Government scheme claims, package by package.
Manage packages, pre-authorisations and claims for the government health schemes your hospital is empanelled with, with a document checklist for every package and every stage.
What Scheme Claims does for your team.
Package master
Package codes, rates and mandatory documents for each scheme you are empanelled with are kept in one master and updated when rates change.
Beneficiary records
Beneficiary ID, family details and verification outcome are stored with the case, ready for the pre-auth and the claim.
Pre-auth with package selection
Choose the package, attach the clinical notes and investigations it requires, and track the scheme pre-auth to approval.
Stage-wise checklists
Admission, pre-operative, intra-operative, post-operative and discharge documents are checked stage by stage, including photographs where required.
Claim status per scheme
Pending, query raised, approved and paid claims are shown separately for each scheme, with the age of every claim.
Separate scheme ledger
Scheme receivables are kept apart from insurer and TPA receivables, so the accounts team sees each one clearly.
Four steps at this desk.
Verify beneficiary
Beneficiary identity and eligibility are recorded at admission.
Select package
The package is chosen and the pre-auth is raised with its required documents.
Upload by stage
Documents and photographs are attached at each treatment stage.
Claim and track
The claim is raised after discharge and tracked until payment.
Schemes the counter is built around
These are built into the desk, so they are checked on every case and not only when someone remembers.
- Ayushman Bharat PM-JAY
- State schemes such as Aarogyasri, MJPJAY and CMCHIS
- CGHS for central government beneficiaries
- ECHS for ex-servicemen and dependants
- Employee and corporate health schemes
- State employee and pensioner schemes
The claim moves on.
Every folder stamped settled before you lock the door.
Show us last month's claims. We will run them through AyyanRCM with your team and show you which ones would have been flagged, and how much would have come back.