Green channel set up for health plan

The Green Channel Payments (GCP) launched by the National Health Authority (NHA) aims to expedite claim adjustment for empaneled hospitals treating the beneficiaries of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), a government official said. should bring.

AB PM-JAY is the world’s largest health insurance scheme.

Under GCP, partial payment of 50% of the claim amount will be automatically released to the hospitals through the system at the time of claim submission, while the balance will be released after the normal claim adjustment process. The NHA has written to the states and union territories informing them about the benefits of the GCP and directing them to implement the protocol in their jurisdiction.

NHA is implementing an insurance scheme that provides cashless and paperless annual healthcare benefits 5 lakh per family for secondary and tertiary care hospitalization to over 100 million poor and vulnerable families. According to the government, the benefits of GCP include increased participation of hospitals under PM-JAY, improvement in working capital for empaneled hospitals and cross-subsidy of treatments. The scheme is operational in all states and union territories except West Bengal, Odisha and Delhi. So far, a network of over 25,000 public and private hospitals have been empaneled with AB PM-JAY.

“The idea is to make timely and judicious adjustment of claims made by hospitals and this is the key to effective implementation of AB PM-JAY scheme. Green channel payment AB will encourage greater participation of hospitals in providing treatment to PM-JAY beneficiaries,” Dr JL Meena, Joint Director, NHA told Mint.

Currently, the empaneled hospital receives the payment after its claim is approved and paid by the State Health Agency (SHA). NHA guidelines stipulate a turn-around time limit of 7 days for the hospital to submit a claim. 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 much higher, and one of the major reasons behind the delay is the time taken by the SHA for final payment after approval by the claim processing physician.

“Green Channel Payment (GCP), aimed at faster release of 50% of the claim amount in respect of such hospitals which have good creditworthiness and impeccable record of participation under the scheme. This facility will be enabled on the IT platform of NHA. Such payments will be released after processing of claims by the Claims Executive (CEX) subject to the fulfillment of certain criteria by the hospitals,” said a National Health Authority office memorandum issued to the states, reviewed by Mint.