Hospitals empanelled under Ayushman scheme get 'green payment channel'

Lucknow: All the 1,242 private hospitals in Uttar Pradesh empanelled for giving treatment to patients under Ayushman Bharat scheme, have been allowed 'green payment channel'.

The hospitals will thus get 50 per cent of their claim amount as soon as they submit the bill, but it will remain under watch for any default and they will face action for the same.

“With green channel there also comes artificial intelligence to watch erroneous billing. There are several parameters that have been brought in to check every bill via artificial intelligence and mark them red in case of any discrepancy,” said Sangeeta Singh, CEO SACHIS, the agency that monitors implementation of Ayushman Bharat scheme in state.

Explaining the benefits of green payment channel, Dr Abhishek Shukla, secretary general, Association of International Doctors said: “Hospitals have to first invest for implant, medicine and consumables on their own. If 50 per cent payment comes from Ayushman Bharat scheme quickly, the same amount can be rotated for treatment of more patients.”

However, the AI will watch many points. For instance, if two bills have name of same patient within a span of a few days, or if one hospital is putting up different amount in bill for similar treatment it will be notified AI.

Once detected via AI, the case will be taken up by the national anti-fraud unit of the national health authority and after screening it will be referred to respective state to deal.

At state level the State Anti-Fraud Unit (SAFU) will screen bills and treatment.

“In many cases, the bills appearing fake are genuine. This is because one person may fall sick again within a week of getting discharged from the hospital or may be due to some other reason. Such cases will be screened by our expert panel involving doctors and if found not fake, the bill will be approved,” said Singh.