Excelsior Correspondent
JAMMU, Feb 21: As part of its efforts to improve services rendered under the AB PM-JAY/ AB PM-JAY SEHAT scheme, Health & Medical Education department, through its 104 Call Centres, contacted 21,145 beneficiaries during the last six months out of the which 58 percent rated the services provided under AB PM-JAY/ SEHAT as excellent, 41 percent as good and only one percent as poor.
On the basis of the feedback of the beneficiaries, grievances received on CGRMS, CPGRAMS, JKIGRMS, feedback of Insurance Company and triggers received from National Anti-Fraud Unit (NAFU) of National Health Authority (NHA) and strictly as per the guidelines issued by NHA, State Health Agency (SHA) conducted audit of 100 percent claims preferred by Empanelled Private Hospitals including highly utilized packages like Cholecystectomy (Removal of Gall Bladder).
So far more than 60,000 cases have been audited during the current policy period. This is in addition to the audit of each claim being done by the Insurance Company. This ensures efficient claim scrutiny which prevents unnecessary procedures from being booked under the scheme.
On the basis of the audit, SHA imposed Rs 3.06 crores as penalty on the erring empanelled health-care providers and have taken action under guidelines against erring hospitals and treating doctors for violating standard treatment guidelines or for any other malpractice.
Pertinent to mention that Government of J&K under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and AB PM-JAY SEHAT, empowers every family of J&K with a financial protection of Rs 5 lakh annually for meeting health expenditure. Jammu & Kashmir was one of the first States/UTs to universalize AB PM-JAY.
So far, under AB PM-JAY and AB PM-JAY SEHAT more than 7 Lakh treatments have been provided to J&K domiciles including treatments received outside J&K using portability option and the treatments amount to more than Rs 1100 Crores. On an average the daily claim outgo is about Rs 2 Crores now.
Every 10 in-patients are facilitated by a Pradhan Mantri Arogya Mitra (PMAM) across all the empanelled health-care facilities of the Union Territory and there are about 425 such PMAMs working in Public Health-care facilities. Besides PMAM, Medical Coordinators have also been designated for each empanelled hospital for smooth processing of the case after admission of the beneficiary in the hospital.
There is a dedicated National & UT level helpline for the beneficiaries who are being facilitated throughout the process of treatment. General Public or prospective beneficiary patients may contact SHA in case of any grievance through 104 Call Centre, QR Code Scan (available at Ayushman kiosk at all the EHCPs), Helpline No: 18002335554, 18002034138, Whatsapp Helpline No: 9906241592.
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