Aarogya Mitra : PMAM

The Aarogya Mitra is the primary contact for the beneficiaries at every Empanelled Health Care Providers

  • The Aarogya Mitra shall be responsible for focusing on three broad areas

    1. Operating the "Beneficiary Identification System" to identify and verify the beneficiaries entitled under AB-PMJAY.
    2. Undertaking "Transaction Management" such as submitting requests for Pre-Authorization and Claims.
    3. Guiding the Beneficiary about the overall benefits under AB-PMJAY and providing information about receiving prompt treatment at Empanelled Health Care Providers.

Key Roles : Beneficiary Identification

  • Collects the Aadhaar Card, Family ID Card or any other Government ID Card from the beneficiary.
  • Searches name, verifies names based on Govt ID card, authenticate beneficiary, take a photo and establishes beneficiary relation with the family
  • Aarogya Mitra receives family and individual match scores; record is saved as ‘Silver Record’ and a provisional card generated
  • Records submitted to verifying authority; once approved, record is saved as ‘Golden Record’
  • Aarogya Mitra will then print the AB-PMJAY e-Card as “Golden Record” and give it to the beneficiary

Key Roles : At Empanelled Hospital for Care Seeking

  • Provide all the necessary assistance and details about the scheme; help locate facilities and guide a patient
  • Collect, scan and upload all the necessary documents for pre-authorization.
  • Liaison with the EHCP for timely admission and availability of bed to patient
  • Liaison and coordinate with the Medical officer for collecting, scanning and uploading all the necessary documents required for submitting claim request.
  • Verify discharge summary and follow-up details to the discharged beneficiaries
  • Bring all grievances to the notice of Grievance Cell.
  • Track and report refund of any investigation amount collected in contravention to the Guidelines
  • Report any irregularities or inadequacy noticed