Ayushman Bharat: NHA, IRDAI launch ‘four’ reports to further strengthen AB-PMJAY

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Published: September 14, 2019 8:39:18 PM

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and privately paid health insurance cover around 60 per cent of the Indian population today. This makes it a great opportunity for IRDAI and NHA to jointly work on key areas for the strengthening of health insurance eco-system in the country, making it more efficient and effective.

nha irdai ayushman bharat reportsAyushman Bharat CEO Dr Indu Bhushan and IRDAI chairman Subhash Khuntia at the launch of JWG reports.

Ayushman Bharat latest news: National Health Authority (NHA) and Insurance Regulatory and Development Authority of India (IRDAI) on Saturday launched ‘four’ reports focussing on – Hospital Network Management, Common IT Infrastructure for Health Insurance Claims Management, Fraud and Abuse Control and on Data Standards and Exchange. The report was launched by Subhash Khuntia, Chairman IRDAI and Dr Indu Bhushan, CEO, National Health Authority. IRDAI and NHA had formed a Joint Working Group to work on key areas of mutual interest and co-operation. The reports are a result of four sub-groups formed to work in-depth with diligence and focus on each area.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and privately paid health insurance cover around 60 per cent of the Indian population today. This makes it a great opportunity for IRDAI and NHA to jointly work on key areas for the strengthening of health insurance eco-system in the country, making it more efficient and effective.

Talking about the work done by the JWG, Ayushman Bharat CEO said, “The recommendations in the report are a step forward in enabling quality healthcare and access to the patients. These reports would help further strengthen the transparency, efficiency and effectiveness of AB-PM-JAY, benefitting millions in India directly.”

IRDAI chairman Khuntia said, “The completion of these report in record time is a huge achievement, and I thank the members of the Joint Working Group who have toiled to put them together. We are confident that implementation of these recommendations shall create a positive impact and lead to further growth of health insurance in the country.”

The National Health Authority (NHA) is responsible for providing the overall stewardship for design, roll- out, implementation and management of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB – PMJAY) at the national level.

Ayushman Bharat: Key recommendations of JWG

The recommendations in the report include best practices, common standards, collaborative measures and IT framework, will benefit all stakeholders – beneficiaries, policyholders, insurers, state health agencies, healthcare providers, implementing agencies and intermediaries etc. The Reports of Joint Working Group will be available on IRDAI and NHA website for comments by industry and public at large.

These JWG focussed their work on four key areas:

1. Hospital Network Management: To build a National Repository of Empanelled Hospitals under insurance/Government schemes with defined standards for quality and package rates and codes by:

a) Defining hospital infrastructure and facility audits to understand the capacity of hospitals and the availability of specialists

b) Developing a roadmap to get one common list of accredited verified hospitals for the entire industry including ROHINl, NHRR, NIN and PMJAY databases

c) Comparative study of packages, their rates and mapping to uniform codes

d) Defining Standards and indicators for safe and quality Healthcare to Patients

2. Data Standardization and exchange: To create standard data formats across Health insurance payers for analysis and policy-making by:

a) Developing standardised data tables to capture and report the data, identifying data elements common with IRDAI and PMJAY

b) Setting up a framework for capturing and exchanging data

3. Fraud and abuse control: To help detect and deter frauds through common repository and capacity building by:

a) Developing a standard reporting format for fraud and abuse to be used across the industry and Govt. Schemes

b) Making a repository of fraudulent transactions, modus operandi and entities

c) Develop standards for field verification and investigation

d) Develop the “name and shame” guidelines

4. Common IT infrastructure for health insurance claims management: To increase service efficiency and transparency amongst stakeholders in the delivery of Health insurance services by

a) Defining the roadmap for electronic, paperless, codified data exchange between payer and provider, collation and analysis

b) Defining a roadmap for the creation of standard electronic personal health record for the insured population with a common identifier

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