- 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