Part of Pillar 4 — RTI for Money & Schemes. Related: RTI for government hospitals.

Claims stall on:

• Pre-authorisation (preauth) denial — hospital's preauth rejected pre-treatment.
• Post-treatment claim rejection on medical / billing grounds.
• Query raised by SHA that hospital didn't address within 15 days.
• Treatment-package mismatch (wrong HBP code).
• Eligibility flagged during claim.
• Empanelled-hospital payment pending beyond 30 days.

• Preauth denied without specific reason.
• Post-claim reject SMS received; hospital silent.
• Hospital demanding cash despite PM-JAY card.
• Empanelled hospital claim pending > 45 days.
• Beneficiary-eligibility dispute.

• Claim ID status in BIS / TMS portal.
• Preauth request date + adjudication date + decision.
• Reason recorded for rejection, with the specific clause of PM-JAY guidelines.
• Medical-officer / claim-adjudicator name.
• Hospital's preauth response / query-reply record.
• Treatment-package (HBP) code used + correct code per procedure.
• Payment status to hospital.
• Beneficiary-eligibility verification log.
• Grievance officer at SHA + NHA.

• State Health Agency (SHA) → state RTI portal → Health & Family Welfare.
• NHA (central) → rtionline.gov.in → Ministry of Health & Family Welfare → National Health Authority.
• Rs. 10 fee; BPL free.

To,
The Public Information Officer,
[State Health Agency / National Health Authority],
[Address]

Subject: Information under Section 6(1) of the RTI Act, 2005, regarding my PM-JAY claim.

Sir/Madam,

I, [Name], PM-JAY Beneficiary / HH ID [masked last 4 digits XXXX], resident of [Full Address], submit:

Hospital name + Empanelment ID: ________
Admission date: ________
Discharge date: ________
Claim / Preauth ID: ________
Procedure undergone: ________
HBP code (if known): ________
Amount claimed: Rs. ________

Please provide:

1. Current status of the claim in the BIS / TMS portal.
2. Preauth request date + adjudication date + decision (approved / queried / rejected).
3. Certified copy of the rejection memo with the specific clause of PM-JAY guidelines relied on.
4. Name and designation of the medical officer / claim-adjudicator who recorded the decision.
5. Hospital's preauth submission + any query-response record.
6. HBP treatment-package code applied to my procedure.
7. Payment status to the hospital for this claim.
8. Beneficiary-eligibility verification log for my case.
9. Procedure and timeline for appeal against rejection.
10. Grievance officer / First Appellate Authority contact at the SHA and NHA.

I enclose IPO No. __________ for Rs. 10.
I declare I am an Indian citizen.

Yours faithfully,
[Signature, Date, Place]

1. BIS/TMS portal status.
2. Preauth timeline.
3. Rejection-memo copy.
4. Adjudicator name.
5. Hospital preauth record.
6. HBP code used.
7. Payment to hospital status.
8. Eligibility verification.
9. Appeal procedure.
10. Grievance / FAA.

• Day 0–15 RTI routed; SHA claims cell pulls record.
• Day 15–25 Many claims reassessed during this window; hospitals pressured to reply.
• Day 30 Reply mandatory.

• Writing full HH ID — only last 4 digits.
• Not citing Preauth ID.
• Filing at hospital — hospital is not a public authority for RTI (unless government).
• Skipping HBP-code question — often the exact dispute.

• Parallel grievance at pmjay.gov.in grievance portal.
• For empanelled private hospital refusing cashless — NHA grievance + SHA RTI.
• Medical-record RTI to hospital (if government) — see hospital RTI guide.

Q1. Is PM-JAY cashless?
Yes, at empanelled hospitals for listed procedures.

Q2. Can I appeal rejection?
Yes. Appeal to the SHA Grievance Cell, then to NHA.

Q3. Coverage limit?
Rs. 5 lakh per family per year.

Q4. Does the card expire?
No — valid for the family, subject to eligibility review.

Ayushman Bharat is large and rule-heavy. Claim disputes follow an adjudication trail — RTI extracts that trail and surfaces the specific decision point.

• Pillar 4 — Money & Schemes
• RTI for government hospitals
• Scheme delay RTI
• PIO framework — health & hospital

• PM-JAY Operational Guidelines
• NHA Circulars; SHA manuals

Last reviewed: 21 April 2026.