Hyderabad:
The insurnace regulator IRDAI has constituated a 11 member joint working Group under the chairmanship of Dinesh Arora, deputy CEO,National Health Authority, (NHA) to support the Implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) with the active involvement of various stakeholders and to further strengthen the health insurance ecosystem.
It is desired that IRDAI and NHA work on key areas of mutual interest and cooperation, said Sujay Banarji, member, IRDA(non life). on Tuesday.
Some of the members of the panel are. Suresh Mathur, ED, IRDAI,who will be co- chairman of the panel, Kunnel Prem, CEO, IIB, Yegnapriya Bharath, CGM, IRDAI, A.V. Rao , G M, IRDAI, D V S Ramesh, GM, IRDAI, Arun Gupta , ED,NHA, Kiran Ananndampillai, Advisor, NHA,
The terms of reference for the joint working group will be to have a National Repository of Empanelled Hospitals under Insurance/Government schemes with defined standards for quality and package rates and codes,defining hospital infrastructure and facility audits to understand capacity of hospitals, specialists availability and developing a roadmap to get one common list of accredited/ verified hospitals for the entire Industry including ROHINI, NHRR, NIN and PMJAY databases.
The other two objectives of the panel; will be, comparative study of packages and their rates and mapping to uniform codes and defining standards and Indicators for safe and quality healthcare to patients.
The panel will also within 12 months will create standard data formats across health insurance payers for analysis and policy making and developing standardized data tables to capture and report the data, identifying data elements common with IRDAI and PMJAY.
In the next six months, six months, the panel will create a common IT infrastructure for health Insurance claims management that will Increase service efficiency and transparency amongst stakeholders in delivery of Health Insurance services. It will also defiine the roadmap for electronic, paperless, codified data exchange between payer and provider, collation and analysis. It would defining a roadmap for creation of standard electronic personal health record for insured population with a common identifier.
In the next three months, the panel will set up fraud and abuse control To help detect and deter frauds through common repository and capacity building and to develop a standard reporting format for fraud and abuse to be used across the industry and Govt. Schemes. The panel will create a repository of fraudulent transactions, modus operandi and entities, develop standards for field verification and investigation and develop “name and shame” guidelines.
Earlier, government had set up NHA to oversee the PM-JAY instead of the Ministry of Health.
Union Minister for Health and Family Welfare will chair the NHA’s governing board, while other members include the NITI Aayog’s CEO and the NHA CEO.Unlike earlier, the CEO of the NHA will now possess powers over the disbursement of finances with the post upgraded to that of a secretary.
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Responsibility for the PM-JAY is being handed over the NHA directly because of the Centre’s desire to seamlessly implement the health insurance scheme and not burden the Ministry of Health with further responsibilities. The NHA CEO will possess total administrative control over the body, said the governmemnt.
AB-PMJAY, since Sep 2018 is providing secondary and tertiary care cashless treatment at empanelled private and public hospitals across the country to families listed in SECC (Socio-Economic Caste Census) 2011.
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