Ayushman Bharat PM-JAY for Hospitals: Billing Workflow and Records

PM-JAY provides health cover to eligible families, and empanelled hospitals treat them cashless against defined packages. Accurate records decide whether claims are paid.

The workflow in outline

1. Verify the beneficiary and identity at the help desk.
2. Select the correct package for the diagnosis or procedure.
3. Obtain pre-authorisation where required.
4. Treat the patient and keep clinical documents ready.
5. Discharge and submit the claim with the required evidence.
6. Track queries and payment.

Records that matter

• Beneficiary identity and verification
• Diagnosis, package and approval references
• Investigation reports and procedure notes
• Discharge summary
• Dates and times of admission and discharge

Practical tips

• Assign a trained scheme coordinator.
• Use a checklist per package.
• Keep scheme patients' bills separate from general billing.
• Review rejected claims monthly for patterns.

Package lists, procedures and processes are updated by the authorities. Follow the latest official guidance for your state and scheme portal.

Preparing the hospital team

• Train the help desk on beneficiary verification.
• Give clinicians a simple guide to package selection and required documents.
• Keep copies or digital scans of every document linked to the case.
• Review rejected or delayed claims in a monthly meeting.

A small, well-trained scheme team usually performs better than leaving the process to whoever is free.

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