in relation to claim shall be carried out in such a manner that it is completed (Turn- around Time, TAT) shall be no longer than 15 calendar days (irrespective of the number of working days).
D. All EHCPs shall be obliged to submit their claims within Seven Days (7 Days) of discharge of patient in the format prescribed by the ISA. However, in case of Public EHCPs this time may be relaxed upto Fifteen Days (15 Days). However, if claim
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documents are not uploaded by EHCP within Thirty Days (30 days) of the discharge of the patient then the claim shall be deemed to be rejected.
E. The counting of days for TAT shall start from the date on which all the claim documents are accessible by the Trust/Implementation Support Agency or its agency.
F. The SHA, on recommendation on Implementation Support Agency, shall make claim payments to each EHCP against payable claims on a weekly basis through electronic transfer to such EHCP’s designated bank account. Implementation Support Agency is then also required to update the details of such payments against each paid claim on the online portal (IT System of Health Scheme).
G. All claims investigations shall be undertaken by a qualified and experienced medical staff/team, with at least one MBBS degree holder, appointed by the Implementation Support Agency or its representative, to ascertain the nature of the disease, illness or accident and to verify the eligibility thereof for availing the benefits under this Agreement and relevant Benefit Cover. The Implementation Support Agency’s medical staff shall not impart any advice on any treatment or medical procedures or provide any guidance related to cure or other care aspects. However, the Implementation Support Agency can ensure that the treatment was in conformity to the Standard Treatment Guidelines, if implemented.
H. The Implementation Support Agency will need to update the details on online portal (IT system of Health Scheme) of:
i) All claims that are under investigation on a fortnightly basis for review; and ii) Every claim that is pending beyond 15 days, along with its reasons for delay in processing such Claim. iii) The Implementation Support Agency may collect at its own cost, complete Claim papers (including diagnostic reports) from the EHCP, if required for audit purposes for claims under investigation. This shall not have any bearing on the Claim Payments to the Empanelled Health Care Provider.
2. Penalty on Delay in Settlement of Claims There will be a penalty for delay in settlement of claims beyond the turnaround time of 15 days. A penalty of 1% of claimed amount per week for delay beyond 15 days to be paid directly to the hospitals by the Implementation Support Agency. This penalty will become due after 30 days in case of Inter-State claims or portability of benefits
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3. Update of Claim Settlement The Implementation Support Agency will need to update the claim settlement data on the portal on a daily basis and this data will need to be updated within 24 hours of claims payment. Any claim payment which has not been updated shall be deemed to have been unpaid and the interest, as applicable, shall be charged thereon.
4. Right of Appeal and Reopening of Claims A. The Empanelled Health Care Provider shall have a right of appeal against a rejection of a Claim by the Implementation Support Agency, if the Empaneled Health Care Provider feels that the Claim is payable. An appeal may be made within thirty (30) days of the said rejection being intimated to the hospital to the District-level Grievance Committee (DGC).
B. The Implementation Support Agency and/or the DGC can re-open the Claim, if the Empaneled Health Care Provider submits the proper and relevant Claim documents that are required by the Implementation Support Agency.
C. The DGC may suo moto review any claim and direct either or both the Implementation Support Agency and the health care provider to produce any records or make any deposition as it deems fit.
D. The Implementation Support Agency or the health care provider may refer an appeal with the State-level Grievance Committee (SGC) on the decision of the DGC within thirty days (30) failing which the decision shall be final and binding. The decision of the SGC on such appeal is final and binding.
E. The decisions of the DGC and SGC shall be a speaking order stating the reasons for the decision
F. If the DGC (if there is no appeal) or SGC directs the Implementation Support Agency to pay a claim amount, the Implementation Support Agency shall pay the amount within 15 days. Any failure to pay the amount shall attract an interest on the delayed payment @ 1% for every week or part thereof. If the Implementation Support Agency does not pay the amount within 2 months they shall pay a fine of Rs. 25,000/- for each decision of DGC not carried out and Rs. 50,000 for each non- compliance of decision of SGC. This amount shall be remitted to the State Health Agency.
5. Guidelines for Portability
An Empanelled Health Care Provider (EHCP) under Health Scheme in any state should provide services as per AB-PMJAY/ Health Scheme guidelines to beneficiaries from any
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Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand other state also participating in AB-PMJAY. This means that a beneficiary will be able to get treatment outside the EHCP network of his/her Home State. Any empanelled hospital under AB-PMJAY will not be allowed to deny services to any AB- PMJAY beneficiary. All interoperability cases shall be mandatorily under pre-authorisation mode and pre-authorisation guidelines of the treatment delivery state in case of AB-PMJAY implementing States or indicative pre-authorisation guidelines as issued by NHA, shall be applicable.
Enabling Portability
To enable portability under the scheme, the stakeholders need to be prepared with the following: A. States: Each of the States participating in AB-PMJAY will sign MoU with Central Government which will allow all any the hospital empanelled hospitals by that state under AB-PMJAY to provide services to eligible beneficiaries of other States from across the country. Moreover, the state shall also be assured that its AB-PMJAY beneficiaries will be able to access services at all AB-PMJAY empanelled hospitals seamlessly in other states across India. B. Empanelled hospitals: The Empanelled Hospital shall have to sign a tripartite contract with its ISA and State Health Agency or with the Trust which explicitly agrees to provide Health Scheme services to Health Scheme beneficiaries from both inside and outside the state and the ISA/Trust agrees to pay to the EHCP through the inter-agency claim settlement process, the claims raised for AB-PMJAY beneficiaries that access care outside the state in AB-PMJAY empanelled healthcare provider network. C. Trusts: The ISA(TPA) signs a contract with all other Insurance companies and Trusts in the States / UTs under AB-PMJAY to settle down the interoperability related claims within 30 days settlement so that the final payment is made for a beneficiary by the ISA or Trust of his/her home state. D. IT systems: The IT System will provide a central clearinghouse module where all inter-insurance, inter trust and trust-insurance claims shall be settled on a monthly/bi-monthly basis. The IT System will also maintain a Balance Check Module that will have data pushed on it in real time from all participating entities. The
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central database shall also be able to raise alerts/triggers based on suspicious activity with respect to the beneficiary medical claim history based on which the treatment state shall take necessary action without delay.
E. Grievance Redressal: The Grievance Redressal Mechanism will operate as in normal cases except for disputes between Beneficiary of Home State and EHCP or IC of Treatment State and between Insurance Companies/Trusts of the Home State and Treatment State. In case of dispute between Beneficiary and EHCP or IC, the matter shall be placed before the SHA of the treatment state. In cases of disputes between IC/Trust of the two states, the matter should be taken up by bilateral discussions between the SHAs and in case of non-resolution, brought to the NHA for mediation. The IC/Trusts of Home State should be able to raise real time flags for suspect activities with the Beneficiary State and the Beneficiary State shall be obligated to conduct a basic set of checks as requested by t-he Home State IC/Trust. These clauses have to be built in into the agreement between the ICs and the Trusts. The NHA shall hold monthly mediation meetings for sorting out intra-agency issues as well as sharing portability related data analytics. F. Fraud Detection: Portability related cases will be scrutinized separately by the NHA for suspicious transactions, fraud and misuse. Data for the same shall be shared with the respective agencies for necessary action. The SHAs, on their part, must have a dedicated team for conducting real time checks and audits on such flagged cases with due diligence. The IC working in the State where benefits are delivered shall also be responsible for fraud prevention and investigation.
Implementation Arrangements of Portability
A. Packages and Package Rates: The Package list for portability will be the list of mandatory AB-PMJAY packages released by the NHA and package rates as applicable and modified by the Treatment State will be applicable. The Clause for honouring these rates by all ICs and Trusts shall have to be built into the agreement.
- Clauses for preauthorization requirements and transaction management system shall be as per the treatment state guidelines.
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- The beneficiary balance, reservation of procedures for public hospitals as well as segmentation (into secondary/tertiary care or low cost/high cost procedures) shall be as per the home state guidelines.
- Therefore, for a patient from Rajasthan, taking treatment in Tamil Nadu for CTVS in an EHCP – balance check and reservation of procedure check will be as per Rajasthan rules, but TMS and preauthorization requirements shall be as per TN rules. The hospital claim shall be made as per TN rates for CTVS by the TN SHA (through IC or trust) and the same rate shall be settled at the end of every month by the Rajasthan SHA (through IC or trust).
B. Empanelment of Hospitals: The SHA of every state in alliance with AB-PMJAY shall be responsible for empanelling hospitals in their territories. This responsibility shall include physical verification of facilities, specialty related empanelment, medical audits, post procedure audits etc.
- For empanelment of medical facilities that are in a non AB-PMJAY state, any AB-PMJAY state can separately empanel such facilities. Such EHCP shall become a member of provider network for all AB-PMJAY implementing States. NHA can also empanel a CGHS empanelled provider for AB-PMJAY in non AB-PMJAY state.
- Each SHA which empanels such a hospital shall be separately and individually responsible for ensuring adherence of all scheme requirements at such a hospital.
C. Beneficiary Identification: In case of beneficiaries that have been verified by the home state, the treatment state EHCP shall only conduct an identity verification and admit the patient as per the case. - In case of beneficiaries that have not been so verified, the treatment EHCP shall conduct the Beneficiary Identification Search Process and the documentation for family verification (ration card/family card of home state) to the Home State Agency for validation. - The Home State Agency shall validate and send back a response in priority with a service turnaround time of 30 minutes. In case the home agency does
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not send a final response (IC/Trust check), deemed verification of the beneficiary shall be undertaken and the record shall be included in the registry. The home state software will create a balance for such a family entry. - The empanelled hospital will determine beneficiary eligibility and send the linked beneficiary records for approval to the ISA/trust of Treatment State which in turn will send the records to the ISA/trust in the home State of beneficiary. The beneficiary approval team of the ISA/trust in the home State of beneficiary will accept/reject the case and convey the same to the ISA/trust in the State of hospital which will then inform the same to the hospital. In case the beneficiary has an E-Card (that is, he/she has already undergone identification earlier), after a KYC check, the beneficiary shall be accepted by the EHCP. - If the NHA and the SHA agree to provide interoperability benefits to the entire Home State Beneficiary List, the identification module shall also include the Home State Beneficiary Database for validation and identification of eligible beneficiaries.
D. Balance Check: After identification and validation of the beneficiary, the balance check for the beneficiary will be done from the home state. The balance in the home state shall be blocked through the necessary API and updated once the claim is processed. The NHA may provide a centralised balance check facility. E. Claim Settlement: A claim raised by the empanelled hospital will first be received by the Trust/Insurer of the Treatment State which shall decide based on its own internal processes. The approval of the claim shall be shared with the Home State ISA/Trust which can raise an objection on any ground within 3 days. In case the Home State raises no objection, the Treatment State IC/Trust shall settle the claim with the hospital. In case the Home State raises an objection, the Treatment State shall settle the claim as it deems fit. However, the objection of the Home State shall only be recommendatory in nature and the Home State shall have to honour the decision of the Treatment State during the time of interagency settlement.
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F. Fraud Management: In case the Trust/Insurer of the home State of beneficiary has identified fraudulent practices by the empanelled hospital, the Trust/Insurer should inform the SHA of the Treatment State of EHCP along with the supporting documents/information. The SHA of the Treatment State shall undertake the necessary action on such issues and resolution of such issues shall be mediated by the NHA during the monthly meetings.
G. Expansion of Beneficiary Set: In case, there is an alliance between AB-PMJAY and any State Scheme or AB-PMJAY has been expanded in the Home State, the above process for portability may be followed for all beneficiaries of the Home State. H. IT Platform: The states using their own platform shall have to provide interoperability with the central transaction and beneficiary identification system to operationalize guidelines for portability for AB-PMJAY. I. Modifications: The above guidelines may be modified from time to time by the National Health Agency and shall apply on all the states participating in the National Health Protection Mission.
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Annex 2.7 Template for Medical Audit
Template for Medical Audit
AB-PMJAY ID Hospital ID Patient Name Hospital Name Case No. Hospital Contact No. Date of Admission Date of Discharge Date of Audit Time of Audit Name of the Auditor Contact No. (Auditor)
Audit Observations
No. Criteria Yes No Comments 1. Does each medical record file contain: a. Is discharge summary included? b. Are significant findings recorded? c. Are details of procedures performed recorded? d. Is treatment given mentioned? e. Is patient’s condition on discharge mentioned? f. Is final diagnosis recorded with main and other conditions? g. Are instructions for follow up provided? 2. Patient history and evidence of physical examination is evident. a. Is the chief complaint recorded? b. Are details of present illness mentioned? c. Are relevant medical history of family members present? d. Body system review? e. Is a report on physical examination available? f. Are details of provisional diagnosis mentioned? 3. Is an operation report available? (only if surgical procedure done) a. Does the report include pre-operative diagnosis? b. Does the report include post-operative diagnosis? c. Are the findings of the diagnosis specified? d. Is the surgeon’s signature available on records? e. Is the date of procedure mentioned? 4. Progress notes from admission to discharge a. Are progress reports recorded daily? b. Are progress reports signed and dated? c. Are progress reports reflective of patient’s admission status? d. Are reports of patient’s progress filed chronologically? e. Is a final discharge note available? 5 Are pathology, laboratory, radiology reports available (if
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ordered)? 6 Do all entries in medical records contain signatures? a. Are all entries dated? b. Are times of treatment noted? c. Are signed consents for treatment available? 7 Is patient identification recorded on all pages? 8 Are all nursing notes signed and dated?
Overall observations of the Auditor:
Significant findings:
Recommendations:
______Signature of the Auditor Date:
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Annex 2.8 Template for Hospital Audit
Template for Hospital Audit
Hospital Name Hospital ID Hospital Address Hospital Contact No. Date of Audit Time of Audit Name of the Auditor Contact No. (Auditor)
Audit Observations
No. Criteria Yes No Comments 1. Was there power cut during the audit? 2. If yes, what was the time taken for the power back to resume electric supply? 3. Was a AB-PMJAY kiosk present in the reception area? 4. Was any staff present at the kiosk? 5. Did you see the AB-PMJAY Empanelled Hospital Board displayed near the kiosk in the reception area? 6. Was the kiosk prominently visible? 7. Was the kiosk operational in local language? 8. Were AB-PMJAY brochures available at the kiosk? 9. Were the toilets in the OPD area clean? 10. Was drinking water available in the OPD area for patients?
Overall observations of the Auditor:
Significant findings:
Recommendations:
______Signature of the Auditor Date:
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Annex 2.9 Key Performance Indicators
KPIs Time Frame Penalty 1 Setting up of a State Project Office 15 days after Rs. 1 lakh per week of delay and Appointment of Project Head signing of ISA and part thereof. and other Staff (to be specified by Contract. SHA) for co-ordination and Scheme implementation 2 Placing of District Coordinator 15 days after Rs. 5 lakh per week of delay signing of ISA and part thereof. Contract. 3 Claims-related Activities: a. Pre-authorisation Within 2 hour for Automatic approval post 2 emergency cases and 4 hours for emergency and 4 hours for all and non-emergency cases other cases respectively. ISA would be penalised at the rate of Rs 100 per hour per delay beyond prescribed time limit of pre-authorisation b. Scrutiny and Claim process from Within 15 days of If the ISA fails to Scrutinize EHCP claim submission and process the claim from for the first time EHCP within a Turn-around excluding the Time of 15 days for a reason days when the other than a delay by the claim is pending SHA in making payment of with the network the Fees that is due and hospital. payable, then the ISA at their own cost shall be liable to pay a penal interest to the EHCP at the rate of 1% of the Claim amount for every 15 days of delay. 4 Delays in compliance to orders of Beyond 30 days. Rs. 25,000 for the first month the Grievance Redressal Committee of delay in implementing (GRC) GRC order, Rs. 50,000 per month for every subsequent month thereafter. 5 Completing minimum audit targets - Specified number Rs. 10,000 for each audit both claims and medical audits of medical and report not submitted as per claims audit plan. reports to be submitted in the reporting quarter. 6 Timely submission of a specified Specified number Rs. 10,000 for each audit minimum audit reports on a of medical & report not submitted in time.
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quarterly basis – both claims and claims audit medical audits reports to be (To be implemented only when the submitted within - IT Platform has developed the 7 days of capability of allowing online filing of completing the these reports) audit.
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Annex 2.10 Indicative Fraud Triggers
Claim History Triggers 1. Impersonation. 2. Mismatch of in house document with submitted documents. 3. Claims without signature of the Health Scheme Beneficiary on pre-authorisation form. 4. Second claim in the same year for an acute medical illness/surgical. 5. Claims from multiple hospitals with same owner. 6. Claims from a hospital located far away from Health Scheme Beneficiary’s residence, pharmacy bills away from hospital/residence. 7. Claims for hospitalization at a hospital already identified on a "watch" list or black listed hospital. 8. Claims from members with no claim free years, i.e. regular claim history. 9. Same Health Scheme Beneficiary claimed in multiple places at the same time. 10. Excessive utilization by a specific member belonging to the Health Scheme Beneficiary Family Unit. 11. Deliberate blocking of higher-priced Package Rates to claim higher amounts. 12. Claims with incomplete/ poor medical history: complaints/ presenting symptoms not mentioned, only line of treatment given, supporting documentation vague or insufficient. 13. Claims with missing information like post-operative histopathology reports, surgical / anaesthetist notes missing in surgical cases. 14. Multiple claims with repeated hospitalization (under a specific benefit period at different hospitals or at one hospital of one member of the Health Scheme Beneficiary Family Unit and different hospitals for other members of the Health Scheme Beneficiary Family Unit), multiple claims towards the end of Benefit Cover Period, close proximity of claims.
Admissions Specific Triggers 15. Members of the same Health Scheme Beneficiary Family Unit getting admitted and discharged together. 16. High number of admissions. 17. Repeated admissions. 18. Repeated admissions of members of the Health Scheme Beneficiary Family Unit. 19. High number of admission in odd hours. 20. High number of admission in weekends/ holidays. 21. Admission beyond capacity of hospital. 22. Average admission is beyond bed capacity of the EHCP in a month. 23. Excessive ICU admission. 24. High number of admission at the end of the Benefit Cover Period. 25. Claims for medical management admission for exactly 24 hours to cover OPD treatment, expensive investigations. 26. Claims with Length of Stay (LoS) which is in significant variance with the average LoS for a particular ailment.
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Diagnosis Specific Triggers 27. Diagnosis and treatment contradict each other. 28. Diagnostic and treatment in different geographic locations. 29. Claims for acute medical Illness which are uncommon e.g. encephalitis, cerebral malaria, monkey bite, snake bite etc. 30. Ailment and gender mismatch. 31. Ailment and age mismatch. 32. Multiple procedures for same Health Scheme Beneficiary – blocking of multiple packages even though not required. 33. One-time procedure reported many times. 34. Treatment of diseases, illnesses or accidents for which an Empanelled Health Care Provider is not equipped or empanelled for. 35. Substitution of packages, for example, Hernia as Appendicitis, Conservative treatment as Surgical. 36. Part of the expenses collected from Health Scheme Beneficiary for medicines and screening in addition to amounts received by the Insurer/ ISA. 37. ICU/ Medical Treatment blocking done for more than 5 days of stay, other than in the case of Critical Illness. 38. Overall medical management exceeds more than 5 days, other than in the case of Critical Illness. 39. High number of cases treated on an OOP basis at a given provider, post consumption of financial limit.
Billing and Tariff based Triggers 40. Claims without supporting pre/ post hospitalisation papers/ bills. 41. Multiple specialty consultations in a single bill. 42. Claims where the cost of treatment is much higher than expected for underlying etiology. 43. High value claim from a small hospital/nursing home, particularly in class B or C cities not consistent with ailment and/or provider profile. 44. Irregular or inordinately delayed synchronization of transactions to avoid concurrent investigations. 45. Claims submitted that cause suspicion due to format or content that looks "too perfect" in order. Pharmacy bills in chronological/running serial number or claim documents with colour photocopies. Perfect claim file with all criteria fulfilled with no deficiencies. 46. Claims with visible tempering of documents, overwriting in diagnosis/ treatment papers, discharge summary, bills etc. Same handwriting and flow in all documents from first prescription to admission to discharge. X-ray plates without date and side printed. Bills generated on a "Word" document or documents without proper signature, name and stamp.
General 47. Qualification of practitioner doesn't match treatment. 48. Specialty not available in hospital. 49. Delayed information of claim details to the Insurer/ ISA. 50. Conversion of OP to IP cases (compare with historical data).
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51. Non-payment of transportation allowance. 52. Not dispensing post-hospitalization medication to Health Scheme Beneficiaries.
Annex 2.11 Indicators to Measure Effectiveness of Anti-Fraud Measures
1. Monitoring the number of grievances per 1,00,000 Health Scheme Beneficiaries. 2. Proportion of Emergency pre-authorisation requests. 3. Percent of conviction of detected fraud. 4. Share of pre-authorisation and claims audited. 5. Claim repudiation/ denial/ disallowance ratio. 6. Number of dis-empanelment/ number of investigations. 7. Share of Health Scheme Beneficiary Family Units physically visited by Scheme functionaries. 8. Share of pre-authorisation rejected. 9. Reduction in utilization of high-end procedures. 10. Health Scheme Beneficiary satisfaction. 11. Share of combined/ multiple-procedures investigated. 12. Share of combined/ multiple-procedures per 1,00,000 procedures. 13. Pre-authorisation pendency rate and Claim pendency rate per 100 cases decided OR percent of pre-authorisation decided after additional observation being attended + correlated with frauds detected as a consequence of this effort. 14. Instances of single disease dominating a geographical area/Service area are reduced. 15. Disease utilization rates correlate more with the community incidence. 16. Number of FIRs filed. 17. Number of enquiry reports against hospitals. 18. Number of enquiry reports against ISA or SHA staff. 19. Number of charge sheets filed. 20. Number of judgments received. 21. Number of cases discussed in Empanelment and Disciplinary Committee. 22. Reduction in number of enhancements requested per 100 claims. 23. Impact on utilization. 24. Percent of pre-audit done for pre-authorisation and claims. 25. Percent of post-audit done for pre-authorisation and claims. 26. Number of staff removed or replaced due to confirmed fraud. 27. Number of actions taken against hospitals in a given time period. 28. Number of adverse press reports in a given time period. 29. Frequency of hospital inspection in a given time period in a defined geographical area. 30. Reduction in share of red flag cases per 100 claims.
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Annex 2.12 Guidelines for Hospital Transaction Process including pre-authorisation Health Scheme would be cashless & paperless at any of the empanelled hospitals. The beneficiaries shall not be required to pay any charge for the hospitalization expenses. The benefit also includes pre- and post-hospitalisation expenses. The scheme is an entitlement based and entitlement of the beneficiary is decided on the basis of family being figured in SECC database.
The core principle for finalising the Balance Check and providing treatment at empanelled hospital guidelines for Health Scheme is to construct a broad framework as guiding posts for simplifying the service delivery under the ambit of the benefit and the technology.
1. Decision on IT platform to be used for Health Scheme:
Responsibility of – State Government
IT platform for identification of beneficiaries and transactions at the Empanelled Health Care Provider (EHCP) will be provided by MoHFW/NHA which would later may customized further as per State needs.
For ease of convergence and on boarding, States which have their own IT systems under their own health insurance/ assurance scheme may be allowed to continue to use their own IT platform. However, these States will need to map their scheme ID with AB-PMJAY ID (AHL TIN) at the point of care and will need to share real time defined transaction data through API with the Central server with respect to AB-PMJAY beneficiaries. States will need to also ensure that no family eligible as per SECC criteria of AB-PMJAY is denied services under the scheme and will need to provide undertaking that eligibility under their schemes covers AB- PMJAY targeted families as per SECC.
2. Preparatory Activities for State’s:
Responsibility of – State Government Timeline – within a period of 30 days, after approval of empanelment of health care provider
The State will need to: A. Ensure the availability of requisite hardware, software and allied infrastructure required for beneficiary identification, AB-PMJAY e-card printing and transactions for delivery of service at the EHCP. Beneficiary Identification and Transaction Software/ Application/ platform will be provided free of cost by MoHFW/NHA. Specifications for these will be provided by MoHFW/NHA. B. Ensure that a Medical Officer as Nodal Officer at EHCP for AB-PMJAY has been nominated. C. Ensure appointment of Ayushman Mitra for the EHCP D. Ensure that a dedicated helpdesk for AB-PMJAY at a prominent place at the EHCP
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E. Availability of printed booklets, in abundant quantities at the helpdesk, which will be given to beneficiaries along with the AB-PMJAY e-cards, if beneficiary has not been issued the AB-PMJAY e-card earlier. F. State/ State Health Agency (SHA) shall identify and set-up team(s) which shall have the capacities to handle hardware and basic software support, troubleshooting etc. G. Training of EHCP staff and Ayushman Mitras by the SHA/ Implementation Support Agency. The State shall ensure availability of above, in order to carry out all the activities laid down in this guideline.
3. Process for Beneficiary identification, issuance of AB-PMJAY e-card and transaction for service delivery
Responsibility of – Ayushman Mitra or another authorised person at EHCP Timeline – Ongoing A. Beneficiary Verification & Authentication i) In addition to AADHAR Card, a Member may bring the following to the Health Scheme helpdesk: - Ration Card NFSA 2014-15 data base - Voter ID No as per 2012 Vidhan Sabha wise Voter list - Employees code as per Treasury Data provided by the Govt of Uttarakhand - Family Health Survey Card - Any other defined document as prescribed by the State Government - Ayushman Mitra/Operator will check if Health Scheme beneficiary has Aadhaar Card, Ration Card/ Voter ID/ Employees Code/ Family Health Survey Card is available with the beneficiary ii) In case Internet connectivity is available at hospital - Operator/Ayushman Mitra identifies the beneficiary’s eligibility and verification status from AB-PMJAY Central Server - If beneficiary is eligible and verified under AB-PMJAY, server will show the details of the members of the family with photo of each verified member - If found OK then beneficiary can be registered for getting the cashless treatment. - If patient is eligible but not verified then patient will be asked to produce Aadhaar Card/Number/ Ration Card for verification (in absence of Aadhaar) - Beneficiary mobile number will be captured. - If Aadhaar Card/Number is available and authenticated online then patient will be verified under scheme (as prescribed by the software) and will be issued a AB-PMJAY e-Card for getting the cashless treatment. - Beneficiary gender and year of birth will be captured with Aadhaar eKYC or Ration Card
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- If Aadhaar Card/Number is not available then beneficiary will advised to get the Aadhaar Card/number within stipulated time. iii) In case Internet connectivity is not available at hospital - AB-PMJAY Registration Desk at Hospital will call Central Helpline and using IVRS enters AB-PMJAY ID or Aadhaar number of the patient. IVRS will speak out the details of all beneficiaries in the family and hospital will choose the beneficiary who has come for treatment. It will also inform the verification status of the beneficiary - If eligible and verified then beneficiary will be registered for getting treatment by sending an OTP on the mobile number of the beneficiary - In case beneficiary is eligible but not verified then she/he can be verified using Aadhaar OTP authentication and can get registered for getting cashless treatment iv) In case of emergency or in case person does not show AB-PMJAY e-Card/ID or Aadhaar Card/Number and claims to be AB-PMJAY beneficiary and show some photo ID proof issued by Government, then beneficiary may get the treatment after getting TPIN (Telephonic Patient Identification Number) from the call centre and same will be recorded. Government Photo ID proof need not be insisted in case of emergency. In all such cases, relevant AB-PMJAY beneficiary proof will be supplied within specified time before discharge otherwise beneficiary will pay for the treatment to the Hospital. v) If eligibility, verification and authentication are successful, beneficiary should be allowed for treatment
These details captured will be available at SHA/ Implementation Support Agency/ Trust level for their approval. Once approved, the beneficiary will be considered as successfully identified and verified under AB-PMJAY.
4. Package Selection A. The operator will check for the specialty for which the hospital is empanelled. Hospitals will only be allowed to view and apply treatment package for the specialty for which they are empanelled. B. Based on diagnosis sheet provided by doctor, operator should be able to block Surgical or Non-Surgical benefit package(s) using AB-PMJAY IT system. C. Both surgical and non-surgical packages cannot be blocked together, either of the type can only be blocked. D. As per the package list, the mandatory diagnostics/documents will need to be uploaded along with blocking of packages. E. Some packages will be reserved for blocking only in public hospitals. F. The operator can block more than one package for the beneficiary. A logic will be built in for multiple package selection, such that reduced payment is made in case of multiple packages being blocked in the same hospitalization event. 359 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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G. If a registered mobile number of beneficiary family is available, an SMS alert will be sent to the beneficiary notifying him of the packages blocked for him. H. At the same time, a printable registration slip needs to be generated and handed over to the patient or patient’s attendant. I. If for any reason treatment is not availed for any package, the operator can unblock the package before discharge from hospital.
5. Pre-authorisation
A. There would be defined packages which will require pre-authorization from the Implementation Support Agency. In case any inpatient treatment is not available in the packages defined, Except for exclusions listed in Annex 2.2, services for any other surgical treatment services may also be allowed after approval from the Chairman of the designated committee, provided the services are within the benefit limit available and pre-authorisation has been provided by the SHA. Under both scenarios, the operator should be able to initiate a request to the ISA/trust for pre- authorization using the web application. B. The hospital operator will send all documents required for pre-authorization to the Implementation Support Agency using the Centralized AB-PMJAY/ States transaction management application. C. The documents exchanged will not be stored on the Health Scheme server permanently. Only the information about pre-authorization request and response received will be stored on the central server. It is the responsibility of the Implementation Support Agency to maintain the documents at their end. D. The documents needed may vary from package to package and hence a master list of all documents required for all packages will be available on the server. E. The request as well as approval of the form will be done using the Health Scheme IT system or using API exposed by Health Scheme (Only one option can be adopted by the ISA), or using State’s own IT system (if adopted by the State). F. In case of no or limited connectivity, the filled form can also be sent to the ISA/ trust either through fax/ email. However, once internet connectivity is established, the form should also be submitted using online system as described above. G. The Implementation Support Agency will have to approve or reject the request latest by 4 hours. If the Implementation Support Agency fails to do so, the request will be considered deemed to be approved after 4 hours by default. H. In case of an emergency or delay in getting the response for pre-authorization request due to technical issues, provision will be there to get the pre-authorization code over the phone from Implementation Support Agency or the call centre setup by Implementation Support Agency/Trust. The documents required for the processing, may be sent using the transaction system within stipulated time. I. In case of emergency, Implementation Support Agency will provide the pre- authorization code generated through the algorithm/ utility provided by MoHFW/NHA-NIC.
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J. Pre-authorization code provided by the Trust will be entered by the operator and will be verified by the system. K. If pre-authorization request is rejected, Implementation Support Agency will provide the reasons for rejection. Rejection details will be captured and stored in the transaction database. L. If the beneficiary or the hospital are not satisfied by the rejection reason, they can appeal through grievance system.
6. Balance Check, Treatment, Discharge and Claim Request
A. Based on selection of package(s), the operator will check from the Central AB-PMJAY Server if sufficient balance is available with the beneficiary to avail services. B. States using their own IT system for hospital transaction will be able to check and update balance from Central AB-PMJAY server using API C. If balance amount under available covers is not enough for treatment, then remaining amount (treatment cost - available balance), will be paid by beneficiary (OOP expense will also be captured and stored) D. The hospital will only know if there is sufficient balance to provide the selected treatment in a yes or no response. The exact amount will not be visible to the hospital. E. SMS will be sent to the beneficiary registered mobile about the transaction and available balance. F. List of diagnostic reports recommended for the blocked package will be made available and upload of all such reports will be mandatory before discharge of beneficiary. G. Transaction System would have provision of implementation of Standard Treatment Guidelines for providing the treatment H. After the treatment, details will be saved and beneficiary will be discharged with a summary sheet. I. Treatment cost will be deducted from available amount and will be updated on the Central AB-PMJAY Server. J. The operator fills the online discharge summary form and the patient will be discharged. In case of mortality, a flag will be raised against the deceased member declaring him as dead or inactive. K. At the same time, a printable receipt needs to be generated and handed over to the patient or patient’s attendant. L. After discharge, beneficiary gets a confirmation and feedback call from the Health Scheme call centre; response from beneficiary will be stored in the database and a letter will be posted to the beneficiary for seeking feedback. M. Data (Transaction details) should be updated to Central Server and accessible to Implementation Support Agency for Claim settlement. Claim will be presumed to be raised once the discharge information is available on the Central server and is
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accessible to the Implementation Support Agency and SHA N. SMS will be sent to beneficiary registered mobile about the transaction and available balance O. After every discharge, claims would be deemed to be raised to the Implementation Support Agency. An automated email alert will be sent to the ISA/trust specifying patient name, AB-PMJAY ID, registration number & date and discharge date. Details like Registration ID, AB-PMJAY ID, date and amount of claim raised will be accessible to the ISA/trust on AB-PMJAY System/ State IT system. Also details like Registration- ID, AB-PMJAY-ID, Date and amount of claim raised, date and amount of claim disbursement, reasons for different in claims raised and claims settled (if any), reasons for rejection of claims (if any) will be retrieved from the Implementation Support Agencythrough APIs. P. Once the claim is processed and the hospital gets the payment, the above- mentioned information along with payment transaction ID will be updated on central AB-PMJAY system by the Implementation Support Agency for each claim separately. Q. Hospital Transaction Management Module would be able to generate a basic MIS report of beneficiary admitted, treated and claim settled and in process and any other report needed by Hospitals on a regular basis R. Upon discharge, beneficiary will receive a feedback call from the Call centre where he can share his feedback about his/her hospitalisation experience.
7. Monitoring of Transaction Process at EHCP
Responsibility of – SHA and Implementation Support Agency Timeline – Continuous
SHA and Implementation Support Agency will need to have very close monitoring of the process in order to ascertain challenges, if any, being faced and resolution of the same. Some examples of the parameters on which monitoring may be based are as follows: A. Number of EHCP and Ayushman Mitras B. Time taken for verification and issuance of e-card of each member C. Time taken for approval of verification of beneficiaries D. Percentage of families with at least one member having issued e-card out of total eligible families in SECC E. Number of admissions per family F. Grievances received against Ayushman Mitras or EHCP G. Proportion of Emergency pre-authorisation requests H. Percent of conviction of detected fraud. I. Share of pre-authorisation and claims audited J. Claim repudiation/ denial/ disallowance ratio K. AB-PMJAY Beneficiary satisfaction
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Annex 2.13 Guideline for Greivance Redressal
Grievance Department has to be manned by dedicated resources to address the grievances from time to time as per the instructions of the NHA. The District authorities shall act as a frontline for the redressal of Beneficiaries’/ Providers/ other Stakeholder’s grievances. The District authorities shall also attempt to solve the grievance at their end. The grievances so recorded shall be numbered consecutively and the Beneficiaries / Providers shall be provided with the number assigned to the grievance. The District authorities shall provide the Beneficiaries / Provider with details of the follow-up action taken as regards the grievance as and when the Beneficiaries require it to do so. The District authorities shall also record the information in pre-agreed format of any complaint / grievance received by oral, written or any other form of communication.
Under the Grievance Redressal Mechanism of Health Scheme, following set of three tier Grievance Redressal Committees have been set up to attend to the grievances of various stakeholders at different levels: District Grievance Redressal Committee (DGRC)/Block Grievance Redressal Committee (BGRC) The District Grievance Redressal Committee (DGRC)/ Block Grievance Redressal Committee (BGRC) will be constituted by the State Health Agency (SHA) in each district within 15 days of signing of MoU with the ISA. The District Magistrate or an officer of the rank of Addl. District Magistrate, who shall be the Chairperson of the DGRC. The Sub District Magistrate who shall be the Chairperson of the BGRC The CMO/ CMOH/ DM&HO/ DHO/MOIC or equivalent rank officer shall be the Convenor of the DGRC/BGRC. Representatives from the district level offices of the Departments of Rural Development. The District Coordinator of the ISA. The District Grievance Nodal Officer (DGNO), Block Grievance Nodal Officer (BGNO) The DGRC/BGRC may invite other experts for their inputs for specific cases.
Note: DGNO/BGNO shall try to resolve the complaint by forwarding the same to Action Taking Authority (ATA). If the complaint is not resolved or comments are not received over the same within 15 days of the complaint, then the matter may be referred to DGRC/BGRC.
State Grievance Redressal Committee (SGRC) The State Grievance Redressal Committee (SGRC) will be constituted by the State Health Agency within 15 days of signing of MoU with the Central Government. CEO of State Health Agency / State Nodal Agency shall be the Chairperson of the SGRC.
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Representatives of the Departments of Rural Development, Women & Child Development, Labour, Tribal Welfare. Director Health Services. Medical Superintendent of the leading state level government hospital. The State Grievance Nodal Officer (SGNO) of the SHA shall be the Convenor of SGRC. The SGRC may invite other experts for their inputs on specific cases.
Note: In case of any grievance between SHA and ISA, SGRC will be chaired by the Secretary of Department of Health & Family Welfare of the State. If any party is not agreed with the decision of DGRC, then they may approach the SGRC against the decision of DGRC.
National Grievance Redressal Committee (NGRC)
The NGRC shall be formed by the MoHFW, GoI at the National level. The constitution of the NGRC shall be determined by the MoHFW in accordance with the Scheme Guidelines from time to time. Proposed members for NGRC are: 1. CEO of National Health Agency (NHA) - Chairperson 2. JS , Ministry of Health & Family Welfare- Member 3. Additional CEO of National Health Agency (NHA)- Member Convenor 4. Executive Director, IEC, Capacity Building and Grievance Redressal 5. NGRC can also invite other experts/ officers for their inputs in specific cases.
CEO (NHA) may designate Addl. CEO (NHA) to chair the NGRC. Investigation authority for investigation of the grievance may be assigned to Regional Director- CGHS/Director Health Services/ Mission director NHM of the State concerned. NGRC will consider: a. Appeal by the stakeholders against the decisions of the State Grievance Redressal Committees (SGRCs) b. Also, the petition of any stakeholder aggrieved with the action or the decision of the State Health Agency / State Government c. Review of State-wise performance based monthly report for monitoring, evaluation and make suggestions for improvement in the Scheme as well as evaluation methodology d. Any other reference on which report of NGRC is specifically sought by the Competent Authority.
The Meetings of the NGRC will be convened as per the cases received with it for consideration or as per the convenience of the Chairman, NGRC. 1.1. Grievance Settlement of Stakeholders
If any stakeholder has a grievance against another one during the subsistence of the benefit period or thereafter, in connection with the validity, interpretation, implementation or alleged breach of any provision of the scheme, it will be settled in the following way by the Grievance Committee: 364 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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A. Grievance of a Beneficiary i) Grievance against ISA, hospital, their representatives or any functionary If a beneficiary has a grievance on issues relating to entitlement, or any other Health Scheme related issue against ISA, hospital, their representatives or any functionary, the beneficiary can call the toll free call centre number defined/announced by the State and register the complaint. Beneficiary can also approach BGRC/DGRC. The complaint of the beneficiary will be forwarded to the relevant person by the call centre as per defined matrix. The BGRC/DGRC shall take a decision within 30 days of receiving the complaint. If either of the parties is not satisfied with the decision, they can appeal to the SGRC within 30 days of the decision of the BGRC/DGRC. The SGRC shall take a decision on the appeal within 30 days of receiving the appeal. The decision of the SGRC on such issues will be final. Note: In case of any grievance from beneficiary related to hospitalisation of beneficiary (service related issue of the beneficiary) the timelines for DGRC to take decision is within 24 hours from the receiving of the grievance.
ii) Grievance against district authorities If the beneficiary has a grievance against the District Authorities or an agency of the State Government, it can approach the SGRC for resolution. The SGRC shall take a decision on the matter within 30 days of the receipt of the grievance. The decision of SGRC shall be final.
B. Grievance of a Health Care Provider i) Grievance against beneficiary, ISA, their representatives or any other functionary If a Health Care Provider has any grievance with respect to beneficiary, ISA, their representatives or any other functionary, the Health Care Provider will approach the DGRC. The DGRC should be able to reach a decision within 30 days of receiving the complaint. Step I- If either of the parties is not satisfied with the decision, they can go to the SGRC within 30 days of the decision of the DGRC, which shall take a decision within 30 days of receipt of appeal. Step II- If either of the parties is not satisfied with the decision, they can go to the NGRC within 30 days of the decision of the SGRC, which shall take a decision within 30 days of receipt of appeal. The decision of NGRC shall be final. C. Grievance of ISA i) Grievance against district authorities/ health care provider If ISA has a grievance against District Authority / Health Care Provider or an agency of the State Government, it can approach the SGRC for resolution. The SGRC shall decide the matter within 30 days of the receipt of the grievance.
In case of dissatisfaction with the decision of the SGRC, the affected party can file an appeal before NGRC within 30 days of the decision of the SGRC and NGRC shall take a decision within 30 days of the receipt of appeal after seeking a report from the other party. The decision of NGRC shall be final.
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1.2. Functions of Grievance Redressal Committees
A. Functions of the DGRC/BGRC The BGRC/ DGRC shall perform all functions related to handling and resolution of grievances within their respective Districts. The specific functions will include:
i) Review grievance records. ii) Call for additional information as required either directly from the Complainant or from the concerned agencies which could be the Insurer or an EHCP or the SHA or any other agency/ individual directly or indirectly associated with the Scheme. iii) Conduct grievance redressal proceedings as required. iv) If required, call for hearings and representations from the parties concerned while determining the merits and demerits of a case. v) Adjudicate and issue final orders on grievances. vi) In case of grievances that need urgent redressal, develop internal mechanisms for redressing the grievances within the shortest possible time, which could include but not be limited to convening special meetings of the Committee. vii) Monitor the grievance database to ensure that all grievances are resolved within 30 days.
B. Functions of the SGRC: The SGRC shall perform all functions related to handling and resolution of all grievances received either directly or escalated through the DGRC. The specific functions will include: i) Oversee grievance redressal functions of the DGRC including but not limited to monitoring the turnaround time for grievance redressal. ii) Act as an Appellate Authority for appealing against the orders of the DGRC. iii) Perform all tasks necessary to decide on all such appeals within 30 days of receiving such appeal. iv) Adjudicate and issue final orders on grievances. v) Nominate District Grievance Officer (DGO) at each District. vi) Direct the concerned ISA to appoint District Nodal Officer of each district.
C. Functions of the NGRC: The NGRC shall act as the final Appellate Authority at the National level. i) The NGRC shall only accept appeals against the orders of the SGRC of a State. ii) The decision of NGRC will be final.
1.3. Lodging of Grievances/ Complaints
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A. If any stakeholder has a complaint (complainant) against any other stakeholder during the subsistence of the benefit Cover Period or thereafter, in connection with the validity, interpretation, implementation or alleged breach of the ISA Contract between the ISA and the SHA or a benefit peroid or of the terms of their agreement (for example, the Services Agreement between the ISA and an Empanelled Health Care Provider), then such complainant may lodge a complaint by online grievance redressal portal or letter or e-mail. B. For this purpose, a stakeholder includes: any Ayushman Uttarakahnd Beneficiary; an empanelled health care provider (EHCP); a De-empanelled Health Care Provider; the Insurer or its employees; the SHA or its employees or nominated functionaries for implementation of the Scheme (DNOs, State Nodal Officer, etc.); and any other person having an interest or participating in the implementation of the Scheme or entitled to benefits under the Ayushman Uttarakahnd Cover. C. A complainant may lodge a complaint in the following manner: i) directly with the BGNO/DGNO of the district where such stakeholder is located or where such complaint has arisen and if the stakeholder is located outside the Service Area, then with any BGNO/DGNO located in the Service Area; or ii) with the SHA: If a complaint has been lodged with the SHA, they shall forward such complaint to the concerned BGNO/DGNO. D. Upon a complaint being received by the BGNO/DGNO, the BGNO/DGNO shall decide whether the substance of the complaint is a matter that can be addressed by the stakeholder against whom the complaint is lodged or whether such matter requires to be dealt with under the grievance redressal mechanism. E. If the BGNO/DGNO decides that the complaint must be dealt with under the grievance redressal mechanism, the BGNO/DGNO shall refer such complaint to the Convener of the relevant Grievance Redressal Committee. F. If the BGNO/DGNO decides that the complaint need not be dealt with under the grievance redressal mechanism, then the procedures set out in various process/guidelines shall apply.
1.4. Redressal of Complaints A. The BGNO/DGNO shall enter the particulars of the complaint on the Web-based Central Complaints and Grievance Management System (CCGMS) established by the MoHFW. B. The CCGMS will automatically: (i) generate a Unique Complaint Number (UCN); (ii) categorize the nature of the complaint; and (iii) an e-mail or letter to be sent to the appropriate stakeholder to which such category of complaint is to be referred (including updating on phone). C. Once the UCN is generated, the BGNO/DGNO shall send or cause to be sent an acknowledgement email/phone call to the complainant and provide the
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complainant with the UCN. Upon receipt of the UCN, the complainant will have the ability to track the progress of complaint resolution online through CCGMS and use the same at the time of calling the helpline for allowing easy retrieval of the specific complaint data. D. The stakeholder against whom a complaint has been lodged must send its comments/ response to the complainant and copy to the BGNO/DGNO within 15 days. If the complaint is not addressed within such 15-day period, the BGNO/DGNO shall send a reminder to such stakeholder for redressal within a time period specified by the BGNO/DGNO. E. If the BGNO/DGNO is satisfied that the comments/ response received from the stakeholder will addresses the complaint, then the BGNO/DGNO shall communicate this to the complainant by e-mail and update the CCGMS. F. If the BGNO/DGNO is not satisfied with the comments/ response received or if no comments/ response are received from the stakeholder despite a reminder, then the BGNO/DGNO shall refer such complaint to the Convener of the relevant Grievance Redressal Committee depending on the nature of the complaint after which the procedures set out shall apply.
1.5. Grievance Redressal Mechanism
Upon escalation of a complaint for grievance redressal the following procedures shall apply: A. The BGNO/DGNO/SGRC shall update the CCGMS to change the status of the complaint to a grievance, after which the CCGMS shall categorize the grievance and automatically refer it to the Convenor of the relevant Grievance Redressal Committee by way of e-mail. B. The Convenor of the relevant Grievance Redressal Committee shall place the grievance before the Grievance Redressal Committee for its decision at its next meeting. C. Each grievance shall be addressed by the relevant Grievance Redressal Committee within a period of 30 days of receipt of the grievance. For this purpose, each Grievance Redressal Committee shall be convened at least once every 30 days to ensure that all grievances are addressed within this time frame. Depending on the urgency of the case, the Grievance Redressal Committee may decide to meet earlier for a speedier resolution of the grievance. D. The relevant Grievance Redressal Committee shall arrive at a reasoned decision within 30 days of receipt of the grievance. The decision of the relevant Grievance Redressal Committee shall be taken by majority vote of its members present. Such decision shall be given after following the principles of natural justice, including giving the parties a reasonable opportunity to be heard. E. If any party to a grievance is not satisfied with the decision of the relevant Grievance Redressal Committee, it may appeal against the decision within 30 days to the
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relevant Grievance Redressal Committee or other authority having powers of appeal. F. If an appeal is not filed within such 30-day period, the decision of the original Grievance Redressal Committee shall be final and binding. G. A Grievance Redressal Committee or other authority having powers of appeal shall dispose of an appeal within 30 days of receipt of the appeal. The decision of the Grievance Redressal Committee or other authority with powers of appeal shall be taken by majority vote of its members. Such decision shall be given after following the principles of natural justice, including giving the parties a reasonable opportunity to be heard. The decision of the Grievance Redressal Committee or other authority having powers of appeal shall be final and binding.
1.6. Proceedings Initiated by the State Health Agency, State Grievance Redressal Committee, the National Health Agency
The SHA, SGRC and/ or the National Health Agency (NHA) shall have the standing to initiate suo moto proceedings and to file a complaint on behalf of itself and AB-PMJAY Beneficiaries under the Scheme. A. Compliance with the Orders of the Grievance Redressal Committees i) The ISA (TPA) shall ensure that all orders of the Grievance Redressal Committees by which it is bound are complied with within 30 days of the issuance of the order, unless such order has been stayed on appeal. ii) If the ISA fails to comply with the order of any Grievance Redressal Committee within such 30-day period, the ISA (TPA) shall be liable to pay a penalty of Rs. 25,000 per month for the first month of such non-compliance and Rs. 50,000 per month thereafter until the order of such Grievance Redressal Committee is complied with. The Insurer shall be liable to pay such penalty to the SHA within 15 days of receiving a written notice. iii) On failure to pay such penalty, the Insurer shall incur an additional interest at the rate of one percent of the total outstanding penalty amount for every 15 days for which such penalty amount remains unpaid.
B. Complaints/ Suggestions received through Social Media/Call centre As Social Media channels will be handled by NHA, hence, the complaints/ suggestions raised through Social Media channels like, Facebook, twitter handles, etc. will be routed to the respective SGNO by NGNO (National Grievance Nodal Officer). SGNO needs to register the same on the Grievance portal and publish a monthly report on the action taken to the NGNO. Complaint may also be lodged through Call center by beneficiary. Call center need to register the details like complaint details in the defined format and forward the same to State Grievance Nodal Officer of the State concerned. SGNO needs to upload the details of the complaint on the grievance portal and allocate the same to the concerned District. The Complaint / grievance will be redressed as per guidelines. 369 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Note: Matrix for grievance referral under the Scheme is presented in the table below: Aggrieved Indicative Nature of Grievance Grievance Referred To Party Against
Denied treatment Money sought for treatment, despite Sum Insured under Health Scheme Cover being available Demanding more than Package Rate/ Health Pre-Authorized Amount, if Sum Insured Hospital BGNO/DGNO Scheme under Health Scheme Cover is Beneficiary insufficient or exhausted Health Scheme Card retained by Empanelled Health Care Provider Medicines not provided against OPD Benefits or follow-up care Claims rejected by Insurer or full Claim amount not paid Suspension or de-empanelment of Empanelled Empanelled Health Care Provider ISA/ SHA DGNO Health Care Hospital IT Infrastructure not Provider functioning Insurer not assisting in solving issue or not accepting manual transaction No space provided for District Office DNO SGNO Health Scheme Beneficiary Database not updated for renewal benefit Cover ISA SHA SGRC Period
Fees not received within time prescribed. Inter State (Portability issues)
Denied treatment Money sought for treatment, despite DGNO of the Sum Insured under Health Scheme State where Beneficiary is Health Cover being available Hospital applying/availing Scheme Demanding more than Package Rate/ benefits of Beneficiary Pre-Authorized Amount, if Sum Insured Health Scheme under Health Scheme Cover is (other than insufficient or exhausted parent State) Medicines not provided against OPD
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Aggrieved Indicative Nature of Grievance Grievance Referred To Party Against
Benefits or follow-up care
Claims rejected by Insurer or full Claim SGRC of both Empanelled parent State and amount not paid ISA / SHA Health Care State where the
Provider claim is raised State
Annex 2.14 ISA Minimum Staff requirement of Key Personnel
Minimum S.No Post manpower Posted at Minimum Qualification/ Experience required 1 State Coordinator 01 Project Office MBA with minimum 5 years Dehradun experience in health insurance or Graduate with minimum 7 years experiencein health insurance. 2 Manager-Claims 01 Project Office MBBS with minimum 05 years of Dehradun clinical experience and working knowledge of operating systems. 3 Dy.Manager- Claims 02 Project Office MBA with minimum 03 years Dehradun experience in claim management. (Non-medical documentation) or Graduate with minimum of 5 years experience in claim management. (Non-medical documentation) 4 Process Associates 04 Project Office Graduate having minimum 03 years (for Pre- Dehradun experience in claim processing. (Non- authorization) Medical documentation) 5 Medical Officer for 04 Project Office MBBS with basic computer Pre- authorization) Dehradun knowledge. (Medical documentation) 6 Medical Officer for 06 Project Office MBBS with basic computer Claims Dehradun knowledge. (Medical documentation) 7 Specialist for Claims. As requird Project Office Empanelled specialist as per (All specialist having Dehradun requirement (Medical MD/MS/DNB/DM documentation). All tertiary care level Degree) claims to be processed and adjudicated by specialist only. Knowledge of operating in systems. 8 Medical Auditor 02 Project Office MBBS with minimum 02 years 371 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
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Dehradun & experience as medical auditor. CMO office US Nagar 09 Office Assistant 04 Project Office Graduate having experience in similar Dehradun field work. 10 District Coordinator 13+4 One each in all MBA with minimum 01 years (ISA) district head experience in related field work or quarters, two Graduate with minimum of 03 years for Dehradun, experience in related field work. Haridwar, US Nagar and Nainital
Note : All the salaries of the ISA personnel should be in compliance with the state Minimum Wages Act.
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Annex 2.15 BENEFICIARY IDENTIFICATION SYSTEM
Beneficiary identification will include the following broad steps: XI. The operator searches through the Health Schemes list to determine if the person is covered. XII. Search can be performed by Name and Location, Ration Card No or Mobile number (collected during data drive) or ID printed on the letter sent to family, GEP Id or MSBY URN XIII. If the beneficiary’s name is found in the Health Schemes list, Aadhaar (or an alternative government ID) and Ration Card (or an alternative family ID) is collected against the Name / Family. XIV. The operator sends the linked record for approval to the ISA / SHA XV. If the health scheme data and provided documents information matched, the operator can issue the e- Card after approval from ISA/SHA and admit the patient for treatment if required. XVI. The SHA will setup a Beneficiary approval team that works on fixed service level agreements on turnaround time. The Health schemes details and the information from the ID is presented to the verifier. The SHA can either approve or recommend a case for rejection with reason. XVII. All cases recommended for rejection will be scrutinised by a State team that works on fixed service level agreements on turnaround time. The state team will either accept rejection or approve with reason. XVIII. The e-card will be printed with the unique ID under health schemes and handed over to the beneficiary to serve as a proof for verification for future reference. XIX. The beneficiary will also be provided with a booklet/ pamphlet with details about health schemes and process for availing services. XX. Presentation of this e-card will not be mandatory for availing services. However, the e-card may serve as a tool for reinforcement of entitlement to the beneficiary and faster registration process at the hospital when needed. C. Addition of new family members will be allowed. This requires at least one other family member has been approved by the ISA/SHA. Proof of being part of the same family is required in the form of iv. Name of the new member is in the family ration card or State defined family card. Or v. A Marriage Certificate relating to marriage to a family member existing in the family. Or vi. A Birth Certificate relating to a birth to a family member existing in the family is available. D. For BIS in respect of GEP Beneficiaries, the Government Order No. 214/XXVIII-3-2020-04/2008 T.C dated 4th May 2020 and guidelines issued by SHA from time to time will also be applicable.
373 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
2.16 AROGYA MITRA UNDER AB-PMJAY, AAUY AND SGHS
Pradhan Mantri Arogya Mitra (PMAM) will need to be hired by Private EHCP for managing the help desk. Public EHCP to follow the final guidelines issued by SHA for PMAMs. This help desk will need to be set up exclusively for AB-PMJAY, AAUY and SGHS. Indicative role of PMAM is as follows:
a. Receive beneficiary at the EHCP b. Guide beneficiary regarding AB-PMJAY, AAUY and SGHS and process to be followed in the EHCP for taking the treatment. c. Carry out the process of Beneficiary Identification for such persons who are beneficiaries of AB-PMJAY, AAUY and SGHS. d. Take photograph of the beneficiary. e. Carry out the Aadhaar based identification for such beneficiaries who are carrying Aadhaar Card. f. If the person is not carrying Aadhaar Card carry out the identification through other defined Government issued ID. g. Scan the identification documents as per the guidelines and upload through the software. h. Send the result of beneficiary identification process to ISA for approval. i. After getting confirmation from ISA or SHA regarding identification of the beneficiary, issue e-card to the beneficiary. j. Refer the patient to doctor for consultation. k. Check the balance of AB-PMJAY / AAUY / SGHS Beneficiary family in her/ his beneficiary cover amount. l. Upon advice of the doctor admit the patient in the EHCP. m. Take the pre-authorisation as and when required as per the guidelines. n. Enter all the relevant details of package and other information as provided by the doctor and required by the AB-PMJAY / AAUY / SGHS software. o. At the time of discharge again enter all the relevant details and discharge summary in the AB-PMJAY / AAUY / SGHS software. p. Carry out any other task as defined by the EHCP related to AB-PMJAY, AAUY and SGHS.
374 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
2.17 PROCESS OF DELIVERY OF BENEFITS, CLAIM REPORTING AND SUBMISSION 1. CASHLESS ACCESS OF SERVICES A. The AB-PMJAY, AAUY and SGHS beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and benefit limit, i.e., not specifically excluded under the Scheme. B. The EHCP shall be reimbursed as per the package cost specified by the NHA for specified packages or as pre-authorized amount in case of unspecified packages. C. The SHA/ ISA shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB-PMJAY, AAUY and SGHS Family ID on the AB-PMJAY, AAUY and SGHS Card and also ascertain the balance available under the AB-PMJAY and AAUY provided by the SHA. D. The SHA / ISA shall provide each EHCP with a transaction manual describing in detail the verification, pre- authorisation and claims procedures. E. The SHA / ISA shall train Pradhan Mantri Arogya Mitras that will be deputed in each EHCP that will be responsible for the administration of the AB-PMJAY, AAUY and SGHS on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services. F. The EHCP shall establish the identity of the member of a AB-PMJAY, AAUY and SGHS Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY and AAUY Beneficiary has balance in her/ his AB-PMJAY/ AAUY Cover amount. (iii) Provisional entry shall be made on the server using the AB-PMJAY, AAUY and SGHS ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of claim amount. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognized system of identification adopted by the SHA of AB-PMJAY, AAUY and SGHS Beneficiary Family Unit to complete the transaction. 2. PRE-AUTHORISATION OF PROCEDURES A. All procedures in Packages and rates to this Agreement shall be subject to mandatory pre-authorisation. In addition, in case of Inter-State portability, all procedures shall also be subject to mandatory pre- authorisation. B. No EHCP shall, under any circumstances whatsoever, undertake any procedure without pre- authorisation unless under emergency. Process for emergency approval will be followed as per guidelines laid down under AB-PMJAY, AAUY and SGHS. C. Request for hospitalisation shall be forwarded by the EHCP after obtaining due details from the treating doctor. The medical team of SHA/ ISA would get in touch with the treating doctor, if necessary. D. The SHA/ ISA shall ensure that in all cases pre-authorisation request related decisions are communicated to the EHCP within 6 hours for all normal cases and within 1 hour for emergencies after receiving the preauthorisation request from EHCP. If there is no response from the SHA/ ISA within 6 hours of an EHCP filing the pre-authorisation request, the request of the EHCP shall be deemed to be automatically authorized. E. The SHA shall not be liable to honor any claims from the EHCP for procedures for which the EHCP does not have a pre-authorisation. F. Reimbursement of all claims for procedures in package rate list shall be as per the limits prescribed for each such procedure. G. The SHA guarantees payment only after receipt of preauthorization and the necessary medical details. 375 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
H. In case the ailment is not covered or the medical data provided is not sufficient for the medical team of the authorisation department to confirm the eligibility, the ISA/ SHA can deny the authorisation or seek further clarification/ information. I. The ISA needs to file a report to the SHA explaining reasons for denial of every such pre-authorisation request. J. Denial of authorisation (DAL)/ guarantee of payment is by no means denial of treatment by the EHCP. The EHCP shall deal with such case as per their normal rules and regulations. K. The authorisation is given only for the necessary treatment cost of the ailment covered and mentioned for hospitalisation. L. The entry on the AB-PMJAY, AAUY and SGHS (TMS) portal for claim amount blocking as well at discharge would record the authorisation number (Case number) as well as package amount agreed upon by the EHCP and the SHA. M. In case the balance sum available is less than the specified amount for the Package, the EHCP should follow its norms of deposit/ running bills etc. However, the EHCP shall only charge the balance amount against the package from the AB-PMJAY, AAUY and SGHS beneficiary. The SHA/ ISA upon receipt of the bills and documents would release the authorized amount. N. The SHA will not be liable for payments in case the information provided during the course of authorisation is found to be incorrect or not fully disclosed. O. In cases where the AB-PMJAY, AAUY and SGHS beneficiary is admitted in the EHCP during the current Benefit Cover Period but is discharged after the end of the Benefit Cover Period, the claim has to be paid by the ISA/ SHA from the Benefit Cover Period which was operating during the period in which the AB- PMJAY, AAUY and SGHS beneficiary was admitted.
3. CLAIMS MANAGEMENT A. All EHCPs shall be obliged to submit their claims within Seven Days (7 Days) of discharge of patient in the format prescribed by the ISA. However, in case of Public EHCPs this time may be relaxed up to Fifteen Days (15 Days). B. The SHA (recommended by ISA) shall be responsible for settling all claims within 15 days after receiving all the required information/ documents. 4. PROCESS FOR BENEFICIARY IDENTIFICATION, ISSUANCE OF AB-PMJAY, AAUY AND SGHS E-CARD AND TRANSACTION FOR SERVICE DELIVERY A. Beneficiary Verification & Authentication o Member may bring the following to the AB-PMJAY, AAUY and SGHS helpdesk: Letter from MoHFW/NHA/SHA MSBY Card NFSA Ration Card Any other defined document as prescribed by the State Government 1. Arogya Mitra/ Operator will check if AB-PMJAY, AAUY and SGHS e-Card/ AB-PMJAY, AAUY and SGHS ID/ Aadhaar Number is available with the beneficiary 2. In case Internet connectivity is available at hospital Operator/ Arogya Mitra identifies the beneficiary’s eligibility and verification status from AB-PMJAY, AAUY and SGHS Central Server If beneficiary is eligible and verified under AB-PMJAY / AAUY / SGHS, server will show the details of the members of the family with photo of each verified member If found OK, then beneficiary can be registered for getting the cashless treatment. If patient is eligible but not verified then patient will be asked to produce Aadhaar Card/ Number/ Ration Card for verification (in absence of Aadhaar) Beneficiary mobile number will be captured.
376 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
If Aadhaar Card/Number is available and authenticated online, then patient will be verified under scheme (as prescribed by the software) and will be issued a AB-PMJAY/ AAUY/ SGHS e-Card for getting the cashless treatment. Beneficiary gender and year of birth will be captured with Aadhaar eKYC or Ration Card. If Aadhaar Card/ Number is not available, then beneficiary will be advised to get the Aadhaar Card/number within stipulated time. 3. In case Internet connectivity is not available at hospital Arogya Mitra at AB-PMJAY, AAUY and SGHS Registration Desk at Hospital will call Central Helpline and using IVRS enters AB-PMJAY/ AAUY /SGHS ID or Aadhaar number of the patient. IVRS will speak out the details of all beneficiaries in the family and hospital will choose the beneficiary who has come for treatment. It will also inform the verification status of the beneficiary. If eligible and verified then beneficiary will be registered for getting treatment by sending an OTP on the mobile number of the beneficiary. In case beneficiary is eligible but not verified then she/he can be verified using Aadhaar OTP authentication and can get registered for getting cashless treatment. 4. In case of emergency or in case person does not show AB-PMJAY/ AAUY/ SGHS e-Card/ ID or Aadhaar Card/ Number and claims to be AB-PMJAY/ AAU / SGHS beneficiary and show some photo ID proof issued by Government, then beneficiary may get the treatment. Government Photo ID proof need not be insisted in case of emergency. In all such cases, relevant Beneficiary proof will be supplied within specified time before discharge otherwise beneficiary will pay for the treatment to the Hospital. 5. If eligibility, verification and authentication are successful, beneficiary should be allowed for treatment.
These details captured will be available at SHA / ISA level for their approval. Once approved, the beneficiary will be considered as successfully identified and verified under AB-PMJAY / AAUY / SGHS. B. Package Selection I. The operator will check for the specialty for which the hospital is empaneled. Hospitals will only be allowed to view and apply treatment package for the specialty for which they are empanelled. II. Based on diagnosis sheet provided by doctor, operator should be able to block Surgical or Non-Surgical benefit package(s) using IT system. III. Both surgical and non-surgical packages cannot be blocked together, either of the type can only be blocked. IV. As per the package list, the mandatory diagnostics/ documents will need to be uploaded along with blocking of packages. V. Some packages will be reserved for blocking only in public hospitals. VI. The operator can block more than one package for the beneficiary. A logic will be built in for multiple package selection, such that reduced payment is made in case of multiple packages being blocked in the same hospitalisation event. VII. If a registered mobile number of beneficiary family is available, an SMS alert will be sent to the beneficiary notifying him of the packages blocked for him. VIII. At the same time, a printable registration slip needs to be generated and handed over to the patient or patient’s attendant. IX. If for any reason treatment is not availed for any package, the operator can unblock the package before discharge from hospital. C. Pre-authorisation a) There would be defined packages which will require pre-authorisation from the SHA/ ISA. In case any inpatient treatment is not available in the packages defined, then hospital will be able to provide that treatment up to Rs. 100,000 to the beneficiary only after the same gets approved by the SHA and will be reflected as an unspecified package. Under both scenarios, the operator should be able to initiate a request to the SHA/ ISA for pre-authorisation using the web application.
377 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand b) The hospital operator will send all documents required for pre-authorisation to the SHA/ ISA using the Centralized AB PM-JAY transaction management application. c) The documents exchanged will not be stored on the AB PM-JAY server permanently. Only the information about pre-authorisation request and response received will be stored on the central server. It is the responsibility of the SHA to maintain the documents at their end. d) The documents needed may vary from package to package and hence a master list of all documents required for all packages will be available on the server. e) The request as well as approval of the form will be done using the AB PM-JAY IT system. f) In case of no or limited connectivity, the filled form can also be sent to SHA/ ISA either through fax/ email. However, once internet connectivity is established, the form should also be submitted using online system as described above. g) The SHA/ ISA will have to approve or reject the request latest by 6 hours. If the SHA/ ISA fails to do so, the request will be considered deemed to be approved after 6 hours by default. h) In case of an emergency or delay in getting the response for pre-authorisation request due to technical issues, provision will be there to get the pre-authorisation code over the phone from SHA/ ISA or the call center setup by it. The documents required for the processing, may be sent using the transaction system within stipulated time. i) In case of emergency, SHA/ ISA will provide the pre-authorisation code generated through the algorithm/ utility provided by MoHFW/ NHA-NIC. j) Pre-authorisation code provided by the SHA/ ISA will be entered by the operator and will be verified by the system. k) If pre-authorisation request is rejected, SHA/ ISA will provide the reasons for rejection. Rejection details will be captured and stored in the transaction database. l) If the beneficiary or the hospital are not satisfied by the rejection reason, they can appeal through grievance system. D. Balance Check, Treatment, Discharge and Claim Request a) Based on selection of package(s), the operator will check from the Central AB PM-JAY Server if sufficient balance is available with the beneficiary to avail services. b) States using their own IT system for hospital transaction will be able to check and update balance from Central AB PM-JAY server using API c) If balance amount under available covers is not enough for treatment, then remaining amount (treatment cost - available balance), will be paid by beneficiary (OOP expense will also be captured and stored) d) The hospital will only know if there is sufficient balance to provide the selected treatment in a yes or no response. The exact amount will not be visible to the hospital. e) SMS will be sent to the beneficiary registered mobile about the transaction and available balance f) List of diagnostic reports recommended for the blocked package will be made available and upload of all such reports will be mandatory before discharge of beneficiary. g) Transaction System would have provision of implementation of Standard Treatment Guidelines for providing the treatment h) After the treatment, details will be saved and beneficiary will be discharged with a summary sheet. i) Treatment cost will be deducted from available amount and will be updated on the Central AB PM-JAY Server. j) The operator/ AM fills the online discharge summary form and the patient will be discharged. In case of mortality, a flag will be raised against the deceased member declaring him as dead or inactive. k) At the same time, a printable receipt needs to be generated and handed over to the patient or patient’s attendant. l) After discharge, beneficiary gets a confirmation and feedback call from the AB PM-JAY call centre; response from beneficiary will be stored in the database
378 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand m) Data (Transaction details) should be updated to Central Server and accessible to SHA/ ISA for Claim settlement. Claim will be presumed to be raised once the discharge information is available on the Central server and is accessible to the SHA/ ISA. n) SMS will be sent to beneficiary registered mobile about the transaction and available balance o) After every discharge, claims would be deemed to be raised to the SHA/ ISA. An automated email alert will be sent to the ISA/ SHA specifying patient name, AB-PM-JAY/ AAUY/ SGHS ID, registration number & date and discharge date. Details like Registration ID, Beneficiary ID, date and amount of claim raised will be accessible to the SHA/ ISA on AB PM-JAY System. Also details like Registration-ID, AB-PM-JAY / AAUY / SGHS ID, Date and amount of claim raised, date and amount of claim disbursement, reasons for difference in claims raised and claims settled (if any), reasons for rejection of claims (if any) will be retrieved through APIs. p) Once the claim is processed and the hospital gets the payment, the above-mentioned information along with payment transaction ID will be updated on central AB-PMJAY system by the SHA/ ISA for each claim separately. q) Hospital Transaction Management Module would be able to generate a basic MIS report of beneficiary admitted, treated and claim settled and in process and any other report needed by Hospitals on a regular basis. r) Upon discharge, beneficiary will receive a feedback call from the Call center where he can share his feedback about his/ her hospitalisation experience.
379 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
Annex :2.18 INDICATIVE LIST OF EMERGENCY CONDITIONS
1. Injury and illness :- [Abdominal pain, severe Appendicitis (leading to peritonitis), Ballistic trauma (gunshot wound), Head trauma, Hyperthermia (heat stroke or sunstroke), Malignant hyperthermia, Hypothermia or frostbite, Intestinal obstruction, Pancreatitis, Peritonitis, Poisoning, Food poisoning, Venomous animal bite, Ruptured spleen, Septic arthritis, Septicemia blood infection, Severe burn (including scalding and chemical burns), Spreading wound infection, Suspected spinal injury, Traumatic brain injury, Spinal disc herniation]. 2. Infections: - [Lyme disease infection, Malaria infection, Rabies infection, Salmonella poisoning]. 3. Cardiac and circulatory: - [Aortic aneurysm (ruptured), Aortic dissection, Bleeding , Hemorrhage, Hypovolemia, Internal bleeding, Cardiac arrest, Cardiac arrhythmia, Cardiac tamponade, Hypertensive emergency, myocardial infarction (heart attack), Ventricular fibrillation]. 4. Metabolic :- [Acute renal failure, Addisonian crisis (seen in those with Addison's disease), Advanced dehydration, Diabetic coma, Diabetic ketoacidosis, Hypoglycemic coma, Electrolyte disturbance, severe (along with dehydration, possible with severe diarrhea or vomiting, chronic laxative abuse, and severe burns), Hepatic encephalopathy, Lactic acidosis, Malnutrition and starvation (as in extreme anorexia and bulimia), Thyroid storm]. 5. Neurological and Neurosurgical: - [Attempted non-fatal suicide, Cerebrovascular accident (stroke), Subarachnoid hemorrhage, Acute subdural hematoma, Convulsion or seizure, Meningitis, Syncope (fainting), Acute spinal cord compression]. 6. Psychiatric: - [Psychotic episode, Suicidal ideation]. 7. Ophthalmological: - [Acute angle-closure glaucoma, Orbital perforation or penetration, Retinal detachment]. 8. Respiratory: - [Agonal breathing, Asphyxia, Angioedema, Choking, Drowning, Smoke inhalation, Acute asthma, Epiglottitis or severe croup, Pneumothorax, Pulmonary embolism, Respiratory failure]. 9. Shock: - [Anaphylaxis, Cardiogenic shock, Hypovolemic shock (due to hemorrhage), Neurogenic shock, Obstructive shock (e.g., massive pulmonary embolism or Cardiac tamponade), Septic shock]. 10. Obstetrics: - [Ectopic pregnancy, Eclampsia, Pre-eclampsia, HELLP syndrome, Fetal distress, Obstetrical hemorrhage, Placental abruption, Prolapsed cord, Puerperal sepsis, Shoulder dystocia, Uterine rupture]. 11. Urological, andrological, and gynecologic :- [Ovarian torsion, Gynecologic hemorrhage, Paraphimosis, Priapism, Sexual assault (rape), Testicular torsion, Urinary retention].
380 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
Annex 2.19 FORMAT OF Bank Guarantee for performance security
THIS DEED OF GUARANTEE executed on this the------day of ------at------by------(Name of the Bank) having its Head/Registered office at------hereinafter referred to as “the Guarantor” which exdpression shall unless it be repugnant to the subject or context there of include successors and assigns.
In favour of
CEO, State Health authority ,Uttarakhand, payable at Dehradun, Plot No - A1, IT Park , Sahastradhara Road Dehradun, 248013 hereinafter to as “State Health Authority or SHA”, which expression shall, unless repugnant to the context or meaning there of include its administrators, successors or assigns.
WHEREAS
A. By the ISA contract entered into between SHA and ------a company incorporated under the provisions of the Companies Act, 1956/2013, having its registered office/ permanent adderess at------(“the ISA”) the ISA has been granted the contract for the implementation of the Health Scheme for providing the Covers (the ISA Contract), Uttarakhand for a period of 03 years subject to renewal after 02 years (heareinafter referred to as “the Scheme”) B. In terms of Clause 29.1 of the ISA Contract (Volume I), the ISA is required to furnish to SHA, an unconditional and irrevocable bank guarantee of 3% of the total contract value as security for due and punctual perfonmance/discharge of its obligations under the ISA contract, relating to Scheme by the ISA. C. At the request of the ISA, the Guarantor has agreed to provide bank guarantee, being these presents guaranteeing the due and punctual performance/discharge by the ISA of Its obligations relating to the Project.
NOW THEREFORE THIS DEED WITNESSETH AS FOLLOWS :
1. Capitalised terms used herein but not defined shall have the meaning assigned to them respectively in the Insurance Contract.
2. The Guarantor hereby irrevocably guarantees the due and punctual performance by M/s------(hereinafter called “the ISA”) of all its obligations relating to the Project and in connection with achieving the project objectives by the ISA in accordance with the Insurance Contract.
3. The Guarantor shall, whithout demur, pay to SHA sums of 3% of Total contract value, within seven (7) calendar days of receipt of a written demand there for form SHA stating that the ISA has failed to meet its obligations under the Insurance Contract. The Guarantor shall not go into the veracity of any breach or failure on the part of the ISA or validity of demand so made by SHA and shall pay the amount specified in the demand not with standing any direction to the contrary given or any dispute whatsoeved raised by the ISA or any other Person. The Guarantor’s obligations here inder shall subsist until all such demands are duly met and discharged in accordance with the provision here of.
381 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand
Tender for Selecting an Implementation Support Agency For providing support services under the Ayushman Uttarakhand in the State of Uttarakhand
4. In order to give effect to this Guarantee, SHA shall be entitled to treat the Guarantor as the principal debtor. The obligations of the Guarantor shall not be affected by any variations in the terms and conditions of the Insurance Contract (Volume II) or other documents or by the extension of time for performance granted to the ISA or postponement/non exercise/ delayed exercise of any of its rights by SHA or any indulgence shown by SHA to the ISA and the Guarantor shall not be relieved from its obligations under this Guarantee on account of any such variation, extension, postponement, non exercise, delayed exercise of any of its rights by SHA or any indulgence shown by SHA , provided nothing contained herein shall enlarge the Guarantor’s obligation hereunder.
5. This Guarantee shall be irrevocable and shall remain in full force and effect until and unless discharged/ released earlier by SHA in accordance with the provisions of the Insurance Contract. The Guarantor’s liability in aggregate be limited to a sum of 3 % of Total Contract Value.
6. This Guarantee shall not be affected by any change in the constitution or winding up of the ISA /the Guarantor or any absorption, merger or amalgamation of the ISA /the Guarantor with any other Person.
7. The Guarantor has power to issue this guarantee and discharge the obligations contemplated herein, and the undersigned is duly authorised to execute this Guarantee pursuant to the power granted under ______.
IN WITNESS WHEREOF THE GUARANTOR HAS SET ITS HANDS HERE UNTO ON THE DAY, MONTH AND YEAR FIRST HEREINABOVE WRITTEN.
SIGNED AND DELIVERED
by ______Bank ISA by the hand of Shri ______its ______and authorised official.
382 Tender Document Volume II: About AB-NHPM Department of Medical Health & Family Welfare, Government of Uttarakhand