PM-JAY Claim Process Made Simple with HMIS Software

PM-JAY (Pradhan Mantri Jan Arogya Yojana) provides health coverage of ₹5 lakh per family per year to over 50 crore Indians. For empanelled hospitals, PM-JAY is a significant revenue source — but the claim process has historically been complex and time-consuming.

The old way: manual and error-prone

Without proper HMIS software, PM-JAY claims involve manual data entry across multiple portals, frequent rejections due to incorrect codes, delays in pre-authorisation, and weeks of follow-up for settlement. Billing staff spend hours on claims that should take minutes.

How HMIS software transforms PM-JAY billing

A modern HMIS like LevelsHMS integrates directly with the PM-JAY portal. When a patient is admitted, the system automatically checks PM-JAY eligibility by verifying the beneficiary's PMJAY ID. Pre-authorisation requests are generated with correct HBP (Health Benefit Package) codes. After discharge, the claim is submitted with all required documentation attached automatically.

Key features to look for

When evaluating HMIS software for PM-JAY, look for: automatic eligibility verification at admission, HBP code mapping to procedures, one-click pre-auth submission, claim status tracking in real-time, and automatic resubmission of rejected claims with error correction guidance.

LevelsHMS PM-JAY module

LevelsHMS includes a dedicated PM-JAY module that handles the entire claim lifecycle — from eligibility check to final settlement. Our billing team reports a 70% reduction in claim processing time and near-zero rejection rates after switching to LevelsHMS.