Request for proposal for Selection of Implementation Support Agency for the implementation of Chief Minister gi Hakshelgi Tengbang and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in the State of Manipur

Setting up a State Project Office (SPO) and providing one State Project Head (State Coordinator) who shall be responsible for implementation of the schemes and performance of the Implementation Support Contract in the State.

Preparation, certification, & deployment of IT Platform (one-time software development & maintenance) which will consist of a dedicated website with modules envisaging beneficiary enrolment, hospital empanelment, pre-authorisation, claims, medical audit & adjudication, follow-up monitoring, grievances, publicity, etc.

Provide adequate manpower, as per "Annexure-2: Minimum Manpower" of the draft ISA Contract Agreement in the tender documents.

Management of Information System to ensure free flow of daily MIS & ensure that progress of the schemes is reported to SNC (for CMHT) & SHA (for AB-PMJAY) in the desired format on a real-time basis.

Enrolment of beneficiaries: enrolment/ e-Card verification for AB-PMJAY and new enrolments for CMHT, if any.

Empanelment of hospitals under the two schemes.

Pre-authorisation & authorisation of procedures for ensuring cashless hospitalisations for beneficiaries.

Portability of benefits, if any.

Processing of Claims (i.e. scrutiny of claims & ensuring that charges are as per package rates) raised by empanelled healthcare providers(EHCP) /hospitals and give proposal for sanction of Claims bill to the SNC (for CMHT) & SHA (for AB-PMJAY) for payment to the EHCPs

Call Centre.

Grievance Redressal.

Fraud detection and control: Providing a team with adequate manpower to analyse data for analysing patterns, fraud, abuse and taking actions against the EHCPs involved.

Medical Auditors: Provide a team of medical doctors and specialists with relevant specialisations for conducting concurrent audits of services delivered and medical facilities available in the EHCPs.

Hospital Audit: For every EHCP visited for medical audit, hospital audit shall also be conducted to ensure completeness of medical record files, evidence of patient history of current illness, operation report (if surgery is done), patient progress notes from admission to discharge, investigation reports, adherence to standard treatment protocols, if any.

Claims Audit: Not less than 5% of total Claims submitted by every EHCP should be audited for every two months.

Beneficiary Audit: Not less than 5% of total hospitalized beneficiaries should be audited for every two months by visiting during hospitalization as well as through telephone queries.