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GOVERNMENT OF INDIA
MINISTRY OFHEALTH AND FAMILYWELFARE
DEPARTMENT OF HEALTH AND FAMILYWELFARE
LOK SABHA
STARRED QUESTION NO. 303*
TO BE ANSWERED ON THE 13TH MARCH, 2026
DELAY IN REIMBURSEMENT OF CLAIMS UNDER AB-PMJAY
*303. SHRI SANJAY DINAPATIL:
Will the MINISTER OF HEALTH AND FAMILY WELFARE be pleased to
state:
(a) whether the Government has reviewed the persistent delays in reimbursement of
claims to hospitals empanelled under Ayushman Bharat–PMJAY in Mumbai, which are
reportedly disrupting services in major public and private hospitals and leading to
denial or deferment of treatment to beneficiaries;
(b) if so, the details of pending reimbursement claims in Mumbai and across
Maharashtra, along with the number of affected hospitals and patients;
(c) the total number of reimbursement claims pending in Maharashtra during each of
the last three years;
(d) the total amount of funds pending for reimbursement to empanelled hospitals in the
State, particularly in Mumbai, the average time taken for settlement and the number of
hospitals empanelled under PMJAY in Maharashtra and particularly in Mumbai;
(e) the reasons for such delays despite digital claim processing mechanisms; and
(f) the corrective measures proposed by the Government to ensure timely
reimbursements and prevent service denial to PMJAY beneficiaries in Mumbai and the
State of Maharashtra?
ANSWER
THE MINISTER OFHEALTH AND FAMILYWELFARE
(SHRI JAGAT PRAKASH NADDA)
(a) to (f) AStatement is laid on the Table of the House.STATEMENT REFERRED TO IN REPLYTO LOK SABHA
STARRED QUESTION NO. 303* FOR 13TH MARCH, 2026
(a) to (f): Under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY),
settlement of claims is a regular and uninterrupted process and claims are settled by
respective State Health Agencies as per claim adjudication guidelines issued by National
Health Authority. As per the guideline, the permissible turnaround time for settlement of
claim to hospitals is within 15 days of claim submission for intra-state hospitals
(hospitals located within the State) and within 30 days in case of portability claims
(hospitals located outside the State).
Under the scheme, the entire claim management process is carried out on the IT platform
which follows the FIFO (First-In-First-Out) principle, subject to necessary medical and
administrative checks. Further, the claims submitted by empanelled hospitals are
scrutinized by States based on the clinical documents, investigation reports and other
supporting records, in accordance with the prescribed standard treatment guidelines.
As per the empanelment guidelines under AB-PMJAY, empanelled hospitals cannot deny
treatment to eligible beneficiaries. In cases of denial of treatment by an empanelled
hospital, beneficiaries can register their grievances through the Centralized Grievance
Redressal Management System (CGRMS) or the 24×7 toll-free helpline number 14555.
Such grievances are monitored through a three-tier grievance redressal mechanism at the
District, State and National level. At each level, designated nodal officers and Grievance
Redressal Committees are in place to examine and resolve the grievances.
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