{"id":25663689,"date":"2026-10-22T21:45:00","date_gmt":"2026-10-22T16:15:00","guid":{"rendered":"https:\/\/entri.app\/blog\/?p=25663689"},"modified":"2026-10-22T21:45:00","modified_gmt":"2026-10-22T16:15:00","slug":"pm-jay-kasp-kerala-hospital-administration","status":"publish","type":"post","link":"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/","title":{"rendered":"Ayushman Bharat PM-JAY and KASP in Kerala: What Hospital Administrators Handle"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_85 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-6ada5533e56d8\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-6ada5533e56d8\"  aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#KEY_TAKEAWAYS\" >KEY TAKEAWAYS<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#What_Is_Ayushman_Bharat_PM-JAY\" >What Is Ayushman Bharat PM-JAY?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#What_Is_KASP_in_Kerala\" >What Is KASP in Kerala?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Key_Differences_Between_PM-JAY_and_KASP\" >Key Differences Between PM-JAY and KASP<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Who_Is_Eligible_for_PM-JAY_and_KASP_Benefits\" >Who Is Eligible for PM-JAY and KASP Benefits?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#How_Hospitals_Enrol_in_PM-JAY_and_KASP\" >How Hospitals Enrol in PM-JAY and KASP<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Role_of_Hospital_Administrators_in_PM-JAY_and_KASP\" >Role of Hospital Administrators in PM-JAY and KASP<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Patient_Registration_and_Beneficiary_Verification\" >Patient Registration and Beneficiary Verification<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Pre-Authorisation_and_Health_Insurance_Claims_Processing\" >Pre-Authorisation and Health Insurance Claims Processing<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Required_Documents_and_Hospital_Records_Management\" >Required Documents and Hospital Records Management<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Common_Challenges_in_PM-JAY_and_KASP_Claim_Processing\" >Common Challenges in PM-JAY and KASP Claim Processing<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#Best_Practices_for_Managing_PM-JAY_and_KASP_in_Hospitals\" >Best Practices for Managing PM-JAY and KASP in Hospitals<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/#CONCLUSION\" >CONCLUSION<\/a><\/li><\/ul><\/nav><\/div>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">In Kerala, Ayushman Bharat PM-JAY and KASP are not separate schemes competing for attention. They are converged into a single unified health assurance system managed by the State Health Agency (SHA). For hospital administrators, this convergence means one claim process, one beneficiary database, and one set of compliance rules. The core administrative burden falls on the hospital superintendent and the designated nodal officer, who are responsible for uploading claims, resolving rejections, and ensuring the hospital receives payment for every eligible procedure performed<\/span><span class=\"\">.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"KEY_TAKEAWAYS\"><\/span><strong><span class=\"\">KEY TAKEAWAYS<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">PM-JAY and KASP are converged in Kerala.<\/span><\/strong><span class=\"\"> All state schemes\u2014RSBY, CHIS, SCHIS, and KBF\u2014were merged with PM-JAY to form KASP, creating a single unified scheme<\/span><span class=\"\">.<\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Hospital superintendents are accountable for claims.<\/span><\/strong><span class=\"\"> The Kerala government order explicitly states that superintendents must upload claims for all procedures and ensure payment is received<\/span><span class=\"\">.<\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Rejected claims must be pursued.<\/span><\/strong><span class=\"\"> Superintendents must identify rejection reasons, rectify defects, and escalate unjust rejections to the District Grievance Redressal Committee<\/span><span class=\"\">.<\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Ayushman Mitra is the frontline role.<\/span><\/strong><span class=\"\"> Empanelled hospitals must hire an Ayushman Mitra to manage the help desk, register beneficiaries, and handle pre-authorisation and discharge entries<\/span><span class=\"\">.<\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Funds are audited and restricted.<\/span><\/strong><span class=\"\"> Claim revenues go into a separate bank account and cannot be used for original construction or branded drugs for individual patients<\/span><span class=\"\">.<\/span><\/p>\n<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"What_Is_Ayushman_Bharat_PM-JAY\"><\/span><strong><span class=\"\">What Is Ayushman Bharat PM-JAY?<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ayushman Bharat PM-JAY was launched by the Indian government back in 2018 as their flagship health assurance program. The idea behind this was to make sure every family gets health cover of up to \u20b95 lakh a year for things like secondary and tertiary care hospital stays &#8211; all of this would be on a cashless basis and on a family floater policy no less, which means there&#8217;s no cap on how many people are covered under that 5 lakh. The scheme is focused on the lowest 40% of the population &#8211; and that&#8217;s determined by the Socio-Economic Caste Census of 2011.<\/p>\n<p>The good news is that PM-JAY is a completely government funded scheme, with the Centre and States sharing the costs. Here in Kerala, theyve implemented it through the State Health Agency (SHA) using a trust model &#8211; which is a pretty standard setup.<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/entri.app\/explore\/free-hospital-administration-courses\/?utm_source=seo&amp;utm_medium=blog&amp;utm_campaign=day_in_life_of_hosp_pro\" target=\"_blank\" rel=\"noopener\"><strong>Explore free Hospital Administration courses now!!<\/strong><\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Is_KASP_in_Kerala\"><\/span><strong>What Is KASP in Kerala?<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  wp-image-25663694 aligncenter\" src=\"https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-300x200.webp\" alt=\"What Is KASP in Kerala?\" width=\"713\" height=\"475\" srcset=\"https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-300x200.webp 300w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-1024x683.webp 1024w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-768x512.webp 768w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-1536x1024.webp 1536w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-2048x1365.webp 2048w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-150x100.webp 150w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-750x500.webp 750w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/indian-healthcare-professional-sharing-medical-expertise-with-patient-office-1-1140x760.webp 1140w\" sizes=\"auto, (max-width: 713px) 100vw, 713px\" \/><\/p>\n<p>You might have heard of Karunya Arogya Suraksha Padhathi &#8211; but KASP for short &#8211; which is actually the state of Kerala&#8217;s converged health scheme. Now, you see, they took all the different state health schemes and basically merged them with PM-JAY to create this one all-in-one scheme. That includes things like the Rashtriya Swasthya Bima Yojana (RSBY), Comprehensive Health Insurance Scheme (CHIS), Senior Comprehensive Health Insurance Scheme (SCHIS) and Karunya Benevolent Fund (KBF) .<\/p>\n<p>Now when you put it all together, KASP gives you the same \u20b95 lakh as PM-JAY but it also covers some other groups too. You see, Kerala is a bit of a trailblazer because they&#8217;re the first state to cover everyone with a 40% or more disability, and transgender people, no matter if they&#8217;re above the poverty line or below. Nice one, Kerala<\/p>\n<p>KASP also has a bonus to it in that it has the Karunya Benevolent Fund (KBF) for people making less than \u20b93 lakh a year, who aren&#8217;t eligible under KASP. The KBF kicks in when people have serious illnesses like cancer , haemophilia, kidney disease or heart disease and the government steps in to give them some much-needed financial aid.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Key_Differences_Between_PM-JAY_and_KASP\"><\/span><strong><span class=\"\">Key Differences Between PM-JAY and KASP<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<div class=\"ds-scroll-area ds-scroll-area--show-on-focus-within ds-scroll-area--enabled _1210dd7 c03cafe9\">\n<table>\n<thead>\n<tr>\n<th><span class=\"\">Feature<\/span><\/th>\n<th><span class=\"\">PM-JAY<\/span><\/th>\n<th><span class=\"\">KASP<\/span><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><strong><span class=\"\">Origin<\/span><\/strong><\/td>\n<td><span class=\"\">Government of India<\/span><\/td>\n<td><span class=\"\">Government of Kerala (converged with PM-JAY)<\/span><\/td>\n<\/tr>\n<tr>\n<td><strong><span class=\"\">Coverage<\/span><\/strong><\/td>\n<td><span class=\"\">\u20b95 lakh per family per year<\/span><\/td>\n<td><span class=\"\">\u20b95 lakh per family per year<\/span><\/td>\n<\/tr>\n<tr>\n<td><strong><span class=\"\">Eligibility<\/span><\/strong><\/td>\n<td><span class=\"\">SECC 2011 deprivation criteria<\/span><\/td>\n<td><span class=\"\">RSBY\/CHIS cardholders, SECC families, persons with disabilities, transgender persons<\/span><\/td>\n<\/tr>\n<tr>\n<td><strong><span class=\"\">Implementation<\/span><\/strong><\/td>\n<td><span class=\"\">National Health Authority (NHA)<\/span><\/td>\n<td><span class=\"\">State Health Agency (SHA) Kerala<\/span><\/td>\n<\/tr>\n<tr>\n<td><strong><span class=\"\">Funding<\/span><\/strong><\/td>\n<td><span class=\"\">Shared Centre-State<\/span><\/td>\n<td><span class=\"\">State trust mode<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<h2><span class=\"ez-toc-section\" id=\"Who_Is_Eligible_for_PM-JAY_and_KASP_Benefits\"><\/span><strong><span class=\"\">Who Is Eligible for PM-JAY and KASP Benefits?<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Eligibility for KASP is broader than PM-JAY alone. The following groups are covered:<\/span><\/p>\n<ul>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Families with a valid RSBY\/CHIS card for 2018-2019 <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Weaker sections identified by the Central Government as per SECC 2011 <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Families that received a direct letter from the Central Government <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Persons with 40% or more disability and transgender persons (universal coverage) <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">KBF: Families with annual income below \u20b93 lakh not eligible under KASP <\/span><\/p>\n<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"How_Hospitals_Enrol_in_PM-JAY_and_KASP\"><\/span><strong><span class=\"\">How Hospitals Enrol in PM-JAY and KASP<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Hospital empanelment is managed through the National Health Authority&#8217;s Hospital Engagement Module (HEM). The process requires:<\/span><\/p>\n<ul>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Registration in the Health Facility Registry under Ayushman Bharat Digital Mission <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Creation of credentials through the User Management Portal (UMP) <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Submission of application through the HEM portal <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Desktop verification followed by physical inspection by the District Empanelment Committee (DEC) <\/span><\/p>\n<\/li>\n<\/ul>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Public hospitals with inpatient services are deemed empanelled. Private hospitals must undergo physical verification, including submission of original photographs and latitude-longitude details<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Hospitals holding NABH accreditation or PM-JAY certification for relevant specialties may be fast-tracked without physical verification<\/span><span class=\"\">. NABH-accredited hospitals also receive incentives: 10% over package rates for Entry Level NABH and 15% for Full NABH accreditation<\/span><span class=\"\">.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Role_of_Hospital_Administrators_in_PM-JAY_and_KASP\"><\/span><strong><span class=\"\">Role of Hospital Administrators in PM-JAY and KASP<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The Kerala government order on KASP guidelines is explicit about administrative responsibilities. The superintendent of each government hospital is accountable for the entire claim management system<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Claim upload and monitoring.<\/span><\/strong><span class=\"\"> Superintendents must upload claims for all procedures performed for insured persons and ensure payment is received. They must also designate a nodal officer to closely monitor the claim management system in each hospital<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Rejection management.<\/span><\/strong><span class=\"\"> When claims are rejected, superintendents must find the reason, rectify defects, and pursue the claim through the District Grievance Redressal Committee if the rejection is unjust. The order states that &#8220;not pursuing all channels to obtain a valid claim will not be accepted&#8221; <\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Financial accounting.<\/span><\/strong><span class=\"\"> Receipts from insurance reimbursements must be deposited in a separate bank account operated by the Superintendent\/RMO and the Lay Secretary or another administrative officer. These funds are not to be deposited in HMC\/HDC\/HDS accounts<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Fund utilisation.<\/span><\/strong><span class=\"\"> KASP funds can be used for purchasing generic drugs from the essential drug list when KMSCL supplies are short, purchasing new equipment, extending AMC, carrying out maintenance, and hiring technical personnel. Original construction is explicitly prohibited. All purchases must follow proper procedures and are subject to audit<\/span><span class=\"\">.<\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/entri.app\/explore\/free-hospital-administration-courses\/?utm_source=seo&amp;utm_medium=blog&amp;utm_campaign=day_in_life_of_hosp_pro\" target=\"_blank\" rel=\"noopener\"><strong>Explore free Hospital Administration courses now!!<\/strong><\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Patient_Registration_and_Beneficiary_Verification\"><\/span><strong><span class=\"\">Patient Registration and Beneficiary Verification<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The Ayushman Mitra (AM) is the frontline role for beneficiary management. Empanelled hospitals must hire an Ayushman Mitra to manage the help desk exclusively for KASP<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The Ayushman Mitra&#8217;s responsibilities include:<\/span><\/p>\n<ul>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Receiving beneficiaries and guiding them through the scheme process <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Registering unregistered members of already-enrolled families through the Beneficiary Identification System (BIS) <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Checking the beneficiary family&#8217;s balance cover amount <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Taking pre-authorisation as required <\/span><\/p>\n<\/li>\n<li>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Entering package details and discharge summary in the KASP software <\/span><\/p>\n<\/li>\n<\/ul>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The SHA has instructed hospitals to assign a dedicated counter for BIS registration, especially in Medical Colleges and District Hospitals, to avoid delays for beneficiaries<\/span><span class=\"\">.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Pre-Authorisation_and_Health_Insurance_Claims_Processing\"><\/span><strong><span class=\"\">Pre-Authorisation and Health Insurance Claims Processing<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The claim process follows a defined workflow. For planned procedures, pre-authorisation is required before admission. The Ayushman Mitra enters the package details and patient information into the system based on the doctor&#8217;s advice<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">At discharge, the Ayushman Mitra enters all relevant details and the discharge summary into the KASP software<\/span><span class=\"\">. The claim is then processed by the Third Party Administrator\/Implementation Support Agency (TPA\/ISA) appointed by the SHA<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The TPA\/ISA is responsible for servicing legitimate claims within allocated timeframes and coordinating grievance redressal<\/span><span class=\"\">. Monitoring of the TPA\/ISA includes claims management processes and grievance redressal performance<\/span><span class=\"\">.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Required_Documents_and_Hospital_Records_Management\"><\/span><strong><span class=\"\">Required Documents and Hospital Records Management<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Claims require complete documentation. The discharge summary must capture presenting features, investigations, line of treatment given during stay, and line of treatment advised at discharge. If these details are missing, the claim may be rejected<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Other required documents include investigation reports signed by the doctor or pathologist with registration number, post-operative photos showing the scar in surgical cases, OT notes detailing surgical steps, pre- and post-operative X-rays where applicable, and verification of length of stay against the discharge summary<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">Hospitals must maintain records of claim approvals, partial approvals, rejections, and amounts received. The Kerala order requires close monitoring of total eligible claims, eligible amount, number of claims approved fully and partially, and reasons for rejection<\/span><span class=\"\">.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Common_Challenges_in_PM-JAY_and_KASP_Claim_Processing\"><\/span><strong><span class=\"\">Common Challenges in PM-JAY and KASP Claim Processing<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Rejections for incomplete documentation.<\/span><\/strong><span class=\"\"> Claims are rejected when mandatory documents are missing or discharge summaries lack required details<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Delayed payments.<\/span><\/strong><span class=\"\"> The TPA\/ISA is bound by service level agreements, but delays can occur. Hospitals must track pending claims and follow up through grievance channels.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Beneficiary registration gaps.<\/span><\/strong><span class=\"\"> If a family member is not registered in BIS, the Ayushman Mitra must register them before treatment can proceed<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Fraud investigations.<\/span><\/strong><span class=\"\"> The SHA conducts field audits and verification to detect fraudulent claims. Hospitals found engaging in malpractices face show-cause notices and potential de-empanelment<\/span><span class=\"\">.<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Best_Practices_for_Managing_PM-JAY_and_KASP_in_Hospitals\"><\/span><strong><span class=\"\">Best Practices for Managing PM-JAY and KASP in Hospitals<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  wp-image-25663695 aligncenter\" src=\"https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-300x220.webp\" alt=\"Best Practices for Managing PM-JAY and KASP in Hospitals\" width=\"715\" height=\"524\" srcset=\"https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-300x220.webp 300w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-1024x752.webp 1024w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-768x564.webp 768w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-1536x1128.webp 1536w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-2048x1503.webp 2048w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-150x110.webp 150w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-750x551.webp 750w, https:\/\/entri.app\/blog\/wp-content\/uploads\/2026\/10\/young-female-doctor-wearing-medical-robe-with-stethoscope-sits-table-with-medical-tools-writing-some-1-1140x837.webp 1140w\" sizes=\"auto, (max-width: 715px) 100vw, 715px\" \/><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Designate a dedicated nodal officer.<\/span><\/strong><span class=\"\"> The superintendent should appoint a nodal officer exclusively for claim management, as required by the Kerala order<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Train Ayushman Mitra staff thoroughly.<\/span><\/strong><span class=\"\"> The counter staff must be proficient in BIS registration, pre-authorisation, and discharge entry to avoid delays<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Maintain a rejection log.<\/span><\/strong><span class=\"\"> Track every rejection with its reason and the corrective action taken. Review patterns monthly to identify systemic issues.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Audit documentation before submission.<\/span><\/strong><span class=\"\"> Verify that discharge summaries, investigation reports, and OT notes contain all required details before uploading claims.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Use KASP funds correctly.<\/span><\/strong><span class=\"\"> Purchase only generic drugs from the essential list, follow approval procedures for non-essential drugs, and maintain separate accounting<\/span><span class=\"\">.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><strong><span class=\"\">Pursue rejected claims.<\/span><\/strong><span class=\"\"> Escalate unjust rejections to the District Grievance Redressal Committee and follow up to the State level if necessary<\/span><span class=\"\">.<\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/entri.app\/explore\/free-hospital-administration-courses\/?utm_source=seo&amp;utm_medium=blog&amp;utm_campaign=day_in_life_of_hosp_pro\" target=\"_blank\" rel=\"noopener\"><strong>Explore free Hospital Administration courses now!!<\/strong><\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"CONCLUSION\"><\/span><strong><span class=\"\">CONCLUSION<\/span><\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">For hospital administrators in Kerala, PM-JAY and KASP are not abstract government schemes. They are operational realities that require daily attention. The superintendent is accountable for claim uploads, rejection management, fund utilisation, and audit compliance. The Ayushman Mitra is the frontline role that determines whether beneficiaries receive timely care.<\/span><\/p>\n<p class=\"ds-markdown-paragraph\"><span class=\"\">The convergence of schemes into KASP simplifies the beneficiary experience but concentrates the administrative burden on hospital leadership. Success requires dedicated staff, disciplined documentation, persistent follow-up on rejections, and strict adherence to fund utilisation rules. Hospitals that master these processes receive timely payments and serve their communities effectively. Those that do not face rejected claims, audit findings, and frustrated patients.<\/span><\/p>\n<table class=\"table\">\n<tbody>\n<tr>\n<td colspan=\"3\"><b>Related Articles<\/b><\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/entri.app\/blog\/hospital-administration-terms\/\" target=\"_blank\" rel=\"noopener\"><b>Hospital Administration Terms Every Healthcare Pro Should Know<\/b><\/a><\/td>\n<td><a href=\"https:\/\/entri.app\/blog\/essential-skills-hospital-pr-officer\/\" target=\"_blank\" rel=\"noopener\"><b>Essential Skills Every Hospital Public Relations Officer Must Have<\/b><\/a><\/td>\n<td><a href=\"https:\/\/entri.app\/blog\/hospital-pro-interview-questions-and-answers\/\" target=\"_blank\" rel=\"noopener\"><b>Hospital Public Relations Officer Interview Questions<\/b><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"https:\/\/entri.app\/blog\/difference-between-a-hospital-pro-and-medical-administrator\/\" target=\"_blank\" rel=\"noopener\"><b>Difference between Hospital PRO and Medical Administrator<\/b><\/a><\/td>\n<td><a href=\"https:\/\/entri.app\/blog\/hospital-pro-salary-in-kerala\/\" target=\"_blank\" rel=\"noopener\"><b>Hospital PRO Salary in Kerala<\/b><\/a><\/td>\n<td><a href=\"https:\/\/entri.app\/blog\/hospital-administration-vs-pro\/\" target=\"_blank\" rel=\"noopener\"><b>Hospital Administration vs PRO in Hospital<\/b><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"<p>In Kerala, Ayushman Bharat PM-JAY and KASP are not separate schemes competing for attention. They are converged into a single unified health assurance system managed by the State Health Agency (SHA). For hospital administrators, this convergence means one claim process, one beneficiary database, and one set of compliance rules. The core administrative burden falls on [&hellip;]<\/p>\n","protected":false},"author":127,"featured_media":25663690,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[802,1958],"tags":[],"class_list":["post-25663689","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","category-hospital-and-healthcare-administration"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ayushman Bharat PM-JAY and KASP in Kerala: What Hospital Administrators Handle - Entri Blog<\/title>\n<meta name=\"description\" content=\"Ayushman Bharat PM-JAY and KASP in Kerala: roles and responsibilities of hospital administrators in claims and compliance.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/entri.app\/blog\/pm-jay-kasp-kerala-hospital-administration\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ayushman Bharat PM-JAY and KASP in Kerala: What Hospital Administrators Handle - 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