Alleged glitch in NHA portal disrupts CMHIS & PM-JAY payment claims

May 22, 2024 11 Views No Comment

Issues resolved, empanelled hospitals told to continue providing service

Morung Express News
Dimapur | May 22

Hospitals empanelled in the Chief Minister’s Health Insurance Scheme (CMHIS) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) have been directed to provide services to beneficiaries without interruption. The directive came from the Chief Executive Officer (CEO) of the Nagaland Health Protection Society (NHPS), Thavaseelan K, through a press release issued on May 21.

The NHPS, which is headed by the Chief Minister, is the governing body or executing agency for the CMHIS as well as the PM-JAY in Nagaland.

According to the release, both the PM-JAY and CMHIS are implemented via an IT Platform provided by the National Health Authority (NHA). A technical glitch in the IT portal has reportedly been causing issues in processing payment claims to the empanelled hospitals, which it claimed, has been resolved.

The release said, “This is to inform all the empanelled hospitals and beneficiaries of PM-JAY and CMHIS that the NHA has recently migrated to a new IT portal for Claims processing and the state has also onboarded a new Insurance Company as Insurer for the new scheme. With the migration and onboarding of new Insurer, there have been some IT issues in processing claims and making claims payment to the hospitals.”

It did not specify whether the alleged “IT issue” has been an extended snag or a temporary episode, only stating that the issues have been resolved and the processing of claims resumed.

Earlier, on April 7, the NHPS CEO had issued a press release informing of “intermittent technical issues within the National Health Authority (NHA) IT Portal for CMHIS (EP).” While efforts were on to resolve the issues, it directed the empanelled hospitals to “submit offline registrations and preauthorisation requests along with all necessary documents by email to the SHA (State Health Agency) and Claim Processing team of the Insurance Company” for ensuring uninterrupted service delivery to beneficiaries till the technical issues were resolved.

Empanelled Health Care Providers (EHCP), meaning hospitals/health establishments, failing the directive were cautioned of inviting “disciplinary actions as per the provision of the Contract.” In the event of empanelled hospitals refusing cashless benefits, it provided the following contacts: 8880515011/8880515012/8880515013/8880515014 and 14555/1800111565 (toll free), nagaland.nhpm@gmail.com, Central Grievance Redressal and Management System on https://stgcgrams.pmjay.gov.in or the NHPS Office, Directorate of Health and Family Welfare, Kohima.