Uttar Pradesh has reported progress in reducing claim pendency and improving payment timelines under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
According to Archana Verma, CEO of the State Agency for Comprehensive Health and Integrated Services (SACHIS), measures have been introduced to speed up and streamline the settlement of claims submitted by empanelled government and private hospitals. Claim pendency, which stood at 10.75 lakh in January 2025, declined to about 3 lakh by December 2025 and is expected to be cleared in the near term. Hospitals across the state submit an average of over two lakh claims each month, and both older pending cases and new claims are being processed on an ongoing basis.
Verma said the focus is on ensuring that empanelled hospitals are able to provide treatment to Ayushman Bharat beneficiaries without delays related to reimbursement.
SACHIS Additional CEO Puja Yadav said the claim settlement process has been made more efficient by strengthening the medical audit system. The number of medical auditors has increased from 40 to 130, helping to speed up claim verification. Claim Processing Desks (CPDs) have also been expanded from 100 to 125. Under the scheme, hospitals are required to receive payments within a 30-day turnaround time, which is being monitored through regular review meetings and tracking of pending claims.
SACHIS officials stated that between January and December 2025, a total of ₹4,649 crore was disbursed to empanelled hospitals against Ayushman Bharat claims. The reduction in pendency and adherence to payment timelines is expected to support hospital participation in the scheme and ensure continued access to cashless treatment for eligible beneficiaries.
