pmjay csc login

PMJAY (Pradhan Mantri Jan Arogya Yojana) is now on csc , now you can access and provide service in pmjay through your csc Digitalseba portal.Register people & register people get free medical service in hospital & also get a insurance policy free of cost, csc can charge in digital seba portal charge slip,

Project Type	Government Project
Ayushman Bharat Website	https://pmjay.gov.in/

Official Website : https://pmjay.csccloud.in/

PMJAY QUESTION & ANSWER :- https://www.pmjay.gov.in/sites/default/files/2018-11/FAQ%20Booklet%20Final_CTC.pdf

Identification of beneficiaries (BIS)

1. Beneficiaries will be identified using the online module prepared by NHA. This can be
accessed at: https://bis.pmjay.gov.in/BIS/mobileverify
2. Identification process can be undertaken using Aadhaar and/or Ration Card and/ or any
other specified identification document produced by the beneficiary at the point of contact.
https://www.abnhpm.gov.in/sites/default/files/2018-
07/GuidelinesonProcessofBeneficiaryIdentification_0.pdf
5. There is further ‘Am I Eligible portal’, which can be used to expedite the process of
identifying beneficiaries/ to reducing patient ques/ better kiosk management at AB-PMJAY
kiosks. This portal can be accessed at https://mera.pmjay.gov.in/search/.
6. Under this indicative process, beneficiary eligibility can first be checked on the ‘Am I
Eligible’ portal and process of beneficiary identification through BIS module can be
initiated once it is confirmed that the beneficiary requires in-patient care.
7. Required training on the BIS process is a strong component of Arogya Mitra training.

Pre-Authorization ( pmjay csc login )

1. As per current rules, pre-authorization is mandatory by the source state. However, in order
to expedite the process of providing treatment, NIEs will be exempted from preauthorization requirements. This customization will be taken-up exclusively for NIEs in the
software, until then, the following rules apply:
2. All procedures shall be subject to mandatory pre-authorization by the source State.
Approval for pre-authorization will be coordinated online.
3. NIEs will need to send defined information and accompanying documentation (as indicated)
through the AB-PMJAY portal. Supporting information, such as a request form, pre/ postoperative investigations etc. would be used for this purpose. For certain conditions like
Cancer the whole treatment plan will be pre-approved by a medial/ tumor board on the best
course of patient management (relevant formats can be found in the AB-NHPM benefits
manual)
4. Pre-authorization will need to be provided within a 6-hour timeframe after receipt of all the
relevant information and documents in case of elective treatments. All related queries on a
request should be completed within this time-frame and approvals must be issued not later
than 6 hours.
5. If pre-authorization will not be provided within the decided timeframe then it will be
deemed to be given.

2. NIE shall maintain a dedicated bank account and books for the amount accrued as claim
under the scheme, as per NHM norms. The bank account opening, and maintenance shall be
as per the general applicable rules in this matter and shall not require any special approval.
3. All the withdrawals and reimbursements from the account for all AB-PMJAY related
matters shall be done by approved banking instrument (Cheque/draft/bank order, etc.) only.
Cash payments should not be done.
4. Up to 25% of the total claim amount can be earmarked for payment of incentive to the
hospital staff.
5. The remaining claims can be used for improving the overall infrastructure (critical gap
funding), functioning of the hospital, quality of services and delivery of services.
6. This claim amount can be used for the following but not limited to the following:
–
8. The NIE can modify and add to the guidelines for specific use of the utilization of the claim
amount.
9. NIEs can formulate specific committees / guidelines for utilization of amount for payment
of incentive to hospital staff. An indicative list for the team of clinical and non-clinical
specialist that shall be rewarded with incentive for service delivery under PMRSSM is as
below:
– Staff nurse and nursing assistants
– Lab technicians or technicians of imaging or rehabilitative departments
– Others (such as involved in ancillary patient care).

Billing & Payment cycle ( pmjay csc login )

1. NIE shall maintain a dedicated bank account and books for the amount accrued as claim
under the scheme, as per NHM norms. The bank account opening, and maintenance shall be
as per the general applicable rules in this matter and shall not require any special approval.
4. The timelines for processing of claim and payment to NIE would be within 30 days of
receiving the claim.
5. Case of dispute, if any, with respect to treatment sought or taken in NIE, will be taken up
through the grievance redressal process as mentioned. Detailed process for the same has
been provided under point 4 of the Grievance Redressal section.
6. Detailed guidelines (portability aspect only will be applicable) could be accessed at:
https://www.abnhpm.gov.in/sites/default/files/2018-07/GuidelinesonClaimSettlement_0.pdf

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) is the world’s biggest
government-financed medical care conspire that involves giving medical care advantages to the oppressed part of the general public. The plan was sent off on September 23, 2018, by Shri
Narendra Modi at Ranchi, Jharkhand. The point is to guarantee that every one of the residents of India get
medical care administrations by making them available, credit only and paperless. The plan has two
parts: the change of existing sub-focuses and Primary Health Centers into Health
Wellbeing Centers to take care of the essential administrations and giving protection inclusion to auxiliary
furthermore, tertiary hospitalization. According to the horizontal part, monetary help of Rs 5 lakh will be
given to almost 100 million families covering around 500 million people (~40%
populace) of the country.
The plan intends to assemble an exhaustive medical services environment in India by uniting all
the partners as far as State Governments and Private establishments to bring about Universal
Medical care. Subsequently, 32 Indian States and Union Territories have consented to embrace and
execute the Center’s AB PMJAY plot. As of July 31, 2019, a solid organization of almost 16,078
empanelled medical clinics have been made that can be gotten to by the enrolled recipients and
out of which 34,59,621 recipients have previously utilized the accessible administrations. To additional facilitate the
process, administrations to be benefited are arranged into 1393 techniques covering pre and posthospitalization, diagnostics, prescriptions and so on. Being a significant change in the Indian is thought of
medical care skyline where interestingly individuals are being treated with no restriction on family
size and age.

AYUSHMAN BHARAT-PMJAY ( pmjay csc login )

Center elements:
• A front of Rs. 5 Lakh for every family each year
• More than 10 Crore poor and weak families qualified
• States given adaptability to settle on method of execution
• Advantages will be convenient the nation over
• Privilege based conspire
Outline
Patient hospitalization>Beneficiary Identification and Registration> Pre-Authorization Request
& Endorsement > Treatment> guarantee demand and Approval > Discharge
• Cover uptoRs. 5Lac/family/year
• <10.74 crore SECC++ recipients
• Totally credit only and paperless
• 1,350+ clinical bundles at empanelled medical clinics
• Incorporated IT frameworks based Ecosystem
• Protection and confidentialiality guaranteed
Administration Coverage
Incorporations
• 1350 treatment bundles
• Family deductible container of INR 5,00,000
• Auxiliary and Tertiary consideration IP administrations including day care systems
• Previous circumstances
• New conceived care
• Pre-approval for characterized bundles
• Arrangement to cover ‘unknown careful circumstances’, on pre-approval p to a furthest reaches of INR
1,00,000
Prohibition
• Out-patient consideration
• Individual diagnostics (for assessment)
• Drug restoration program
• Corrective related
• Ripeness related
• Transfers including organs and so on.
What comprises treatment bundle?
Start to finish inclusion for whole episode of care
• Clinical assessment, treatment and meeting
• Pre-hospitalization (3 days)
• Medication and clinical consumables
• Non-serious and escalated care administrations
• Indicative and research facility examination
• Clinical embed administrations (where vital)
• Convenience benefits
• Food administrations
• Difficulty emerging during treatment
• Post-hospitalization (15 days) – at release prescriptions
Supplier installment system
• Abdominal muscle PMJAY would be credit only and paperless at any of the empanelled medical care suppliers
(EHCP)
• Guarantee the executives will be paperless at all stages-guarantee enrollment, suggestion, installment,
examination by EHCP/SHA
• Recipients will not be expected to pay any charges for the hospitalization costs
• All exchanges should be kept online in control to guarantee continuous case
the board and announcing
Pre Authorization process
1.>Upload docs (online)> ISA/Insurer (in something like 6 hours) > Approved/Rejected > if Approved>
Affirmation
2. FAX/Mail reports/docs (disconnected)
3. call SHA call focus (crisis) > ISA/Insurer > Providers pre-approval code over call
> Transfer records
TREATMENT
Determined UN-SPECIFIED
careful Medical
To arranged and preapproved by delegate/SHA
Case based packaged
installment
Each day rate for complete number of
days conceded
Extraordinary bundle requiring pre
approval
Treatment not recorded in characterized
bundles
• Clinical and careful notes to be transferred at the hour of cases accommodation TMS has a component
• All bundles are likely to pre-approval in case of movability
• Ace rundown of records to be transfer for various bundles will be accessible on the server
Guarantee settlement process
EHCP raises claims> claims supervisory group audit claims >claim approved> claims installment on week after week premise move to financial balance
Claims dismissal > share explanations behind dismissal
Further assessment > survey on fortnightly premise
(in no less than 15 days, entomb state in 30 days or less)
• SHA will endorse or dismiss a case inside 15 schedule days (Turn Around Time) from the date or quiet accommodation
• SHA might gather symptomatic reports from EHCP for grown-up reason
• EHCP can interest region complaint (DGC) to survey the case, in no less than 30 days of guarantee dismissal
AYUSHMAN MITRA
• The AyushmanMitra is the essential contact for the recipients
• Quantities of AMs will be reliant upon the typical case – load each day
• The AM will be answerable for zeroing in on three wide regions.
Working the Beneficiary recognizable proof framework to distinguish and check the recipients entitled under AB
– NHPM
Undertaking exchange Management, for example, submitting demand for Pre-Authorization and Claims
Directing the recipient about the general advantages under AB-NHPM and giving data about
getting quick treatment at EHCP
Installment Assurance
• will be no longer than 30 schedule days (independent of the quantity of working days).
• EHCP is supposed to transfer all guarantee related archives in no less than 24 hours of release of the recipient (this will be loose for
NHCP)
• The Trust/State will make guarantee installments to each NHCP against payable cases consistently through electronic exchange
to such NHCP’s assigned ledger
• Punishment on delay in settlement of cases
o Beyond the completion time of 30 days. A punishment of 1 % of guaranteed sum each week for delay past 15 days to
be paid straightforwardly to the emergency clinics by the state trust
o Trust/IC should refresh the case settlement information on the gateway consistently and this information should be
refreshed in the span of 24 hours of guarantee installment
o Any case installment which has not been refreshed will be considered to have been neglected and the interest, as
relevant, will be charged consequently.