· A joint working group (JWG) comprising senior officials from IRDAI and National Health Authority (NHA) has been formed to recommend measures to help improve the implementation of the Centre’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) or the health insurance scheme for the poor.
· The group consists of 11-member , with NHA Deputy CEO Dinesh Arora as the chair and lRDAl Executive Director Suresh Mathur as the co-chair.
· It would submit a report on various aspects pertaining to network hospitals’ management; data standardisation and exchange; fraud abuse and control; and common IT infrastructure for health insurance claims management.
· Under network hospitals’ management, the group had 12 months to submit its report on a national repository of empanelled hospitals under insurance/government schemes. with defined standards for quality and package rates and codes.
· The JWG would define hospital infrastructure and facility audits to understand capacity of hospitals as well as specialists availability and chalk out a roadmap for one common list of accredited verified hospitals for the entire industry, including ROHINl, NHRR, NIN and PMJAY databases.
· It would undertake a comparative study of packages and their rates and mapping to uniform codes; and define standards and indicators for safe and quality healthcare.
· In three months, the group will submit a report on data standardisation and exchange from a perspective of creating standard data formats across health insurance payers for analysis and policy making; developing standardised data tables to capture and report data, identifying data elements common with IRDAI and PMJAY; and setting up a framework for capturing and exchanging data.
· Under the fraud and abuse control component, the JWG would make recommendations in six months to help detect and deter frauds through a common repository and capacity-building.
Source : The Hindu
07.03.2019