The government has set up a fast-track channel for insurance claims under Ayushman Bharat, with the goal of reducing the delays that have been crippling the country's flagship health insurance scheme.
According to a government official, the National Health Authority's (NHA) Green Channel Payment (GCP) intends to speed up claim adjustments for empaneled hospitals treating Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) beneficiaries.
The largest health-assurance scheme in the world is AB PM-JAY.
Under GCP, a partial payment of 50% of the claim amount will be issued to hospitals automatically through the system at the moment of claim submission, with the remainder released after the standard claim adjustment procedure. The NHA has written to states and union territories to advise them of the benefits of GCP and to encourage them to implement it in their jurisdictions.
Over 100 million poor and vulnerable households would benefit from the insurance scheme, which will provide cashless and paperless annual healthcare services benefits of up to 5 lakh per family for secondary and tertiary care hospitalisation. GCP's benefits, according to the government, include enhanced hospital involvement in PM-JAY, improved working capital for empanelled hospitals, and treatment cross-subsidization. Except for West Bengal, Odisha, and Delhi, the scheme is functioning in all states and union territories. AB PM-JAY has empanelled a network of more than 25,000 public and private hospitals thus far.
"The purpose is to have fast and intelligent modifications of claims raised by hospitals, and it's the key to the AB PM-JAY scheme's effective implementation." Green Channel Payment would incentivize hospitals to provide more care to AB PM-JAY beneficiaries, according to Dr. JL Meena, NHA's joint director.
Currently, the empanelled hospital gets paid once the State Health Agency approves and pays its claim (SHA). The NHA standards for hospital claim filing stipulate a 7-day turnaround time restriction. It takes 15 days to settle and pay non-portability claims, and 30 days to settle and pay portability claims. However, the real time spent is far longer, and one of the main causes for the delay is the time it takes for SHA to make the final payment after the claim processing doctor has approved it.
"The Green Channel Payment (GCP), which aims to expedite the payment of 50% of the claim amount to hospitals with strong credentials and a proven track record of participating in the system. On the NHA's IT platform, this feature will be enabled. According to a National Health Authority office memorandum sent to states, such funds would be given when claims are processed by Claim Executive (CEX) and the hospitals meet specific conditions.
