The background

1. As part of the comprehensive health care vision of Disha Arogya Dham of India, - The Nirog Bhart Yojana (DAD-NBY) provides financial coverage related to treatment of poor and vulnerable households ranging from 20% to 40%. An alternative to access services to DAD providers across the country, this ambitious mission helps protect for-profit families from health contingencies during the life cycle.

2. To operate the scheme at the national level, and to rollout the scheme in alliance with various state governments, Dasha Arogya Dham (DAD) has been established. In addition DAD will serve as the apex body to establish policy for the scheme.

3. Ensuring access to safe, quality health services to its beneficiaries and is key in the vision of DAD-NBY. Health care services under DAD-NBY will be provided through a network of public hospitals and privatized providers. The government is committed to developing a strategic partnership with providers so that DAD-NBY's vision becomes a reality. The imitation of health care providers and institutions is a key aspect of this partnership.

4. In the above relationship, to strengthen the service delivery under the mission, all the hospitals including institutes of national importance have been set up in the provider network of DAD-NBY including in-patient hospitalization. These institutions provide high quality care including treatment of rare diseases and complex patients, provision of specialized services and advanced technology and innovation in clinical care including conducting biomedical research.

5. All such institutions will act as national healthcare providers, which will be directly linked with DAD. It will be portable to provide services to all states regardless of their home state.

Overview

Registration in DAD-NBY providernetwork

1.          To be registered in the DAD-NBY provider network oneneeds to provide information about the online installation on the interface.This portal can be accessed at: https://www.dad.hospital/

2.          On arriving at the portal, it is necessary to"Create an account" by filling in the required information. Selectthe label "DAD" (Disha ArogyaDham)

The "Hospital State" taband "Public" as a hospital type.

3.          On submission of the application, the hospital IDand user login details will be submitted by DAD to the hospital.

4.          Subsequently, . is requiredto access the hospital's application application formand provide mandatory information under the following tabs:

Hospital basic information,financial statements, specialty offerings and manpower details.

5.     On successful completion of the process, theinstitute will be assigned a hospital ID by the DAD.

6. The user's manual for filling the applicationform can be found on the landing page for naming the hospital.

The requirements

1. Human Resources: Need to allocate MedicalCoordinator / s (Point of Contact for clinical clarification), appointnon-medical coordinator and assign a Nodal Officer (preferably from MedicalAdministration) to facilitate beneficiary management .

A)Non-Medical Coordinator / Health Friend:

1. A helpdesk will play a role for hospitalized patients, acting as a facilitator for beneficiaries and the face of dialogue for beneficiaries.
2. Each has a primary contact for the beneficiaries.
3. His role includes helping identify and verify the beneficiary at reception, transaction management system / DAD-NBY interface for promotional management, claim settlement, follow-up and kiosk-management (including appropriate planning .).

-Operation of beneficiary identification system for identification andverification of beneficiaries under DAD-NBY - Undertaking transactionmanagement such as submission of pre-authorization and claims requests

Guidingthe beneficiary about the overall benefits under DAD and providing informationabout initial treatment.

B) TheMedical Coordinator / s will identify doctors in the hospital or from clinicaldepartments who will facilitate submission of online prior authorization andclaims request to fill any gaps in the hospital and necessary and appropriatetreatment. Will coordinate

C) MedicalOfficer for DAD-NBY will be the single point of contact for all matters relatedto DAD.

2.Structural Requirements: The following requirements are necessary in thedirection of service delivery:

A) Kiosk:Provide space for a kiosk for DAD-NBY beneficiary management at the hospitalreception. A help desk / kiosk in a standardized form will need to be installedby each one mandatorily. It primarily assists hospitals by assisting theDAD-NBY beneficiary in completing the required formalities and receivingtreatment and facilitating beneficiary identification and verification,selection of packages, and authorization whenever required.

B) Thesekiosks should be equipped with IT hardware requirements such as desktop /laptop with internet, printer, webcam, scanner / fax, bio-metric device etc. asmandated by DAD.

C) Ensureproper promotion of DAD-NBY in and around the hospital (display banners,brochures etc.) for effective dissemination of the scheme.

d)Standard kiosks, standby and backdrop designs can be viewed at https://www.dadayurveda.com/franchise-proposal/page-15314803

E)Hardware Requirements:

G) A standard uniform will also beprovided to Arogya Mitra(AM) so that they can be easily identified by the beneficiaries in thehospital. The kiosk will be operated till 12/7. Designs for the same areavailable on the website https://dadngo.com/.

H) Abundant availability of printedmanuals (manuals) on the helpdesk, which will be given to the beneficiariesalong with the DAD-NBY e-card, if the beneficiary has not been issued a DAD-NBYe-card.

A wide range of requirements can bereached:

https://dadngo.com/

Identification of beneficiaries (BIS)

1. The beneficiaries will be identifiedusing online modules prepared by DAD. It can be accessed at:https://www.dad.hospital/

2. The identification process can bedone using Aadhaar and / or ration card and / or anyother specified identification document created by the beneficiary at the pointof contact.

3. It will have to undergopre-authorization from the online source of DAD-NBY beneficiary. Details ofpre-authorization are provided later in the document.

4. Detailed guidelines for thebeneficiary identification process, including steps, requirements and workflow,can be accessed at: https://www.dad.hospital/

5. In addition there is the 'AMLLQualified Portal', which can be used to speed up the process of identifyingbeneficiaries / patient queries at DAD-NBY kiosks. This portal can be accessedat https://www.dad.hospital/

6. Under this symbolic process, thebeneficiary eligibility can be checked on the first II eligible portal and theprocess of identification of the beneficiary can be started through the BISmodule, once it is confirmed that the beneficiary is in patient care. . the wanted.

7. The training required on the BISprocess is a strong component of Arogya Mitra training.

service provision

1. DAD-NBY beneficiaries will beprovided free treatment for all such diseases covered under DAD-NBY within thelimit / sub-limit and sum insured.

2. National Benefit Package and rateswill be applicable for the beneficiaries treated under DAD-NBY. Benefitpackages and rates can be viewed at https://dadngo.com/

3.In case of unspecified packages such treatment and pre-authorized amount willbe reimbursed as per package cost specified in 'DAD-NBY Benefit Manual'.

4.Treatment package includes counseling, therapy, diagnosis, transplant, food,hospital fees etc. In other words, the package must cover the entire cost ofthe patient 15 days after discharge from the date of their discharge from thehospital, cashless to the patient allowing the transaction to take placecorrectly.

5.Under no circumstances additional amount should be taken during the treatmentperiod of the package as per DAD-NBY policy. Creating robustprocurement systems to provide cashless services to include DAD-NBYbeneficiaries in clinical services.

6.The existing system regarding allocation of patient beds for DAD-NBYbeneficiaries, waiting lines for alternative treatments etc. will beapplicable.

7.Further DAD-NBY beneficiaries are required to receive referrals from otherEmpaneled Healthcare Providers (EHCPs) within the DAD-NBY provider network.

8.The final package rates to be applied will have to be displayed on theirrespective websites.

9.For DAD-NBY Beneficiary Transactions (TMS) the entire process in the hospitalcan be viewed at https://dadngo.com/. This includes packages,pre-authorization, balance checks, remediation, discharge and claim requests.

10.Arogya Mitra / non-medicalcoordinators will be trained and equipped to perform these tasks.

11.Arogya Mitra will use thetransaction management system for processing the patient registration and treatmentphases. It can be accessed at: https://dadngo.com/

12.The training required on the process is a strong component of Arogya Mitra training.

Nationalportability

1.DAD has laid down procedures and conditions to increase the portability of benefitsto all DAD-NBY beneficiaries in the provider network in India. Will apply to all.

2.There are provisions for portability of the following benefits:

a)Package list and package rates will be applicable as per national package list

B)Payment to the hospital will be made by the trust / insurance company whichwill implement DAD-NBY in the home state in which the beneficiary is.

C)The time limit for claim processing and hospitalization will be for otherclaims, ie, within 30 days of receiving the claim.

D)As per the dispute resolution process, a matter of dispute, if any, in relationto treatment will be taken up. The detailed procedure for the same is providedunder point 4 of the Grievance Redressal Section.

prior authorization

1.According to the current rules, pre-authorization by the source state ismandatory. However, to speed up the process of providing treatment,pre-authorization requirements will be exempted. This optimization will be doneexclusively in software, until then, the following rules apply:

2.All procedures will be subject to pre-authorization mandated by the sourcestate. Approval for pre-authorization will be coordinated online.

3.The defined information and accompanying documentation (as indicated) will haveto be sent through the DAD-NBY portal. Supporting information, such as requestforms, pre / post-operative investigations, etc., will be used for thispurpose. The entire treatment plan will be pre-approved by a mediator / tumorboard on the best course of patient management for certain conditions such ascancer (the relevant format can be found in the DAD-NBY Benefits Manual).

4.In case of alternative treatment, pre-authorization has to be provided within atime limit of 6 hours after receipt of all relevant information and documents.All related questions on a request must be completed within this time frame andapproval must be issued no later than 6 hours.

5.If pre-authorization will not be granted within the stipulated time limit, itwill be deemed to be granted.

6.In case of emergency, one should not wait for pre-authorization to starttreatment. However, it would necessarily obtain regular pre-authorizationwithin 2 hours.

7.In areas where there is an issue of internet connectivity, approval can beobtained through the assigned hotline number.

Claimsto use by

1.The claim amount earned under DAD-NBY will be maintained at the hospital levellocally. Hospital level committees will be responsible for the use of thisclaim amount. This amount can be spent on improving the infrastructure andservices in the hospital, which will improve overall infrastructure and qualityof care.

2.As per DAD norms, maintain a dedicated bank account and books for the amountclaimed under the scheme. Bank account opening and maintenance will be as perthe general applicable rules in this case and no special approval will berequired.

3.For all DAD-NBY related matters, all withdrawals and reimbursements from theaccount will be done through accepted banking instruments (check / draft / bankorder, etc.) only. Cash should not be paid.

4.Up to 50% of the total claim amount can be deposited for payment of incentivesto hospital employees.

5. The remaining claims can be usedto improve overall infrastructure (critical gap funding), hospital functioning,quality of services and delivery of services.

6. This claim amount can be used forbut not limited to the following:

·            Payment of remuneration to a healthfriend.

·            Local purchase of consumables andmedicines which are not available in departmental supplies (only generic drugsshould be prescribed and obtained as far as possible)

·            Local procurement of servicesrelated to diagnosis and investigation not available at .

·            Recruitment of services of clinicalexperts and non-clinical man power like technicians, computer operators etc.

·            Any other diagnostic or non-clinicalservices of a patient-centered nature.

7.All local purchases should be made by registering a well negotiated rate withthe supplier as per the rules applicable in this case. As far as possible,everyone should be hired as per the rules of NHM.

8.May modify and add guidelines for the specific use of the use of the claimamount.

9.Specific committees / guidelines may be prepared for the use of funds forpayment of incentives to hospital employees. An indicative list for the team ofclinical and non-clinical experts who will be rewarded with incentives forservice delivery under DAD is as follows:

·        Surgeon / Medical Specialist /Physician, key person treating the patient

·        Includes assistant surgeons / othermedical specialists (such as pediatricians in cases of childbirth).

·        Anesthetist / other specialistinvolved in care

·        Call / at roster doctor

·        Staff Nurse and Nursing Assistant

·        Laboratory technicians or techniciansof imaging or rehabilitation departments

·        Others (such as those involved insupportive patient care).

10.May prefer to formulate a specific guideline for disbursement of incentivesbased on their local situation.

11.As a symbolic reference, a government order of the state of Kerala for use ofclaim incentives has been rescinded.

DAD-NBYSoftware and Technical Support:

1.DAD will provide an IT platform with functional modules for identification ofeligible beneficiaries, transaction and claims management and provision of allservices under S.B.

DAD-NBY

2.These portals can be accessed at the following link:

a)Hospital supplementation portal: https://www.dad.hospital/

B)Beneficiary Identification: https://www.dad.hospital/

C)Transaction and Claims Management: https://www.dad.hospital/

3.A national helpline number (01412420077) is provided for technical assistance.

4.In addition, contact details have been provided for specific technicalcoordinators on each portal for additional assistance.

5.DAD will also assist in the training required for the assigned individualwithin the . for the same.

Information,education and communication (IEC) material

1.DAD will provide standard design for IEC materials and branding.

2.It is the responsibility of . toensure printing and placement of adequate materials in the hospital premises.

3.IEC and branding designs can be accessed at: https://www.dad.hospital/

Trainingand capacity building

1.For DAD will provide standard training manuals in conducting orientation cumsensitization workshops.

2.In addition, DAD will conduct regular training for ArogyaMitra (AM), Hospital Medical Coordinator (Medco) andother concerned staff to equip them to use the software for the scheme.

3.The focus of such workshops will be to orient the AM on the whole life cycle ofbeneficiary verification and provide treatment services in the hospital,grievance redressal system and sympathy service for the beneficiaries.

4.Further Medco will be equipped to meet the requirements of clinicaldocumentation and the process of guidelines and for faster claim settlement.

5.Following are some aspects for which training will be conducted: ProgramFacilities, Beneficiary Rights, BIS, TMS, Basic Hardware Troubleshooting,Grievance Redressal System, Penalties, Financial Settlement Tracking and SoftSkills. Treatment service process, documents required for pre-authorization,change in line of treatment, submission of claim and appeal of rejection.

grievance redressal

1.The related grievances and grievance redressal management system will behandled by the concerned DAD.

2.DAD will establish a specific route for grievance redressal for which thegrievance will be empowered to redress immediately and recommend action to bepresent within the stipulated time frame.

3.A major change with the introduction of the National Call Center. Complaintsfrom various stakeholders including hospital officials and beneficiaries willbe logged in the call center and the call center will direct these complaintsto the concerned authorities. Each complaint / complaint will be closelyscrutinized by a dedicated team in the DAD to check the resolution time andintervene if unresolved. The DAD will communicate the guidelines on thechannels through which complaints / grievances can be lodged, accepted,monitored and resolved at various levels.

4.If there is any complaint regarding beneficiary, payment, SHA, SHAintermediaries, their representatives or any other officer, you can contact DADthrough the Grievance Portal.

i.Complaints can be lodged through an online portal, call center (01412420077) orby email to DAD.

ii.File a complaint through the complaint process and generate a unique complaintnumber and then share an acknowledgment via e-mail and SMS.

iii.The complaint will be investigated and reviewed by the DAD State GrievanceRedressal Committee.

iv.The inquiry committee will request the concerned stakeholder for clarificationand resolve the complaint within 30 days.

v.If neither of the two parties is satisfied with the decision, they can go tothe National Grievance Redressal Committee (NGRC) within 30 days of the receiptof the decision, which will take the decision within 30 days of receipt of theappeal. The decision of the NGRC will be final.

Applicableincentive

1.are eligible for incentives based on the following criteria:

.Hospitals will be encouraged to achieve quality milestones by mandating DADpre-entry level accreditation for all ineligible hospitals to be obtained within1 year with 2 extensions each year. Hospitals with DAD entry levelaccreditation will receive a 10% premium on package rates.

ii.DAD accredited hospitals will be given a 15% premium on package rates.

iii.Aspirational districts hospitals will be given a 10% premium on package rates.

iv.Hospitals are to be given 10% premium on package rates.

v.In relation to the above incentive requirements your position has to bespecified and the package rates will be auto-enabled accordingly.

vi.The applicable incentive package rates will be dependent on the institutionsmeeting the respective criteria with a possible incentive equal to 35%.