Skip to main content
quora image
150 Years of Celebrating The Mahatma image
PM-JAY logo image

PM-JAY FAQs

Packages have been enlisted under Medical, Radiation and Surgical oncology. In the case of Surgical packages, they are not exhaustive – since there are significant overlaps with packages under other specialty domains. Such packages may be used as deemed necessary.

Yes, however the type and duration of treatment is different for all cancers. Cancer care treatments need to undergo a whole treatment plan approval similar to a ‘tumor board concept’ on the best course of patient management. A clinical treatment approval process is mandated for cancer care, since it involves a multi-modal approach covering surgical, chemotherapy and radiation treatments and appropriate supportive care that could assess to determine the best course of patient management for such conditions. Pre-authorization is mandatory for all packages involving cancer treatment. There would be 2-step approach for Pre-auth Pre-auth for the complete course of treatment mentioning the various stages of treatment and the detailed Oncology Treatment Plan Approval form has to be filled, signed & uploaded (Annexure 1) as part of Pre-auth Pre-auth has to be sought at each pre-defined stage / selecting package

TMS application does not allow file to be uploaded if a file with same name has been uploaded earlier for a patient.

This happens if the specialties have not been provided in HEM application. Procedures would appear in TMS only for specialties which have been approved in HEM application. Specialties must be updated in HEM application.

In registered patient view, registered patients will be displayed. After that primary diagnosis will be done by the MEDCO and then either the patient will be converted as IP or OP. Case Status is available for IP cases only.

If a beneficiary is already registered in another hospital and has not been discharged, then such beneficiary cannot be registered

Please check the file type allowed. Only JPG or PDF file are allowed. The file size should not exceed 500 KB

More than 1350 procedures including Medical and Surgical are available under PMJAY in the National Package list.

A hospital can initiate claim after the procedure has been completed and patient has been either discharged or marked as dead in TMS.

Such cases will require enhancement to be preauthorized in TMS.

Hospital will call Central Helpline and using IVRS enter AB-NHPM ID or Aadhaar number of the patient. IVRS will speak out the details of all beneficiaries in the family and hospital will choose the beneficiary who has come for treatment. It will also inform the verification status of the beneficiary - If eligible and verified then beneficiary will be registered for getting treatment by sending an OTP on the mobile number of the beneficiary. In case beneficiary is eligible but not verified then she/he can be verified using Aadhaar OTP authentication and can get registered for getting cashless treatment.

Hospitals with poor connectivity must always keep a print out of the authorized package list including the package code names and rates.

NHA has issued guidelines for usage of software when there is intermittent connectivity or no connectivity. This has to be followed in such hospitals / scenarios.

As per guidelines, extension of stay is not applicable for medical cases which are paid in packages. Extension would be required only for packages which are paid on ward basis. The same can be done through Pre-authorization within the existing case.

In such cases please reach out to your SHA

Please refer to the detailed process flow.

Enhancement is allowed only for surgery cases for another surgery. Enhancement to surgery is not allowed for Medical cases.

A package includes end to end treatment for the entire episode of care required. i.e. Diagnosis, doctor and nursing charges, pre-hospitalization investigation, bed charges, consumables, medicines, food for the patient and post-surgery investigations and medicines.

Certain procedures do not require pre-authorization approval from PPD. In such case, approval is done immediately by TMS after initiation by Medco and the treatment can be started immediately. There 914 such procedures in the National Package. Certain other procedures are pre-approved for only the 1st day of admission. For any extension of treatment, approval has to be taken by Medco from PPD after every 5 days' interval. There are 164 such procedures in the National Package.

In case of an emergency, when a surgery needs to be done immediately (emergency cases) telephonic approval is taken from concerned Approvers and a Telephonic ID is generated. Later the Arogya Mitra / Medco will need to register the case into TMS as per process.

All eligible beneficiaries can avail free services for secondary and tertiary inpatient hospital care as per identified packages under PMJAY at all public/government hospitals and empanelled private hospitals. Beneficiaries will have cashless and paperless access to inpatient hospital care under PMJAY.

Please check that you have entered the word correctly as per the list of words available in primary diagnosis drop down menu. Therefore, enter valid characters only.

TMS application has not been made public for the general public

The package amount includes the cost of diagnosis / investigation as needed after the patient has been registered.

Post-hospitalization expense is part of the package amount for the treatment. No expenditure is to be done by the patient or beneficiary post-discharge. Prior to discharge, the hospital has to provide a follow-up date for such treatment

PRF was earlier a mandatory upload. However, since 23 Oct 2018, PRF has been removed

The Hospital TMS has the following types of Users:

  • Hospital User - Pradhan Mantri Arogya Mitra or Medical Coordinator (MEDCO)
  • Preauthorization Panel Doctor (PPD)
  • Claim Executive (CEX)
  • Claim Panel Doctor (CPD)
  • State Health Agency (SHA)

The TMS application is only available in English

Yes. There is no limit of family size. The neonate will be provided care provided the benefit limit is not exhausted and the neonate is added to a family with at least one PMJAY verified beneficiary

Patient mortality details may be updated in the TMS application and discharged. Payment for the services provided will be determined by the ISA/TPA after verifying the documents.

The beneficiary has to provide NHPM-ID / Ration Card / Mobile Number / Aadhaar / Other Valid Identity Proof to the Medco or AM. The details of the beneficiary if available in the BIS will be retrieved in TMS for case registration.

This provision is currently not built in TMS. The beneficiary can be re-registered correctly after discharging or cancelling registration in TMS.

Yes. If beneficiary wants an upgrade in room the all expenses for treatment will not be covered under PMJAY scheme. Admission to ICU for specified packages is allowed

No. Under PMJAY, medicines will be included in the package for the duration of treatment

No, IP and OP cases will have different registration numbers.

As of now MEDCO cannot. Currently, TMS application and HEM application have separate login IDs.

Yes, the hospital can claim if the patient has undergone treatment but does not survive. The same would be subject to verification / approval of the CPD.

The hospital is required to maintain complete confidentiality of patient information and must not be shared to unauthorized persons. For further details please refer to detailed guidelines

No. Only those specialties specified in the hospital empanelment module will be visible in the TMS.

This will be handled on a case to case basis and the required process will be escalated for resolution within the grievance framework.

Yes – Grievances against the Arogya Mitra can be escalated to the District Grievance Nodal Officer.

A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.

There is no provision of payment of transportation charges under the scheme.

Yes. There is no limit of family size. The neonate will be provided care provided the benefit is not exhausted

Normal Labour and delivery, including high risk deliveries, C-sections and associated treatments are covered under PMJAY. But JSY and another voucher scheme benefit are not given under PMJAY

No. Under PMJAY, medicines will be included in the package for the duration of treatment, including up to 15 days after discharge from hospital, as needed.

Yes. PMJAY benefits will be available from Day 1 of the roll out of the scheme for inpatient hospital care. Any inpatient hospital care for pre-existing diseases will be covered. However, OPD will not be covered.

Any surgery that is not in the package will need to be pre-authorized after which the price will be negotiated between the hospital and SHA/IC and then the procedures can be planned. This is capped to an amount of Rs 1 lakh. This option is available for surgical procedures only.

Any outpatient care, drug rehabilitation, cosmetic treatments, organ transplants and fertility treatment are not covered.

Need to codify enhancements- Days, Surgery+Surgery, Medical+Surgery

Yes. The hospital can challenge the decision in writing to the ISA/TPA. If the issues are not resolved, the same may be brought to the attention of grievance redressal committee.

Patient will not be able to receive the benefits; However, he can utilize the same for next visit.

Patient should be discharged in TMS and relevant information may be updated in the discharge summary

When Medico legal case is added as Yes, the police station number is mandatory but legal case number is optional. Both should not be mandatory

Patient mortality details may be updated in the TMS application and discharged. Payment for the services provided will be determined by the ISA/TPA after verifying the documents.

The information will need to be informed to the SHA in writing. The hospital will either be permitted to update the information through HEM portal or will be updated in backend by the SHA/ISA/TPA

No. Only those specialties specified in the hospital empanelment module will be visible in the Transaction Management Software

The new Doctor's information should be informed to ISA/IC in writing immediately after joining. If there is technical delay in updating the Doctor's information in TMS, "others" option may be selected from the doctor list in TMS. But it should only be used as a contingency option.

No, IP and OP will have different registration number.

Yes, we can use the QR code, or we can use the HHID

The state will work in trust mode until new Insurance company is on board for, the scheme.

States can explore the option of group tendering.

Need to set up a standard definition on HDU/ICU for effective settlement of claims

Government has stopped its policy for posting an all India partner

The packages rate applicable in the State where the hospital is situated will be applicable in case of portability

The home state where the benficiary originate from will pay for the treatment expenses

Treatment may be provided as per the guideline issued by NHA on usage of TMS in intermittent / poor connectivity locations

The patient may contact the toll-free helpline number 14555 for support or reach out to the Ayushman Mitra in the hospital. 

As a part of hospital empanelment process, hospitals must agree to the pre-fixed package rates, and it cannot be changed during the contract period.