Common list of hospitals for govt schemes

Chennai: Insurance regulator IRDAI and the National Health Agency have set up a joint working committee for implementing the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

The committee will form a National Repository of Empanelled Hospitals under insurance/government schemes with defined standards for quality and package rates and codes.

The panel will develop a road map to get one common list of accredited/verified hospitals for the entire industry, taking databases of Registry of Hospitals in Network of Insurance (ROHINI) System National Health Resource Repository (NHRR), National Insti-tute of Nutrition (NIN) and PMJAY. It will also compare health insurance packages and define quality healthcare standards as well as hospital infrastructure and facility audits.

The committee is also entrusted with standardisation of data and its exchange. It will develop a standard reporting format to detect and deter fraud and abuse across government insurance schemes.

The panel will create a repository of fraudulent transactions, the entities involved in such activities and their modus operandi. Developing standards for field verification and investigation and developing “name and shame” guidelines also will form part of the agenda of the committee.

In order to increase service efficiency and transparency amongst stakeholders in delivery of health insurance services, the committee will form a common IT infrastructure for health Insurance claims management.

“This is a great step towards standardising the protocols of a huge scheme like Ayushman Bharat. This is a demand-based insurance scheme, providing access to a large number of hospitals, including public and private ones. From an industry standpoint, this will bring in lot of insights on data, pricing, cost etc. and the industry can learn a lot from such a broad-based scheme,’ said Sanjay Datta, Chief-Underwriting, Claims and Reinsurance, ICICI Lombard.