Ayushman Bharat (PM-JAY) billing & empanelment

Ayushman Bharat (PM-JAY) can bring a steady stream of patients to an empanelled hospital — but the scheme runs entirely on documentation and clean claims. Understanding how billing and empanelment work helps you decide whether to join, and how to get paid on time once you do.

What PM-JAY is

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) is India's flagship public health-insurance scheme, providing eligible families cashless cover of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation. As of early 2026 the network spans over 32,000 empanelled public and private hospitals, and coverage has expanded to include all senior citizens aged 70+.

Can your hospital empanel?

Empanelment is for hospitals offering in-patient care. Commonly cited minimum criteria for private hospitals include:

• At least 10 functional in-patient beds.
• 24/7 qualified medical and technical staff on duty.
• Support systems — pharmacy, laboratory and blood bank (in-house or formal tie-up).
• All statutory licences (Clinical Establishment registration, etc.) and hospital registration.
• Specialty-specific infrastructure (e.g. a Cath Lab for cardiology).

How empanelment works

1. Apply online through the Hospital Empanelment Module (HEM) on the PM-JAY portal (some states use their own portal).
2. Upload registration, licences, PAN, bank mandate and quality certificates.
3. District Empanelment Committee (DEC) verification and a physical inspection.
4. State Health Authority (SHA) gives final approval — typically within around 30 working days.

The cashless claim flow

1. Beneficiary is verified at your Ayushman Mitra help desk (Aadhaar / card).
2. You raise pre-authorisation for the planned procedure/package.
3. Treatment is given cashless to the patient.
4. You submit the claim with supporting documents; SHA/insurer settles via the web-based system within the stipulated timeline.

Where software helps

PM-JAY billing happens on the government portal, but your hospital's own system is where the supporting records come from. Strong, consistent patient and treatment records make pre-authorisation and claims far smoother — and reduce rejections.

MedisuperiorHow Medisuperior solves this

• Complete, consistent patient and IPD records to support pre-auth and claims.
• Lab, pharmacy and billing linked to each patient — a full treatment trail.
• Audit-clean documentation that reduces claim rejections.
• Run your day-to-day OPD, IPD, lab and pharmacy in one system alongside scheme work.

Start free →

Sources: National Health Authority PM-JAY empanelment guidelines and official portals, 2025–2026. Verify current rules with NHA / your State Health Authority.