Claims under PM-JAY and state schemes: a file checklist for empanelled hospitals
Government scheme claims follow package rates and strict documentation. A short, repeatable checklist keeps them moving.
Ayushman Bharat PM-JAY and state schemes such as West Bengal's Swasthya Sathi pay empanelled hospitals by package. The rules differ from private insurance, but the reasons claims get stuck are familiar.
What is different
- Treatment is paid by package, not by itemised bill.
- Beneficiary identity is verified at admission, and photographs may be required at admission and discharge.
- Pre-authorisation is raised on the scheme portal, with specific documents for each package.
A repeatable checklist
- Beneficiary verification done and recorded at admission.
- Pre-auth raised with the correct package and the reports that justify it.
- Clinical notes, investigation reports and procedure notes for the stay.
- Discharge summary signed, with dates matching the portal.
- Photographs and any package-specific documents uploaded.
Watch the deadlines
Each scheme sets time limits for raising pre-auth and submitting the claim after discharge. Track every claim against them, every day.
One desk for every payer
Ekline Claims keeps government schemes, corporates and private insurers in one tracker, with a checklist for each, so the same desk can handle them all without separate spreadsheets.
More from the blog
Documents required for a cashless claim: the complete hospital checklist
The documents insurers and TPAs ask for most often, grouped by the desk that owns them, so nothing is missing when the file is sent.
Cashless claim process in a hospital: a step-by-step guide for the TPA desk
From the patient at the admission counter to the money in the hospital account: the eight steps of a cashless claim, and where each one goes wrong.