Rajasthan tightens claim process to boost healthcare schemes

The state health authorities have issued clear instructions to Chief Medical Health Officers (CMHOs), Principal Medical Officers (PMOs), and hospital administrators to actively monitor and rectify deficiencies in claims filed under the MAA Yojana.

The RGHS provides cashless treatment to a wide range of beneficiaries, including ministers, MLAs, ex-MLAs, All India Services officers, as well as current and retired employees of the state government and its autonomous institutions. Treatments are offered based on Central Government Health Scheme (CGHS) package rates, as per medical rules applicable to their respective categories.

Medical dialogues had previously reported that Rajasthan Chief Minister Bhajanlal Sharma reiterated that the state government's top priority is to ensure affordable, accessible, and quality healthcare for the people. The chief minister said that free treatment is being provided to the general public under the Chief Minister Ayushman Arogya Yojana. The government has decided to include pediatric packages under this scheme and rationalise the rates of some packages.

According to the Times of India, a state government official stated, "The scheme ensures reimbursement for each OPD consultation under RGHS, while IPD cases receive compensation for actual expenses incurred, thereby creating a revenue stream for the hospitals. The funds generated will be utilised by the hospitals for improving their infrastructure and facilities.”

Speaking about MAA Yojana to TOI, the official said, "Directions have been issued to ensure that the deficiencies in the claims filed under the MAA scheme are completed by having them monitored properly. This will also increase the revenue of health institutions. If a claim is rejected, the insurance company benefits, and your hospital's financial situation does not strengthen," he said.

The Mukhyamantri Ayushman Arogya Yojana, aligned with the broader Ayushman Bharat initiative, provides cashless treatment at both government and empanelled private hospitals. Patients can avail treatment at a wide range of facilities, including community health centres, satellite hospitals, sub-divisional hospitals, district hospitals, hospitals affiliated with medical colleges, and hospitals of the Government of India located in the state, and private hospitals associated with the scheme. The task of empaneling hospitals with the scheme will be undertaken by the Rajasthan State Health Assurance Agency.