Efforts Being Taken to Improve Access of the Poor to Health Services under AB-PMJAY

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is an entitlement-based scheme. No enrolment or registration of beneficiary is required to avail benefits under the scheme. The beneficiary may directly visit the empanelled hospital (public or private) to avail cashless treatment benefits. The beneficiary may use the following channels to check his/her eligibility under the scheme:

1. NHA has a 24×7 call centre 14555, which is widelypublished.
2. Beneficiary can reach out to any government hospital (CHC and above) for beneficiary verification. After verification at the government hospital, the beneficiary can be provided necessary treatment or can be directed to nearby other public or empanelled private hospital.
3. Beneficiary can check his/her eligibility and also search for the nearest empanelled hospital through PMJAY Mobile App.
4. The beneficiary can visit mera.PMJAY.gov.in to check his/her eligibility under AB-PMJAY.
5. All empanelled hospitals (public orprivate) have Pradhan Mantri Arogya Mitra who facilitate the beneficiary with all the necessary steps required to avail scheme benefits.

National Health Authority -the implementing agency of AB-PMJAY has issued a comprehensive set of anti-fraud guidelines. Regular anti-fraud advisories are issued to States/UTs. National Anti-Fraud Unit (NAFU) is created at NHA for overall monitoring and implementation of anti-fraud framework supported by State Anti-Fraud Units (SAFUs) at State level. All claims require mandatory supporting documents along-with on-bed patient photo before approval and payment. The feature of Aadhar-based biometric verification of beneficiary at the time of admission and discharge is launched at all private hospitals. Use of artificial intelligence and machine learning is made for a comprehensive fraud analytics solution to detect fraud pro-actively, develop algorithms that can be used on large volume of data to identify suspect transactions and entities and risk scoring of hospitals and claims on continuously.

The Union Minister of State for Health and Family Welfare, Dr Bharati Pravin Pawar stated this in a written reply in the Rajya Sabha today.

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