PMJAY Empanelment for Clinics: Step-by-Step Guide to Ayushman Bharat Tie-Up

What Is PMJAY Empanelment and Why It Matters

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is the world's largest government-funded health insurance programme — covering 50+ crore beneficiaries with ₹5 lakh annual coverage per family. For empanelled clinics, it's a significant patient and revenue source.

Eligibility Criteria for PMJAY Empanelment

• Registered clinical establishment under state Clinical Establishments Act
• Minimum infrastructure as per Health Benefit Package (HBP) requirements for intended specialties
• Qualified medical professionals with valid Medical Council registration
• Active HFR registration (ABDM) with verified HFID
• Fire NOC and building safety certificate (for IPD facilities)
• Bio-medical waste management agreement

Step-by-Step PMJAY Empanelment Process

PMJAY Billing: How It Works for Empanelled Clinics

Each HBP has a fixed package rate — your clinic receives the full package rate per approved procedure. The billing flow:

1. Patient presents PMJAY e-card or beneficiary ID at registration
2. Clerk verifies eligibility online via TMS portal
3. Pre-authorisation request submitted for the procedure
4. SHA approves (usually within hours for emergencies, 24–48 hrs for elective)
5. Treatment delivered — discharge summary and bills uploaded to TMS
6. Claim processed — payment typically within 15 working days

5 Most Common PMJAY Empanelment Rejection Reasons

• ✗HBP over-selection — selecting packages without matching infrastructure
• ✗Incomplete ABDM/HFR registration — HFID not verified or linked
• ✗Missing documents — bio-waste agreement and fire NOC are commonly forgotten
• ✗Equipment not physically present — listed equipment not found during inspection
• ✗Doctor credentials mismatch — doctor's listed specialty doesn't match council registration specialty

Frequently Asked Questions

Can a small OPD-only clinic get PMJAY empanelment?

PMJAY primarily covers hospitalisation and daycare procedures. OPD-only clinics have limited PMJAY scope, but can be empanelled for specific daycare packages relevant to their specialty.

How long does PMJAY empanelment take?

From complete application to empanelment letter: 4–8 weeks typically, depending on the state SHA's inspection schedule.

What software do I need for PMJAY billing?

ABDM-compliant software with TMS portal integration. Cliniq Flo handles PMJAY pre-auth, billing, and claim tracking.

Related guides: ABDM Compliance → | Choosing Clinic Software →