J&K govt to clear pending payments for empanelled hospitals by Dec end

Srinagar, Nov 22: The Jammu and Kashmir Government has announced that all pending payments to public and private hospitals empanelled under the AB-PMJAY SEHAT Scheme will be cleared by the end of December. The payment process was initiated on October 5, following directives from the High Court.
On September 2, private hospitals and dialysis centers in J&K had halted their services for 10 days after IFFCO-TOKIO, the private insurance company managing the scheme, failed to comply with the High Court’s order.
Sanjiv M. Gadkar, Chief Executive Officer (CEO) of the State Health Agency (SHA) J&K, said that since October 2024, the SHA has processed over 54,000 cases across both private and public hospitals, underscoring the government’s commitment to supporting healthcare providers and beneficiaries. He acknowledged that delays have occurred due to some Empanelled Health Care Providers (EHCPs) failing to adhere to the National Health Authority’s guidelines. “Many claims have been submitted without the mandatory documents, which delays processing and causes inefficiencies,” he explained.
Chief Executive Officer (CEO), State Health Agency J&K, Sanjiv M. Gadkar said since October 2024, the SHA has processed over 54,000 cases across private and public hospitals, underscoring the commitment to healthcare providers and beneficiaries.
To address these issues, the SHA has urged all EHCPs to ensure the submission of complete and accurate documentation. “We are strictly following the High Court’s directions to ensure that no claims are unfairly rejected. Sufficient funds are available to process all claims, and every valid claim will be paid without delay,” Gadkar assured.
Despite the challenges posed by IFFCO-TOKIO’s failure to honor its contractual obligations, Gadkar stressed that the SEHAT scheme remains vital for J&K residents, alleviating the financial burden of healthcare and providing free access to essential medical services. The SHA has appealed to all stakeholders, including private hospitals, to collaborate in resolving these issues.
The CEO also reaffirmed the government’s commitment to resolving operational challenges and ensuring that the scheme benefits every eligible resident in the region. In J&K, over 8.6 million Ayushman Bharat Card holders are registered, with 255 hospitals (122 public and 133 private) empanelled under the scheme.
Officials confirmed that the J&K Government is still in the process of securing a new insurance provider, as the case against IFFCO-TOKIO is still pending in the High Court. The Court had earlier directed the SHA to process payments until a final judgment is delivered.
The health insurance scheme was initially implemented through Bajaj Allianz General Insurance Company Limited, but after its contract ended in 2022, IFFCO-TOKIO took over. However, IFFCO-TOKIO attempted to exit the scheme in November 2023, one year before its contract’s expiration. Despite requests to continue, the company declined. Subsequently, the SHA sought a High Court stay on the exit and asked for the insurance company to fulfill its contractual obligations until March 2025.
Due to the ongoing dispute, hospitals and diagnostic centers in J&K have faced significant financial strain. Many private healthcare providers expressed concerns over the delays. “We’ve faced financial losses and had to let go of staff due to payment delays. We not only provide services but also create jobs. The system must be streamlined,” said a private hospital owner in Srinagar.