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The government of Kerala launched the Karunya Health Scheme mainly to provide health insurance coverage for the underprivileged sections of the society at a nominal premium charge. This ambitious project was originally launched by the UDF government in the year 2012. The reigning government has decided to continue with this project to provide the necessary benefits to the underprivileged sections of the society. Funding for this scheme is raised through Kerala Lottery, and the amount is directly transferred to provide settlement for the empanelled hospitals.The Karunya Health Scheme by the Government of Kerala functions similar to that of a critical illness cover. People suffering from major chronic illnesses can avail treatment benefits under this cover. Date of roll-out (Ayushman Bharat PM-JAY) is 1st April, 2019.


1 Patient coming to hospitalwithout KASP registration/Hospital is not login into the KASP system There is a facility for initiating admission within 5 days of actual admission,hence if the beneficiary fails to produce PMJAY Number at the time of admission/hospital is not log in into the KASP system( RSBY Hospital going for auto empanelment) ,hospital can proceed with the treatment and get him registered/hospital login into KASP system, within 5 days.

2 Beneficiary in KASP counter Once the doctor suggest for admission,the patient needs to come to KASP counter,the registration and Inpatient conversion can be done in one stretch

3 Photo uploading As there is no bio metric cross checking of the patient happens in the counter, a chek photo is mandatory.Using  mobile phone,with connector to the system for integration /webcam a photo has to be taken and uploaded.Same photo can be uploaded for discharge time too.

4 Pre authorisation Most of the procedures are auto approved, but the counter staff has to initiate preauth by uploading the scanned copy of the admission note and the relevant investigation result.The system will automatically reveal,if it is auto approved. If  Pre-authorisation is mandatory,in elective case it will be approved in 6 hours,if not deemed it as approved,if there is no query from insurance company. If query is there please respond with the needed documents.If an Emergency case,the Insurance company has to give approval in 1 hour time.

5 Admission Initiation Once the approval is there initiate the surgery in case of surgical cases and scan and keep the surgery note. In case of General ward admission, we can block for one day only  in first instance and depends on the need enhance more days needed,with a ceiling of 5 days  in Pre-authorisation tab, by uploading substantiating documents-case note,investigation results and doctors statement,if any.

6 Discharge initiation Once the patient is discharged from the ward,upload the surgery note and discharge summary in case of surgical case and the balance case note to be uploaded ( balance of already uploded case note for enhancement)in case of general ward admission along with discahrge summary has to be uoloaded for discharging the patient.

7 Claim initiation After discharge claim initiation has to be done,verifying all the uploaded documents.missed documents if any can be uploaded now and claim has to be initiated.It has to be done the earliest.After claim initiation only the reimbursement will happen in 15 days.If the Claim initiation is not happening in 30 days,the claim wont be addressed. 

8 U1-0001-Un specified surgical package Request for authorisation letter,signed by the treating doctor has to be uploded  to Insurance company along with the relevant investigation result-attached herewith RAL

9 U1-0002-State specific Un specified surgical/medical package Request in template for cost of  additional drugs needed / oncology drugs/radiation therapy along with the relevant investigation results has to be uploded.the template is attached.