Patient Registration and Verification
Identify the appropriate PMJAY package/code applicable to the patient's diagnosis and treatment.
Verify package rates, inclusions and exclusions.
Ensure that services billed are covered under the approved package.
Avoid billing for non-permissible or duplicate services.
Coordinate with doctors and nursing staff regarding the treatment/package selected.
Accuracy of PMJAY billing
Timely pre-authorisation submission
Timely claim submission
keep a track on Reduction in claim rejection
keep a track on Reduction in claim deductions
Proper documentation
Timely response to queries
Claim settlement/reconciliation
Compliance with PMJAY guidelines
Able to Coordinate with Hospital Departments
Immediately report suspected billing irregularities or discrepancies to hospital management