Ayushman Mitra : Guidelines under PM-JAY

By | September 24, 2018
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(Last Updated On: September 24, 2018)

Ayushman Mitra

Here are the complete details on Ayushman Mitra under under ayushman bharat Yojana , PM-JAY (Pradhan Mantri Jan Aarogya Yojana )

1. Introduction

A support system for assisting beneficiaries at Empanelled Health Care Provider (EHCP) under Ayushman Mitra is critical to be established. Thus, to streamline the health service delivery and provide a seamless experience to the beneficiary, an Ayushman Mitra will be placed at each EHCP. An Ayushman Mitra (AM) is a certified frontline health service professional who shall be present at each of the EHCP and shall serve as a first contact point for beneficiaries.

2. Criteria for Selection of Ayushman Mitra

The Ayushman Mitra (AMs) will be selected based on the following criteria:

● Completed 10+2 from a recognized institution
● Basic proficiency in computer operations
● Completed the Ayushman Mitra Training Course and passed the respective course exam/certification
● Possessing fluent communication skills in Hindi/ English and Local language of the State/ region
● Having adequate functional computer literacy which shall include understanding of Microsoft Office Suite and navigating through Internet Portals.

Preference to be given to Female Candidates for the position of Ayushman Mitra. Qualified ASHA workers may be given preference for the position of AM (if interested).

Existing staff of Government hospitals can also be nominated to act as Ayushman Mitra by the State Government

3. Recruitment of Ayushman Mitra

a. The State Health Agency (SHA) will have the flexibility to recruit Ayushman Mitra through third-party agency/agencies or through any other mechanism for public facilities. The SHA, based on the number of AMs required shall pay the Ayushman Mitra through a third-party agency/agencies. In case of requirement of extra AMs, the SHA/Selected Agency should have the capability to promptly scale up its capacity and provide the required number of AMs.

b. SHA can directly hire AMs also at State/ District or hospital level.
c. If the State Government requires, they can even nominate existing staff of public hospitals as AM.
d. For Private EHCP, the recruitment and placement of Ayushman Mitra should be done by the health care provider itself. The cost of the AM in that facility should be borne by the Private EHCP.

4. Placement of Ayushman Mitra

AMs will be placed at every public EHCP. The exact numbers of AMs to be placed shall be dependent on the average case-load per day. A suggestive placement of AM based on cases registered per day is given below.

(i) 0-10 Cases – 1 AM
(ii) 10-20 Cases – 2 AMs
(iii) 20-30 Cases – 3 AMs
(iv) 30-40 Cases – 4 AMs

The State can revise the number of AMs based on local conditions, however, they will need to ensure that services are available to the beneficiaries 24×7 in the hospital.

After the initial placement, State Government may also consider to shuffle AMs every 6/12 months within the same city /town. The reshuffling of AMs (if required) shall be done by the district nodal officer either directly or through selected agency.

5. Roles and Responsibilities

The Ayushman Mitra is the primary contact for the beneficiaries at every EHCP. The AM shall be responsible for the following three broad areas:

a. Operating the Beneficiary Identification System to identify and verify the beneficiaries entitled under AB-NHPM
b. Undertaking Transaction Management such as submitting requests for Pre-Authorization and Claims
c. Guiding the Beneficiary about the overall benefits under AB-NHPM and providing information about receiving prompt treatment at EHCP

For ensuring timely access to medical care, AM is responsible for operating the Beneficiary Identification System (BIS) to identify, authenticate and verify the beneficiaries entitled under the AB-NHPM.

Ayushman Mitra role

The AM shall work on the BIS as per the process mentioned below.

a. AM receives the potential Beneficiary visiting an EHCP at the designated kiosk.

b. AM collects the AADHAAR Card, Family ID Card or any other Government ID Card from the
beneficiary.

c. AM searches the beneficiary name/family using different parameters
d. On identification of beneficiary name in database, AM proceeds for beneficiary authentication through the provided Government ID card.

e. AM either does online authentication using Aadhaar or enter details in case of Non-AADHAAR
document and validate beneficiary mobile number. A digital photo of the beneficiary is also taken by the AM.

f. Post, beneficiary authentication, AM scans the family card submitted by the beneficiary for
establishing the beneficiary relation in the family.

g. The AM, after uploading Government ID and Family ID receives a ‘name match score’ and ‘family match’ score on the BIS application.

h. After the beneficiary verification (personal and family-level) is complete, record gets inserted into the database as a ‘silver’ record and the AM shall print a Provisional Card mentioning the AB-NHPM ID of the beneficiary

i. The AM, then submits the ‘record’ to the Approving authorities for further verification and approval.
The tentative time required for approval is 30 mins.

j. If beneficiary gets verified and approved by the Approving Authorities, the beneficiary data will be stored as a “golden record” and AM will receive the notification. k. AM will then print the AB-NHPM e-Card as “golden record” and give it to the beneficiary.

Ayushman Mitra role when a Beneficiary visits a empanelled health care facility

Along with ensuring a systematic operation of BIS, the AM is also responsible for the following duties:
● To provide all the necessary assistance and details about the scheme to the beneficiaries.
o In case of OPD: If the ailment does not require hospitalization, AMs will have to explain to the
beneficiary that the AB-NHPM card does not cover the OPD treatment and hence any cost
incurred for treatment under OPD will be necessarily borne by the patient.
● To collect, scan and upload all the necessary documents required for submitting the request for preauthorization.
● To ensure that the patient, from the time of pre-authorization to discharge, is getting all the benefits as per AB-NHPM norms.
● To liaison with the EHCP for timely admission and availability of bed to patient.
● To help locate facilities and guide a patient in receiving prompt treatment.
● To liaison and coordinate with the Medical officer for collecting, scanning and uploading all the
necessary documents required for submitting claim request.
● To ensure that all the facilities that the AB-NHPM beneficiaries requires are being rendered without charging any amount.
● To verify discharge summary and follow-up details to the discharged beneficiaries.
● In an unlikely scenario of e-card being lost or damaged, AM is to guide the cardholder for obtaining a copy of the e-card
● To immediately bring all grievances to the notice of Grievance Cell directly or through District
Coordinator.
● To facilitate the hospital in giving prior phone intimation to the concerned authority for carrying out the emergency surgeries.
● To track and report refund of any investigation amount collected in contravention to the Scheme
Guidelines
● To report any irregularities or inadequacy noticed to the concerned supervisors.

Thus, to ensure that AMs fulfil the responsibilities in an efficient manner, it is important to have a
comprehensive monitoring mechanism. The SHA, (in coordination with the selected agency, if hired) shall be responsible for monitoring the performance of AMs. The monitoring of AMs shall include the following parameters.

● Evaluating the percentage of complete Pre-Authorization Requests at first instance
● Assessing performance in Periodic Trainings
● Analysing Beneficiary Feedback in terms of score rating and qualitative questionnaire
● Evaluating the performance reviews submitted by District Coordinators and Senior AMs
● To conduct refresher training of the AMs ensuring they are aware of any changes in their role

6. Help Desk/ Kiosk

a. A help desk/ kiosk in a standardised form (to be provided by NHA later) will need to be mandatorily set up by each EHCP. This is mainly to assist an AB-NHPM beneficiary in completing required formalities & obtain treatment as also assist hospitals by facilitating beneficiary identification and verification, selection of packages, and seeking authorizations whenever required.

b. The EHCP should establish this help desk/ Kiosk near the reception of the Hospital for easy access of the beneficiaries. AMs should ensure that they have access to use infrastructure and necessary hardware such as PC, Printer, Scanner, Digital Camera, Webcam, QR code Reader, Stationery etc.

c. The EHCP shall provide preferably a dedicated 2 Mbps or higher broadband connectivity to the
computer to be exclusively used by the AM.

d. A standard uniform shall also be provided to the AM so that they are identified easily by the
beneficiaries in the hospital.

7. Training of Ayushman Mitra

Each Ayushman Mitra will be trained in all aspects of their roles and responsibilities. Training will use both face-to-face as well as online modes. Post training, eligible Ayushman Mitra would take up tests and would receive a certificate on successful completion of the test.
NHA is collaborating with Ministry of Skill Development and Entrepreneurship (MSDE) to use platform of Pradhan Mantri Kaushal Kendra (PMKK) to train and certify Ayushman Mitra at each district. NHA will communicate details of empanelled PMKKs to the States.

8. Benefits to Ayushman Mitra

A. For Public Hospitals
For all the AMs working in public facilities, benefits shall be paid by the SHA/SHA Selected Agency.
The suggested benefits for the AM can be done in two ways:
a. A fixed honorarium with case-based incentive OR
b. A fixed salary per month based on minimum wages in the State
Honorarium/ salary can be paid from the Rogi Kalyan Samiti from the funds generated through ABNHPM.

Provision of Mobile Closed User Group (CUG) network either through the Third-Party Agency
selected by the SHAs or through some other mechanism.
State may also revise the suggested benefits to AM, based on local conditions.

B. For Private Hospitals
For all the AMs working in Private EHCP, benefits shall be paid by the Private EHCP itself. The nature of benefits should be decided by the Private EHCP.

9. Term of Ayushman Mitra

An Ayushman Mitra may be hired for initially for a period of one year and his/ her contract can be renewed yearly based on the performance.

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Ayushman Bharat : Annexure II – Discharge Summary : Download /Print

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