Efficient PMJAY Policy Audit Services
As a trusted India-based assurance company, we specialize in PMJAY (Pradhan Mantri Jan Arogya Yojana) policy audits. Our expert team ensures compliance, accurate claim validations, and fraud prevention, delivering comprehensive audit solutions to strengthen your operational efficiency and trustworthiness.
Comprehensive PMJAY Policy Review
We offer precise PMJAY policy audit services to help healthcare providers and insurers maintain transparency and meet regulatory standards. By identifying discrepancies and ensuring claim accuracy, we support cost-effective and reliable processes that enhance your credibility and customer relationships.
Experience of 21 L+ Claim investigation
| Sr no | Category | Brief scope of service |
|---|---|---|
| 1 | Hospital On bed live medical Audit | Package mismatch, absenteeism, medical frauds, impersonation, OOP expenditure, authenticity of diagnostic reports |
| 2 | Hospital Infrastructure audit | hospital infrastructure, human resources, equipment, and treatment quality as per empanelment guidelines |
| 3 | Desk medical audit | To rule out package up-coding, package bundling, package mismatch, procedure mismatch and to make sure correct and legitimate payment. |
| 4 | Tele and video call audit | An Audit by experienced tele executive at PPD level to rule out OOP expenditure, absenteeism, impersonation, package mismatch, treatment satisfaction |
| 6 | Grievance handling | Handling grievances raised by EHCPs, SHAs in relation to audit activities |
