Lucknow, June 20: The Yogi Government is continuously taking significant steps to make healthcare services more accessible, transparent and effective. In this direction, a major relief measure has been implemented for beneficiaries of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Beneficiaries will no longer have to visit the Lucknow office of the State Health Agency (SACHIS) for the resolution of various issues related to their Ayushman cards. Their grievances can now be addressed at the district level itself.
SACHIS CEO Archana Verma said that Chief Minister Yogi Adityanath's effort is to ensure that the real benefits of the Ayushman Bharat Yojana reach all eligible beneficiaries. They should receive services on time without any unnecessary inconvenience. This is why special emphasis is being placed on the digitisation of healthcare services and the simplification of administrative processes across the state.
District-level powers expanded
Accordingly, all Chief Medical Officers (CMOs), Nodal Ayushman Officers and District Implementation Unit teams across Uttar Pradesh have been provided with special technical IDs. Through these IDs, district-level officials will now be able to resolve technical processes such as Ayushman card approvals, rejections and card disabling locally and swiftly.
This arrangement will save both time and money for beneficiaries while ensuring faster service delivery than before.
Faster claim settlement process
SACHIS has also launched several important initiatives to ensure quality treatment and timely payments to hospitals. The agency aims not only to provide better healthcare facilities to patients but also to encourage hospitals that work honestly by ensuring timely payments.
Continuous improvements are being made to make the claim settlement and payment process simpler, more transparent and faster. At present, pending payments in the state have been largely brought under control, with liabilities of only about Rs 500 crore remaining pending.
The average turnaround time for claim settlement and payment in Uttar Pradesh is approximately 57 days, compared to the national average of 73 days. This achievement reflects the effectiveness of the state's administrative systems and technological reforms.
Training and compliance measures
The SACHIS CEO stated that claims are often rejected because hospitals fail to submit the required documents on time or do not provide complete documentation. This creates difficulties for hospitals in receiving payments.
To address this issue, the agency is conducting online training programmes in multiple phases. These training sessions educate hospitals on the correct claim submission process, required documentation, and treatment and claim management in accordance with Standard Treatment Guidelines.
Through these programmes, hospitals will be able to submit accurate and complete claims on the first attempt. This will reduce claim rejections and make the payment process faster and more transparent, benefiting both patients and hospitals.
Strict monitoring of hospitals
At the same time, strict monitoring is being carried out to ensure that only quality and beneficiary-friendly hospitals remain empanelled under the scheme. During the current financial year, approximately 200 hospitals have been de-empanelled from the scheme due to non-compliance with quality standards and various irregularities. This action has been taken to maintain the quality of healthcare services.
Around 300 hospitals have been identified where concerns have emerged regarding upcoding or the possibility of obtaining undue payments through suspicious claims. Notices are being issued to such hospitals, and detailed field audits are being conducted.
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If irregularities are confirmed during investigations, strict action will be taken against the concerned hospitals. This will further strengthen the transparency and credibility of the scheme.
SACHIS has a clear objective that only those hospitals should remain active under the Ayushman Bharat Yojana that provide quality treatment to beneficiaries in accordance with prescribed standards.
Such hospitals will be encouraged, and the settlement of their claims and payments will be made even more systematic and time-bound.
