Ayushman Bharat / PM-JAY cashless claim not processed
First Steps — Verify & Initiate
1
Verify your PM-JAY eligibility: mera.pmjay.gov.in — enter your mobile number or name and ration card number to check eligibility and see your unique PM-JAY ID.
2
Obtain your PM-JAY e-card at the hospital’s Ayushman Mitra desk or Common Service Centre — the e-card is required for cashless treatment at empanelled hospitals.
3
Confirm the hospital is currently empanelled under PM-JAY: hospitals.pmjay.gov.in — empanelment can change; always verify before admission.
4
Call the PM-JAY helpline (14555) to verify your eligibility and report the non-processing — they can confirm whether the issue is with beneficiary data or hospital connectivity.
5
Ask the hospital’s Ayushman Mitra (dedicated PM-JAY liaison) to escalate the pre-authorisation directly with the SHA. Never pay cash upfront to any hospital without demanding an official written refusal/receipt. Contact the District Implementation Unit (DIU) or approach the hospital’s Arogya Mitra desk directly for spot intervention.
Follow-up Steps — Next 2–4 Weeks
1
If the SHA is not responding within the mandated time: the hospital can initiate treatment and the SHA is required to settle the claim retrospectively — under PM-JAY guidelines, denial of cashless for genuine emergencies is not permitted.
2
Contact your State Health Agency (SHA) directly — each state has a dedicated PM-JAY helpline in addition to the national 14555.
3
If the hospital refuses to initiate cashless treatment despite valid eligibility: contact the District PM-JAY Implementation Officer.
4
Obtain a written denial from the hospital specifying the exact reason — this is required for complaint filing.
Escalation — If Still Unresolved After 30 Days
1
Call 14555 (PM-JAY national helpline) and register a complaint with the claim and hospital details.
2
File a grievance on the PM-JAY portal: pmjay.gov.in > ‘Grievance.’
3
Contact the State Health Agency’s grievance desk — SHA contact details are on each state’s PM-JAY website.
4
File on pgportal.gov.in under Ministry of Health and Family Welfare.
5
Contact your elected representative (MP/MLA) — PM-JAY implementation is politically monitored and representative intervention is often effective.
Prevention — Keep Your Entitlement Active
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Download your PM-JAY e-card in advance — do not wait until you are at the hospital in an emergency.
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Verify hospital empanelment before choosing a hospital for planned procedures — empanelment status changes.
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Ensure your family details (name, Aadhaar) match the PM-JAY beneficiary database — check at mera.pmjay.gov.in.
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Save the PM-JAY helpline (14555) in your phone — call it before going to a hospital to confirm your eligibility is active.
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Your Rights
PM-JAY is a rights-based health coverage scheme. Empanelled hospitals cannot refuse treatment to eligible beneficiaries. The insurer/SHA must respond to pre-authorisation within 1 hour for emergencies and 3 hours for planned cases. If a hospital wrongly denies PM-JAY benefits to an eligible beneficiary, the hospital can face de-empanelment and the SHA can be penalised.
Key Contacts & Portals
| Who / What | Contact / Action |
|---|---|
| PM-JAY Helpline | 14555 (national) | pmjay.gov.in |
| PM-JAY Eligibility Check | mera.pmjay.gov.in |
| Hospital Empanelment Check | hospitals.pmjay.gov.in |
| Who / What | Contact / Action |
|---|---|
| State SHA | Your state’s PM-JAY website — state helpline number |
| CPGRAMS | pgportal.gov.in — Ministry of Health |