Latest news with #CGRMS
Time of India
4 days ago
- Health
- Time of India
1,114 hospitals de-empanelled, 1,504 penalised under Ayushman Bharat Insurance scheme
New Delhi: Actions including de-empanelment of 1,114 hospitals, levying penalty worth Rs 122 crore on 1,504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities under the Ayushman Bharat Health Insurance scheme as reported by the states and Union Territories (UTs), the Lok Sabha was told on Friday. In a written reply, Minister of State for Health and Family Welfare Prataprao Jadhav said that Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed on a zero-tolerance policy towards misuse and abuse. Various steps are taken for prevention, detection and deterrence of different kinds of irregularities that could occur in the scheme at different stages of its implementation, he added. A robust anti-fraud mechanism has been put in place and the National Anti-Fraud Unit (NAFU) has been set up with the primary responsibility for prevention, detection and deterrence of misuse and abuse under AB-PMJAY. "Suitable actions including de-empanelment of 1,114 hospitals, levying penalty worth Rs 122 crore on 1,504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities as reported by the states and UTs," Jadhav said. According to the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme. In case of denial of treatment by the empanelled hospital, beneficiaries can lodge complaints, he said. Under the AB-PMJAY, a three-tier grievance redressal system at the district, state and national level has been created to resolve the issues faced by beneficiaries in utilising healthcare services . There is a dedicated nodal officer and grievance redressal committees at each level to address the grievances. Beneficiaries can file their grievances using different mediums including web-based portal, centralised grievance redressal management system (CGRMS), central and state call centres (14555), email, letter to state health agencies (SHAs) and the like. Based on the nature of the grievance, necessary action including providing support to the beneficiaries in availing treatment under the scheme is taken, Jadhav said. Settlement of claims is an ongoing process. Under the AB-PMJAY, claims are settled by respective SHAs. The NHA has laid down guidelines for the payment of claims to hospitals within 15 days of claims submission for the intra-state hospitals (hospitals located within a state) and within 30 days in case of portability claims (hospitals located outside a state), the minister informed. Claims are required to be settled within the timeline specified under the scheme. Notable improvements have been recorded in the overall average turnaround time (TAT) for claim settlements year on year. Regular review meetings are organised to take stock of the progress with regard to the claims. Further, capacity-building activities are organised for efficient claims settlement, he said.
The Hindu
5 days ago
- Health
- The Hindu
1,114 hospitals de-empanelled, 1,504 penalised under Ayushman Bharat Insurance scheme
Actions including de-empanelment of 1,114 hospitals, levying penalty worth Rs 122 crore on 1,504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities under the Ayushman Bharat Health Insurance scheme as reported by the states and Union Territories (UTs), the Lok Sabha was told on Friday. In a written reply, Minister of State for Health and Family Welfare Prataprao Jadhav said that Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed on a zero-tolerance policy towards misuse and abuse. Various steps are taken for prevention, detection and deterrence of different kinds of irregularities that could occur in the scheme at different stages of its implementation, he added. A robust anti-fraud mechanism has been put in place and the National Anti-Fraud Unit (NAFU) has been set up with the primary responsibility for prevention, detection and deterrence of misuse and abuse under AB-PMJAY. "Suitable actions including de-empanelment of 1,114 hospitals, levying penalty worth Rs 122 crore on 1,504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities as reported by the states and UTs," Jadhav said. According to the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme. In case of denial of treatment by the empanelled hospital, beneficiaries can lodge complaints, he said. Under the AB-PMJAY, a three-tier grievance redressal system at the district, state and national level has been created to resolve the issues faced by beneficiaries in utilising healthcare services. There is a dedicated nodal officer and grievance redressal committees at each level to address the grievances. Beneficiaries can file their grievances using different mediums including web-based portal, centralised grievance redressal management system (CGRMS), central and state call centres (14555), email, letter to state health agencies (SHAs) and the like. Based on the nature of the grievance, necessary action including providing support to the beneficiaries in availing treatment under the scheme is taken, Jadhav said. Settlement of claims is an ongoing process. Under the AB-PMJAY, claims are settled by respective SHAs. The NHA has laid down guidelines for the payment of claims to hospitals within 15 days of claims submission for the intra-state hospitals (hospitals located within a state) and within 30 days in case of portability claims (hospitals located outside a state), the minister informed. Claims are required to be settled within the timeline specified under the scheme. Notable improvements have been recorded in the overall average turnaround time (TAT) for claim settlements year on year. Regular review meetings are organised to take stock of the progress with regard to the claims. Further, capacity-building activities are organised for efficient claims settlement, he said.
Time of India
06-08-2025
- Health
- Time of India
Ayushman Bharat: Haryana initiates hospital payments
Chandigarh: The state health agency, Haryana, on Tuesday urged all the stakeholders to mellow down their call of withdrawal of services under the Ayushman scheme as a protest. In an official communication to stakeholders, the health agency stated that the budget was received from the state govt on August 4, and accordingly, payment to empanelled hospitals was initiated on a first-in-first-out basis. The development reflects the state govt's commitment to ensuring timely disbursement of funds and uninterrupted delivery of healthcare services under the Ayushman Bharat scheme , read the communication. The state health agency (SHA), Haryana, has already processed and paid claims submitted by the empanelled hospitals up to the first week of May 2025. A total of Rs 2,900 crore was disbursed to hospitals since the inception of the scheme. During the financial year 2025-26, up to July 16, an amount of Rs 240.63 crore was received from the state and central govts and fully utilised for the settlement of eligible claims, stated the SHA. Claims submitted by empanelled hospitals are processed by a team of 50 doctors through the NHA's online platform. The portal ensures a transparent and impartial claim allocation process by randomly assigning cases to processors. All deductions are made strictly as per the NHA guidelines and only when adequate clinical justification or documentation is lacking. Before any rejection or deduction, hospitals are given an opportunity to upload the required supporting documents such as vital charts, clinical images, OT notes, and test reports. If a hospital disagrees with a deduction, it may file an appeal through the portal. These appeals are reviewed by a designated medical audit committee, the SHA mentioned. The state health agency has also taken cognisance of the grievances raised by hospitals regarding payment delays, claim rejections, and non-processing of claims. To date, over 400 grievances from empanelled hospitals have been formally registered and resolved through the Central Grievance Redressal Management System (CGRMS) 2.0 portal, it mentioned.
