PM-JAY for Clinics: How to Get Empanelled Under Ayushman Bharat (2026 Guide)

PM-JAY (Pradhan Mantri Jan Arogya Yojana) is the world's largest health insurance scheme, covering over 55 crore Indians for cashless hospitalisation up to ₹5 lakhs per family per year. For private clinics and hospitals, PM-JAY empanelment opens access to a massive patient base. Here's how to get your facility empanelled.

What is PM-JAY?

Pradhan Mantri Jan Arogya Yojana (PM-JAY), launched in 2018 under the Ayushman Bharat programme, is managed by the National Health Authority (NHA). It provides cashless, paperless health coverage to beneficiaries for:

• Secondary and tertiary hospitalisation (3 days minimum)
• Pre and post-hospitalisation expenses (3 days pre / 15 days post)
• Over 1,900 medical procedures across specialties
• Day-care procedures (no overnight stay required)
• Over 1,900 medications as part of the package

Coverage is ₹5 lakhs per family per year and is portable across India — a patient from Rajasthan can avail PM-JAY treatment at an empanelled hospital in Mumbai.

Who Can Get Empanelled Under PM-JAY?

Both public and private facilities can apply. Private hospitals, clinics, and nursing homes can be empanelled if they meet the following basic eligibility criteria:

• Registered clinical establishment under the Clinical Establishments Act (or state equivalent)
• Minimum bed strength: 10 beds for most specialties (some day-care procedures have no minimum)
• Qualified medical and nursing staff as per specialty requirements
• Equipment as per NHA technical standards for the specialty
• Valid fire NOC, biomedical waste management certificate
• NABH accreditation preferred but not mandatory for initial empanelment

Single-doctor OPD clinics without IPD beds are generally not eligible for PM-JAY empanelment, but they can refer patients to empanelled facilities and use PM-JAY for outpatient procedures where available under state schemes.

Step-by-Step PM-JAY Empanelment Process

Step 1: Check Eligibility on the NHA Portal

Visit the PM-JAY provider portal at provider.pmjay.gov.in. Create an account and check if your state is a PM-JAY state or has an integrated state scheme (Ayushman Bharat + state top-up).

Step 2: Submit the Online Application

Log in to the NHA Provider Portal and complete the facility registration form. You will need:

• Registration certificate of the clinical establishment
• PAN of the entity (hospital / clinic)
• Bank account details for claim settlement
• Details of medical staff with registration numbers (MCI/NMC)
• List of specialties and procedures you wish to offer under PM-JAY
• Facility infrastructure details (beds, OT, ICU, equipment)
• Fire NOC and biomedical waste management documents

Step 3: State Health Agency (SHA) Verification

Your State Health Agency (SHA) assigns an empanelment committee to verify your application. This includes a physical inspection of your facility to check:

• Infrastructure matches the declared details
• Staff credentials are valid
• Medical equipment is functional and meets NHA standards
• Patient safety protocols are in place

Step 4: Receive Empanelment Certificate + Provider ID

If approved, you receive an empanelment letter and a unique Provider ID on the PM-JAY portal. Your facility is now visible to Ayushman Bharat beneficiaries and listed on the PM-JAY hospital finder.

Step 5: Set Up Claims Submission

Claims under PM-JAY are submitted digitally through the NHA portal (or integrated HMS). The workflow:

1. Patient presents Ayushman Bharat card or biometric verification
2. Eligibility verified via PM-JAY portal in seconds
3. Treatment provided as per empanelled package
4. Claim submitted with discharge summary, treatment documents, and photos
5. NHA/SHA verifies and settles claim (typically 15–30 working days)

Common Reasons for PM-JAY Empanelment Rejection

PM-JAY Package Rates: What to Expect

PM-JAY reimburses at fixed package rates defined by NHA. Rates are lower than private market rates but provide predictable, cashless, and paperless revenue. Some representative packages:

• Normal Delivery: ₹9,000 per package
• Caesarean Section: ₹14,000 per package
• Cataract Surgery: ₹10,000 per eye
• Knee Replacement: ₹75,000 per knee
• Coronary Angiography: ₹4,500
• Total Hip Replacement: ₹60,000

Rates are periodically revised by NHA. Many states add a state top-up above the NHA rate.

PM-JAY and Digital Claims with ABDM

The government is progressively integrating PM-JAY claims with the ABDM ecosystem. Empanelled facilities with ABDM integration can:

• Verify PM-JAY eligibility via ABHA ID (no physical card required)
• Submit claims digitally with pre-authorisation via the NHA portal
• Link discharge summaries to patient ABHA records automatically

OpdNest supports ABDM integration and PM-JAY eligibility verification. See our ABDM integration guide for details.

Should Your Clinic Apply for PM-JAY?

PM-JAY empanelment is worth considering if:

• You serve patients from Tier 2 / Tier 3 cities or rural areas where PM-JAY beneficiaries are common
• You have IPD beds and perform procedures covered under PM-JAY packages
• You want to increase patient volume with a guaranteed payment mechanism
• You are in a specialty with high PM-JAY package utilisation (maternity, ortho, cardiology, ophthalmology)

Single-doctor OPD clinics without beds should focus instead on ensuring your patients can be referred to PM-JAY empanelled facilities, and look into Ayushman Bharat Health & Wellness Centres (AB-HWC) linkage if you are in a primary care setting.

For clinics ready to set up PM-JAY claim workflows, OpdNest's hospital management software includes PM-JAY eligibility verification and claim submission integration on the Enterprise plan.