Dr. Indu Bhushan SINT RETR Chief Executive Officer visita waren ofa Ayushman Bharat Nalional Health Protection Mission ag feel - 110 011 Tele.: 23061097 / 23063618 wate oad Government of India e-mail . | bhushan@gov.in National Health Agency ‘D.O, No. S-12012/24/2018-NHA New Delhi-110 011 Dated 22 October, 2018 Dear Colleague, ‘This is with reference to the above subject. The following changes will be implemented for PM-JAY, IT systems on 23% October, 2018: 1. Expansion of National Portability PMJAY beneficiaries can now avail treatment in any empaneled hospital across the country. Until now, it was available only at National Health Care Providers (NHCPs). All states that have signed an MOU with NHA and have shared their package master with NHA, shall be enabled to offer portability benefits to beneficiaries in the National Transaction Management System (NIMS). National portability will have the following constructs and measures: + All Empaneled Health Care Providers (BHCPs) must use NIMS to raise claims for out-of-state beneficiaries. ‘+ AIlSHAs/ ISAs/ Insurer must use NTMS to approve pre-auth and claims for beneficiaries receiving treatment out of state. * Same login credentials (username and password) being used in State TMS would work in the NTs. ‘+ Package reserved for public hospitals by home state will not show up in private hospitals outside the state. Package rates of the treating state will apply. Pre-Auth would be mandatory for all portability cases. Payment to the treating EHCP shall be processed directly by the home state SHA. Single point approval would be provided for all Pre-Auth and Claim requests for portability cases. All approval requests would be sent to a single state level approver login of the beneficiary's home state on NIMS, Note: States are requested to familiarize themselves with the process and conduct training for all hospitals to ensure PMJAY beneficiaries can receive care across the country. 2. CSC Enablement for Beneficiary Verification ‘To expedite the process of beneficiary verification, NHA has signed an MOU with CSC eGovernance Services India Ltd. (under MeitY) to enable verification of beneficiaries at Common Service Centers (CSC3) across the country. + Village Level Entrepreneurs (VLEs) registered with CSC would be empowered to search for beneficiaries, verify them using AADHAAR and submit for approval to state. + Once the beneficiary is approved by the state the VLE shall also be able to print eCard for the beneficiary.+ The service will be available at a fee of Rs. 30 inclusive of all taxes per transaction for verification, printing and lamination of eCard on A4 paper. ‘+ Approvers would be able to see the records sent from hospitals and non-hospitals (CSCs) separately, to ensure hospital requests are given priority, Note: States are requested to engage with the local CSC team to activate CSCs for beneficiary verification in their state. 3. Simplification of Pre-Auth and Claims process in TMS Based on the feedback received from states, the following simplifications have been done: + Removal of the Pre-Auth Registration Form (PREF) which was earlier mandatory ‘+ Removal of Download Discharge Summary. However, the hospital must upload the discharge summary that is currently being provided to the patient. ‘+ Allowing for Admission, Treatment/Surgery date to be back dated by 5 days, for limited time duration, Thope that these key changes will help you expedite the implementation of PMJAY. With regards, Yours sincerely, onh- a aeelis (Dr. Indu Bhushan) CEOs of all State Health Agencies