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To curb fraud and delays in Ayushman Bharat claims, AI will now process approvals under a pilot in UP and MP. If successful, the system may soon expand nationwide
The objective is to make the process of claim verification and approval faster, more efficient, and more transparent.
Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), claim decisions will soon be taken by artificial intelligence (AI) rather than doctors. The National Health Authority (NHA) has approved a pilot project to introduce this new system.
The trial of this AI-based claim system will begin in Uttar Pradesh and Madhya Pradesh. Authorities plan to test the technology in these two states before considering wider implementation across the country.
Automated System To Be Set Up In Uttar Pradesh
In Uttar Pradesh, the State Agency for Comprehensive Health and Integrated Services (SACHIS) will soon establish an automated adjudication system.
The objective is to make the process of claim verification and approval faster, more efficient, and more transparent.
Until now, claim verification under the scheme was conducted manually. Doctors and officials had to review documents and medical details before approving claims, a process that often took several days to complete. With the introduction of AI, simple claims could be approved within a few hours.
The automated system will analyse claims according to the scheme’s guidelines, identify suspicious or fraudulent entries, and quickly approve genuine claims.
Hospitals To Receive Payments More Quickly
Officials say the new system will significantly reduce delays in payments to hospitals. Faster claim approvals will help hospitals receive funds promptly, allowing them to continue providing treatment without financial bottlenecks.
Aim To Reduce Fraud And Improve Services
According to the National Health Authority, the use of AI will strengthen monitoring of claims, help detect fraudulent submissions, and ensure better implementation of the scheme. It is also expected to improve service delivery for patients.
Initial Focus On Selected Treatments
In Uttar Pradesh, the pilot project may initially focus on specific treatments, particularly claims related to kidney care and dialysis. This limited rollout will help authorities assess how effectively the AI system handles medical claims.
The initiative is part of efforts to further strengthen the Ayushman Bharat programme. The scheme provides free medical treatment of up to Rs 5 lakh per family each year for economically weaker sections of society.
Better Use Of Resources Through Technology
By incorporating AI, the government aims to improve efficiency in the health insurance system and ensure better utilisation of available resources. Automation is expected to streamline administrative work and reduce processing time.
If the pilot project proves successful in Uttar Pradesh and Madhya Pradesh, the system could later be expanded to other states across India.
Experts Stress Data Security And Accuracy
Health experts believe the use of AI could bring significant transformation in healthcare management. However, they also emphasise the importance of maintaining strong data security and ensuring the accuracy of AI-based decisions.
Impact On Uttar Pradesh’s Healthcare System
Millions of people in Uttar Pradesh are already benefiting from the Ayushman Bharat scheme. The new AI-based initiative is expected to make the state’s healthcare administration more digital, efficient, and responsive.
Uttar Pradesh, India, India
March 06, 2026, 12:23 IST
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