Timely settlement of claims is one of the key parameters against which scheme performance is measured, the minister said.
“The status of claim settlement under the scheme is constantly monitored and review meetings are organised regularly to take stock of the progress with regards to the claims,” he stated.
A three-tier grievance redressal system at the district, state, and national levels has been created to resolve the issues faced by the beneficiaries in utilising healthcare services under the scheme.
The beneficiaries can file their grievance using different mediums including the web-based portal Centralised Grievance Redressal Management System, Central and State call centres, emails, and letters to state health agencies.
Based on the nature of the grievance, necessary action for resolution is taken including coordination with the hospital and providing support to the beneficiaries in availing treatment under the scheme, Jadhav said.
To improve the participation of hospitals, the NHA has released a revised health benefit package with an increased number of procedures. Further, rates have been increased for 350 packages and new packages have been added.
Claim settlement is monitored at the highest level and it is ensured that a claim is settled within the defined turnaround time, Jadhav said.
Besides, virtual and physical capacity building of hospitals is undertaken. A hospital-specific call center—14413—has been set up to address their concern on a real-time basis, and District Implementation Units have been set up to regularly visit empanelled hospitals.
