Ayushman Bharat
Pradhan Mantri Jan Arogya Yojana

Hospital will call Central Helpline and using IVRS enter AB-NHPM ID or Aadhaar number of the patient. IVRS will speak out the details of all beneficiaries in the family and hospital will choose the beneficiary who has come for treatment. It will also inform the verification status of the beneficiary - If eligible and verified then beneficiary will be registered for getting treatment by sending an OTP on the mobile number of the beneficiary.

As per guidelines, extension of stay is not applicable for medical cases which are paid in packages. Extension would be required only for packages which are paid on ward basis. The same can be done through Pre-authorization within the existing case.

In such cases please reach out to your SHA

Please refer to the detailed process flow.

Enhancement is allowed only for surgery cases for another surgery. Enhancement to surgery is not allowed for Medical cases.

A package includes end to end treatment for the entire episode of care required. i.e. Diagnosis, doctor and nursing charges, pre-hospitalization investigation, bed charges, consumables, medicines, food for the patient and post-surgery investigations and medicines.

Certain procedures do not require pre-authorization approval from PPD. In such case, approval is done immediately by TMS after initiation by Medco and the treatment can be started immediately. There 914 such procedures in the National Package. Certain other procedures are pre-approved for only the 1st day of admission. For any extension of treatment, approval has to be taken by Medco from PPD after every 5 days' interval. There are 164 such procedures in the National Package.

In case of an emergency, when a surgery needs to be done immediately (emergency cases) telephonic approval is taken from concerned Approvers and a Telephonic ID is generated. Later the Arogya Mitra / Medco will need to register the case into TMS as per process.

All eligible beneficiaries can avail free services for secondary and tertiary inpatient hospital care as per identified packages under PMJAY at all public/government hospitals and empanelled private hospitals. Beneficiaries will have cashless and paperless access to inpatient hospital care under PMJAY.

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