Green Channel Payment, Fast Track Channel for Insurance Claims under Ayushman Bharat

The National Health Authority has introduced Green Channel Payment, its aim is to expedite claim adjustments for empaneled hospitals treating Ayushman Bharat Pradhan Mantri Jan Yojan (AB PM JAY) beneficiaries, govt official stated.

AB PM-JAY is World's Largest Health Assurance Scheme, as per this scheme, the GCP, a partial payment of about 50% of the claim amount would be released automatically to hospitals through the system at the time of claim submission, while the balance would be released following the usual claim adjustment process. The NHA has written to the state as well as the union territories informing them about the varied benefits of GCP and directed them to apply this protocol within their jurisdiction.

NHA is implementing the insurance scheme, which offers cashless as well as paperless annual healthcare services benefits of nearing to Rs. 5 lakh each family for secondary as well as tertiary care hospitalization to above 100 million poor as well as vulnerable families.

Presently, a network of more than 25000 public as well as private hospitals has been empanelled with AB PM JAY.

The ideal is to have timely as well as judicious adjustments of claims raised by hospitals and it is key to the effective implementation of the AB PM JAY scheme. The Green Channel Payment would encourage greater participation of hospitals in offering treatment to AP PM JAY Beneficiaries, Dr. JL Meena, Joint Director, NHA.

Presently, the empanelled hospital tends to receive payment once their claim is approved and paid by the State Health Agency. Th NHA Guidelines for submission of Claim by the hospital prescribe a turn around time limit of 7 days. For settlement and payment of non-portability claims, it is 15 days and fort 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 the final payment by the SHA after approval by the claim processing doctor.

The Green Channel Payment (GCP), it is aimed at swift release of 50% of the claim amount related to such hospital which have sound credentials and impeccable record of participation under the scheme. This facility would enable on the NHA's IT platform. Such payment would 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.