BackGreen channel set up for health scheme
Green Channel Payment aims to expedite claim adjustments for hospitals treating AB PM-JAY beneficiaries
PremiumNEW DELHI : The government has created a fast-track channel for insurance claims under Ayushman Bharat, aiming to reduce delays currently plaguing its flagship health insurance scheme.
Green Channel Payment (GCP), introduced by the National Health Authority (NHA), aims to expedite claim adjustments for empaneled hospitals treating Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) beneficiaries, a government official said.
AB PM-JAY is world’s largest health assurance scheme.
Under GCP, a partial payment of 50% of the claim amount will be released automatically to hospitals through the system at the time of claim submission, while the balance will be released following the usual claim adjustment process. The NHA has written to the states and union territories informing them about the benefits of GCP and directed them to apply this protocol within their jurisdiction.
NHA is implementing the insurance scheme that offers cashless and paperless annual healthcare services benefits of up to ₹5 lakh per family for secondary and tertiary care hospitalization to over 100 million poor and vulnerable families. According to the government, GCP’s benefits include increased participation of hospitals under PM-JAY, improvement in working capital for empanelled hospitals and cross-subsidizing of treatments. The scheme is operational in all states and union territories except West Bengal, Odisha, and Delhi. So far, a network of more than 25,000 public and private hospitals have been empanelled with AB PM-JAY.
“The idea is to have timely and judicious adjustments of claims raised by hospitals and it is the key to the effective implementation of the AB PM-JAY scheme. Green Channel Payment will encourage greater participation of hospitals in providing treatment to AB PM-JAY beneficiaries," Dr. JL Meena, joint director, NHA told Mint.
Currently, the empanelled hospital receives payment once its claim is approved and paid by the State Health Agency (SHA). The NHA guidelines for submission of claim by hospital prescribe a turn-around time limit of 7 days. For settlement and payment of non-portability claims, it is 15 days and for portability claims, it is 30 days. However, the actual time taken is far higher, and one of the key reasons behind the delay is time taken for final payment by SHA after approval by the claim processing doctor.
“The Green Channel Payment (GCP), which is aimed at swift release of 50% of the claim amount related to such hospitals which have sound credentials and impeccable record of participation under the scheme. This facility will be enabled on the NHA’s IT platform. Such payments will be released after processing of claims by Claim Executive (CEX) subject to fulfilment of certain criteria by the hospitals," stated a National Health Authority’ office memorandum issued to states reviewed by Mint.
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