Ayushman Bharat (PM-JAY): Empanelment Guide

This is a straightforward, step-by-step guide for private hospitals on how to join Ayushman Bharat (PM-JAY). The first step is to get your hospital empaneled. Please read our article on Ayushman Bharat’s nuances before proceeding. Once you understand and accept the risks and benefits of joining the scheme, you can follow the steps below to participate.

(This article is based on official government resources.)

Step 1: Minimum Requirements

• Minimum Bed Capacity: You must have at least 10 functional in-patient beds.

• 24/7 Manpower: You must have qualified medical and technical staff physically present and on duty around the clock. At least one “Medical” and one “Technical” detail must be submitted in the application process.

• Support Systems: Your facility must have arrangements for 24/7 support, including a pharmacy, laboratory, and blood bank (either in-house or through a formal tie-up).

• Statutory Licenses: You must possess valid and current certificates for:

• Hospital Registration (e.g., under the Clinical Establishments Act).

• Fire Safety (No Objection Certificate from the local fire department).

• Bio-Medical Waste Management (Authorization from the State Pollution Control Board).

• Super Specialty Criteria: The required infrastructure, advanced equipment, and super-specialist manpower for specialised treatments.

• Ex. Empanelment for cardiology may require a functional Cath Lab, while oncology may require specific radiation therapy equipment.

Step 2: Gather Documents

• Institutional Documents:

• Hospital Registration Certificate.

• All statutory licenses mentioned in Step 1.

• PAN Card of the hospital or its parent entity.

• Financial Documents:

• A cancelled cheque leaf clearly showing the hospital's bank account details.

• A Bank Mandate Form (download from the application portal, fill out, sign, stamp, and then scan).

• Quality Accreditations (if applicable):

• NABH Accreditation Certificate or PM-JAY Quality Certification (Bronze, Silver, Gold). These are optional but recommended, as they can fast-track your empanelment process.

• Also, hospitals with PM-JAY quality grades (Bronze, Silver, Gold) are eligible for higher package rates (5%, 10%, 15% respectively).

Table 1: Document Checklist

Step 3: The Online Application

(Tip: Ensure your hospital is "inspection-ready" when you submit your application.)

All applications must be submitted through the central, web-based Hospital Empanelment Module 2.0 (HEM). 

#1: Register on the HEM Portal

1. Access the Portal: Navigate to the official PM-JAY website (pmjay.gov.in) and find the link for the "Hospital Empanelment Management (HEM)" in the top-left drop-down menu to reach the portal (hospitals.pmjay.gov.in). 

(Update: the portal has been shifted to HEM 2.0: hem.nha.gov.in )

2. Create Your Account: First-time users must create an administrator account. Use a reliable mobile number and email address, as your login credentials will be sent there.

3. Activate Your Account: You will get a unique Hospital Reference Number & one-time password (OTP). Use these to log in for the first time. Now set a new, permanent password and answer three security questions for future recovery.

#2: Complete & Submit the Application

1. Fill Out All Sections: Log in with your new password and fill out every section of the online form. You can save your progress at any time. It includes:

• Organisation: Name, address, ownership type, contact info, etc.

• Infrastructure: Beds, OTs, ICUs, Backup power supply, etc. 

• Equipment: Ventilators, Monitors, Diagnostic Machines, etc.

• Manpower: Personal & professional details of the staff (medical, technical, & non-medical). At least one medical and one technical is mandatory.

• Licenses: Hospital’s Registration Certificate, Pollution Control Board Certificate, NABH, etc.

2. Upload Documents: Upload the scanned documents you prepared in Step 2 into the appropriate sections.

3. Final Review and Submission: Before submitting, use the "Check Eligibility and Submit" feature. The system will flag any incomplete or incorrect sections in red. Once everything is correct, tick the final declaration and click "Submit".

Step 4: Verification and Approval

Once submitted, your application is first verified by the District Empanelment Committee (DEC) and then approved by the State Health Agency (SHA). This should take a maximum of 30 working days from the date of submission.

1. Desktop Verification: The DEC matches the filled application info with the uploaded docs info. Minor issues may mark your application as "clarification required," giving you 30 days to provide the necessary information.

2. Physical Inspection: Then, an inspection team visits the facility to confirm the presence and functionality of all the declared assets (infra, staff, equipment, etc.). They also take original, time-stamped, and geo-tagged photos as evidence.

3. Final Decision by SHA: The SHA approves or rejects your application after considering the DEC’s report & recommendations. You will be notified of the decision via SMS and email.

Step 5: Final Onboarding

Approval is the final hurdle in the application process, but a few key steps remain to become fully operational.

1. Memorandum of Understanding (MoU): Within 2-3 days after approval, the system will generate a legal contract (MoU) with details like payment terms, legal obligations,  & package rates. You must sign it and ensure the SHA countersigns it within 7 working days post-approval.

2. IT System Integration: Your hospital will be onboarded onto the PM-JAY IT platforms. Your staff must be trained to use the Beneficiary Identification System (BIS) (to verify patients) and the Transaction Management System (TMS) (to manage pre-authorizations and claims). 

3. Establish On-site Support: It is mandatory to set up a dedicated PM-JAY Kiosk or help desk at a visible location in your hospital. This kiosk must be staffed by a trained Arogyamitra, who acts as a facilitator to guide beneficiaries through the entire cashless process. 

State-Level Variations

For example:

• Karnataka

• Scheme Name: Ayushman Bharat-Arogya Karnataka (AB-ArK), managed by the Suvarna Arogya Suraksha Trust (SAST). 

• Key Feature (Mandatory Referral System): For most complex and tertiary procedures, private hospitals can only treat patients who have an online referral from a public hospital.

• Referral Condition: The referral is issued only if the required treatment is unavailable at the public facility.

• Exception: Direct admission to private hospitals is allowed for 171 specified emergency procedures without a referral.

• Maharashtra

• Scheme Name: Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY), integrated with PM-JAY. 

• Key Feature (Universal Coverage): As of July 2024, the scheme covers the entire population of Maharashtra, expanding beyond the national PM-JAY beneficiary list. 

• Specific Criteria: A minimum of 50 beds for multi-specialty hospitals (relaxed to 20 in tribal/aspirational districts) and a quality-linked grading system that directly impacts payment rates. 

• Delhi NCR

• Implementation Status: Delhi is a late adopter, with formal implementation beginning April 5, 2025. 

• Governing Body: Department of Health & Family Welfare, Govt. of NCT of Delhi. 

• Process Alignment: The empanelment process is expected to follow the national NHA guidelines strictly. 

• Fast-Track Option: Hospitals already empaneled under other central schemes like CGHS or ESIC may qualify for an accelerated process. 

• Gujarat

• Scheme Name: Converged with the Mukhyamantri Amrutam (MA) Yojana. 

• Key Requirement (Bank Guarantee): Private hospitals must submit a bank guarantee as financial security, with the amount depending on the hospital's classification (up to ₹10 lakh). 

• Strict SOPs: The state has implemented stringent new Standard Operating Procedures, including mandatory video-recorded consent for major surgeries and the establishment of multi-disciplinary tumor boards for cancer care. 

• Tamil Nadu

• Scheme Name: Integrated with the mature, pre-existing Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS). 

• Key Feature (Administrative Autonomy): The state has a highly developed and independent system for managing the scheme.

• Dedicated Portal: Tamil Nadu uses its own state-specific online portal for empanelment (claim.cmchistn.com). 

• Structured Process: The state has a well-documented, seven-stage online application process detailed in its own manual, which hospitals must follow precisely.

FAQs

Q1. What is Ayushman Bharat (PM-JAY)?
Ayushman Bharat (PM-JAY) is India’s largest public health insurance scheme. IT covers the bottom 40% households (as per the Socio-Economic & Caste Census 2011) and all citizens above 70 with a health cover of ₹5 lakh (each). Learn more here.

Q2. How long does the empanelment process take?
Typically, the process takes up to 30 working days from submission, including DEC verification, physical inspection, and SHA approval.

Q3. Can a hospital be empaneled for only some specialties?
Yes. Single-specialty hospitals may choose to empanel only for the procedures they offer, while multi-specialty hospitals are expected to apply for all specialties they can support.

Q4. Are quality certifications like NABH necessary?
They are optional but highly recommended. Quality certifications can help fast-track the process and even allow hospitals to charge higher package rates (PM-JAY Bronze, Silver, & Gold accreditation).

Q5. What documents are mandatory for empanelment?
Minimum requirements include hospital registration, statutory licenses (fire, biomedical waste), PAN, bank details, and staff credentials.

Q6. What happens after application approval?
Your hospital is issued an MoU, integrated into the PM-JAY IT platforms (BIS & TMS), and must set up on-site support for beneficiaries, usually with a trained Arogyamitra.

Q7. Are there state-specific differences in the empanelment process?
Yes. States like Karnataka, Maharashtra, Delhi NCR, Gujarat, and Tamil Nadu have additional requirements or variations, such as referral systems, bank guarantees, or separate portals.

Q8. Can a hospital lose its empanelment?
Yes. Non-compliance, fraudulent practices, or repeated claim irregularities can lead to de-empanelment or disciplinary action by the SHA.

Q9. Where can hospitals find the official application portal?
The latest portal is HEM 2.0:https://hem.nha.gov.in