Haryana directs strict third-party audit, strategy to increase Ayushman claims

Chandigarh: Additional chief secretary, health and family welfare, Sumita Misra on Monday directed that audit and claims processing be handled strictly through a third-party administrator (TPA) via the Haryana Medical Services Corporation Ltd (HMSCL), while also ordering a strategy to boost claims from govt medical colleges and public health institutions under various schemes.Misra said this while charing a high-level review meeting in Chandigarh to assess the progress of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the state's CHIRAYU scheme. Misra said third-party audits would be made mandatory across the scheme's operations to ensure that no fraudulent activities are carried out in the Ayushman Bharat process. She directed that a clear strategy be drawn up to examine how claims from govt colleges and medical institutions can be significantly increased under Ayushman Bharat.In another key directive, Misra stated that chronic haemodialysis, a critical and recurring treatment for kidney patients, must be actively claimed under the Ayushman Bharat scheme, ensuring that patients requiring regular dialysis receive full coverage without financial hardship. The review noted that Haryana has settled nearly 28 lakh claims under the Ayushman Bharat and CHIRAYU schemes, with financial assistance of over Rs 3,900 crore disbursed to beneficiaries across the state. In the state for financial year 2025-26, claims have crossed Rs 1,500 crore, reflecting growing awareness and utilisation of the scheme among citizens.The state has a network of 1,364 empanelled hospitals (private: 777, public: 586), including both govt and private institutions, ensuring cashless treatment is available to beneficiaries across Haryana.Haryana has gone beyond the national Ayushman Bharat PM-JAY framework by implementing the CHIRAYU scheme and its extension, which covers families with an annual income of up to Rs 3 lakh, significantly widening the healthcare safety net beyond the national eligibility criteria and bringing a larger section of the state's population under assured health coverage. Around 1.38 crore cards of eligible beneficiaries have been generated. MSID:: 130392866 413 |
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