Under AB PM-JAY, claims are settled by respective State Health Agencies under the State Government. Timely settlement of claims is one of the key parameters against which scheme performance is measured. The status of claim settlement under the scheme is constantly monitored and review meetings are organized regularly to take stock of the progress with regards to the claims.

A three-tier grievance redressal system at District, State, and National level has been created to resolve the issues faced by beneficiaries in utilizing healthcare services under the scheme. Beneficiaries can file their grievance using different mediums including web-based portal Centralized Grievance Redressal Management System (CGRMS), Central & State call centers, email, letter to State Health Agencies etc. Based on the nature of grievance, necessary action for resolution is taken including coordination with the hospital and providing of support to the beneficiaries in availing treatment under the scheme.

In order to improve the participation of hospitals, following actions have been taken:

1. NHA has released a revised health benefit package with increased number of procedures (1961). Further, rates have been increased for 350 packages and new packages have been added.
2. Claim settlement is monitored at the highest level and it is ensured that claim is settled within defined turnaround time.
3. Virtual and physical capacity building of hospitals are undertaken.
4. A hospital-specific call center (14413) has been set-up to address their concern on a real-time basis.
5. District Implementation Units (DIUs) have been set-up to regularly visit empaneled hospitals to understand the issues faced by beneficiaries and hospitals.

 

The Union Minister of State for Health and Family Welfare, Shri Prataprao Jadhav stated this in a written reply in the Rajya Sabha today.

 

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HFW/ Measures taken for improving Claim Settlements under PM-JAY/03 December 2024/2

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