How to Use Ayushman Card in Hospital? - Important Steps

After deriving the card, it is important to know everything about the available medical packages to list down the diseases that are covered under this scheme. The scheme offers medical and surgical treatments in 25 specific fields of specialities that incorporate branches like cardiology, neurosurgery, oncology, paediatrics, etc.It is imperative to note that the cost of medical and surgical expenses cannot be claimed one after the other.

In a situation where multiple surgeries are necessary, the highest cost is paid off first, followed by a 50% waiver for the second and a 25% waiver for the third event.The most compelling part about the Ayushman Bharat Scheme is the fact that there is no waiting period involved in the process. If one has an Ayushman card, he/she can visit any empanelled government or private hospital and get treatment under any of the covered packages.

While there is no specific enrollment procedure, each patient must carry a valid government-issued photo identity proof like a ration card, aadhar card, or driving licence for their hospitalisation process.Along with the card mentioned above, the patient must also bring the Ayushman Bharat card with them during the hospitalisation process. Below mentioned are the steps involved in getting admitted into any empanelled hospital that is covered under the Ayushman Bharat Scheme:

1. Walk into the OPD of any empanelled hospital to get an OPD ticket generated. 
2. Consult with the physician or surgeon.
3. If, after diagnosis, the patient is advised admission to the hospital, the specialist will mention the package code on the OPD ticket and perform mandatory investigations specific to the procedure. 
4. The nurse in charge will identify if the patient is an Ayushman beneficiary and ask for the identification documents. 
5. The nurse will then prepare an admission case sheet according to the provided format. 
6. The patient's information will be checked on the Beneficiary Identification System (BIS). 
7. The verification can be done for ambulatory patients at an Ayushman Bharat kiosk. However, for non-ambulatory patients, the warranty will be performed by Ayushman Mitra in hospital wards. 
8. At the Ayushman Bharat kiosk, Ayushman Mitra will search patients’ information based on Samagra ID (a family ID of 8 digits).
9. If the search is not completed with Samagra ID, they find the patient by their mobile number, HHID number, or SECC name. 
10. If the search is successful and the patient’s information is found in the BIS, they can go ahead to get their KYC performed. 
11. KYC (eKYC) will be done through Aadhar and biometric fingerprint devices. 
12. In case the patient is non-ambulatory, or the biometric device is not configured with the laptop or tablet, a non-Aadhar verification is performed. 
13. The approval (golden record cards created by ISA) is expected to be provided within 30 minutes to the operator. 
14. Once approved, the nurse will place an Ayushman Bharat seal on the front page of the case sheet for quick identification. 
15. After the validation (creating the golden card), Ayushman Mitra will register the patient on the Transaction Management System (TMS). Registration can be performed for up to five days from the admission date.
16. If the validation gets rejected by ISA and SHA, Ayushman Mitra will repeat the same process, keeping in mind the reason for rejection. 
17. Before performing the procedure, the nurse will send the case sheet to the kiosk for raising pre-authorisation.
18. Ayushman Mitra will take the patient’s “on-bed photograph” and upload it on the TMS. 
19. The Ayushman Mitra or the Medical Coordinator may raise the pre-authorisation within two days of the registration in the TMS. 
20. Next, the Ayushman Mitra will select the surgical or non-surgical benefit packages according to the patient’s health condition with the help of the Medical Coordinator. They cannot choose both surgical and non-surgical packages together.
21. The ISA will approve or reject the request within six hours.
22. The nurse in charge will send the patient’s daily clinical notes to the kiosk for uploading on the TMS. 
23. At discharge time, Ayushman Mitra will take an “on-bed photograph” or any other post-surgical photograph to be uploaded on the TMS. 
24. After the treatment, the details will be saved on the TMS, and the patient will be discharged with a summary sheet. 
25. The Ayushman Mitra will fill out an online discharge summary for the patient's discharge from the hospital. 
26. They will raise a flag against the deceased member if the patient dies, declaring them dead or inactive. Additionally, they will upload a death certificate. 
27. Upon discharge, the patient will be asked to fill out a feedback form, encouraging the hospital to improve its Ayushman Bharat services. 
28. The ISA will accept or reject any claim received from the hospital. 
29. If the ISA rejects the claim, it will send a rejection notice to the hospital. The message states the hospital’s right to appeal against the rejection of the claim. 
30. The hospital gets the payment after the claim is accepted. 

The Ayushman Bharat Scheme has helped hundreds and thousands of Indians access required healthcare assistance. However, it is important to determine the correct usage of the Ayushman card for the best possible help. With the help of HexaHealth, you can end all these queries and connect with a medical expert straight away! You can learn everything about the Ayushman card and its usage by contacting HexaHealth at 8860688606 or logging in to website for complete in-person assistance for free. 

Suggested Reads

• Ayushman Card Download
• Ayushman Bharat Covered Diseases List
• Ayushman Bharat Health and Wellness Center - Portal Login
• Ayushman Bharat Health Card Benefits
• Ayushman Card vs Health ID Card

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