There is going to be a major technical change in the country’s major health scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. Now under this scheme, claims for treatment made by hospitals will be examined and approved with the help of Artificial Intelligence (AI) instead of doctors.
The National Health Authority has approved the pilot project for this new system. This experiment will be started first in UP and MP. It is believed that this will make the claim process faster, transparent and more reliable.
Move from manual system to digital system
Till now, investigation of claims under Ayushman Bharat scheme was done completely through manual process. Hospitals used to send claims after treatment and a team of doctors and officials used to check the documents.
This process often took several days, causing delays in hospitals receiving payments. In many cases, claims got stuck due to paperwork.
With the introduction of the new AI based system, investigation of simple claims can be completed within a few hours. This system will investigate the claims based on the prescribed medical guidelines and approve the right cases expeditiously.
Automated Adjudication System will be built in UP
The responsibility of implementing this pilot project in Uttar Pradesh has been given to the State Agency for Comprehensive Health and Integrated Services. This agency will develop an automated adjudication system.
This system will digitally analyze the claims sent by the hospitals and decide whether the claim is correct or not. In the initial phase, this experiment can be started with specific treatments, such as kidney related treatments and dialysis claims.
Fake claims will be banned
The government believes that the AI based system will be able to curb fraud in health schemes to a great extent. The AI algorithm will be able to identify whether a claim is suspicious by analyzing medical records, nature of treatment and expenditure patterns. With this, fake billing and wrong claims can be detected quickly.
This will not only save government resources, but the benefits of the scheme will actually reach the needy patients.
Hospitals will get payment soon
Hospitals will get the biggest benefit of the new system. Currently, due to delay in claim approval, it takes a long time for hospitals to get payment.
With the implementation of AI based system, claims will be processed faster and hospitals will be able to get payments quickly. This is expected to improve the quality of health services.
Patients will also get better benefits
Under Ayushman Bharat scheme, poor and weaker section families get free treatment up to Rs 5 lakh every year. With the implementation of new technology, patients are also likely to get better and faster health services. Besides, transparency and efficiency in the operation of the scheme will also increase.
If successful, the model can be implemented in the entire country
Health experts believe that if this pilot project is successful, it can be implemented in other states of the country also. However, experts also say that while using AI, it will be necessary to pay special attention to data security, patient privacy and accuracy of the system.
Overall, this initiative is being considered a big step towards digital transformation in India’s health sector, which can make healthcare services more modern and effective in the future.
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