SRINAGAR: The Chief Secretary of Jammu and Kashmir, Atal Dulloo, chaired the 9th Governing Council Meeting of the State Health Agency (SHA) to review the performance of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and AB-PMJAY SEHAT schemes. During the meeting, the Chief Executive Officer of SHA, Sanjiv Gadkar, provided an update on the status of claims under these flagship health insurance schemes.
According to Gadkar, a total of 3,36,859 claims have been submitted to the SHA, out of which 1,22,839 claims, amounting to Rs 222.58 crore, have been paid. The agency has rejected 3,198 claims to date, reflecting its commitment to maintaining rigorous standards of verification.
Gadkar further informed the council that claims from private hospitals have largely been cleared, with all claims made up to October 2024 fully processed and paid. High-priority claims, particularly those related to high-end and emergency procedures, have received special attention to ensure the smooth implementation of the schemes across the Union Territory.
The Chief Secretary underscored the importance of enhancing the efficiency of monitoring mechanisms to prevent fraud by empanelled hospitals. He directed the framing of fresh claim utilisation guidelines to improve the effectiveness of the schemes. Additionally, he called for the creation of a dedicated portal for public hospitals to streamline fund management and utilisation.
Dulloo also emphasised the need to check the reasonableness of insurance rates quoted by tenderers for the upcoming policy cycle and directed the establishment of a committee to review and revise insurance packages for public benefit.
The council noted the progress on directives issued during its previous meeting, with members providing further suggestions to improve the schemes. Secretary, Health and Medical Education, highlighted the strengthening of the Anti-Fraud Unit, which now includes 12 additional doctors and a neutral anti-fraud officer to address fraudulent claims comprehensively.
The Chief Secretary concluded the meeting by directing preparations for inviting fresh tenders to continue the schemes beyond March 14, 2025, ensuring the bidding process is transparent and free of ambiguities.
