Insights · PM-JAY
PM-JAY empanelment: what it takes, what it pays, and what to do when it doesn't
Ten beds gets you in. The accreditation premium is 10 or 15 per cent. And the scheme owes you one per cent a week when it pays late.
As on 28 February 2026 there were 36,229 hospitals empanelled under PM-JAY, of which 16,746 were private. The threshold to join is lower than most owners assume, and the payment rules are stronger than most owners use.
What it takes
The floor is 10 in-patient beds, or five in an aspirational district, with day-care exemptions for eye, ENT and standalone dialysis. General ward space is specified at 80 square feet per bed. X-ray is mandatory; NABL-accredited labs are preferred, not required.
Beyond that, the essential criteria are a list of twenty. Most are what you would expect: qualified staff round the clock, an equipped operation theatre, an ICU, 24-hour emergency, ambulance, generator backup, waste management, fire safety. Three catch people out because they are administrative rather than clinical:
- A NEFT-enabled bank account in the hospital's name
- A dedicated beneficiary kiosk at reception
- A dedicated medical officer named as scheme coordinator
No accreditation is required to be empanelled.
Accreditation is not a condition. It is a rate premium — but only if your state pays it
The published incentives raise package rates by 10 per cent for NABH entry level and 15 per cent for full NABH, compounding with 10 per cent each for teaching hospitals, aspirational districts and metro locations. The worked example in the NHA manual takes a ₹10,000 package to ₹12,650. The catch is that these incentives are voluntary for states. Check your own state agency's tariff notification before building a business case on them, because hospital associations in at least one state have complained of incentives being cut at re-empanelment.
The timelines nobody quotes back at the payer
These are published, and they are the most useful thing in this article.
- Pre-authorisation: six working hours. If the payer's doctor takes no action within that window, the system is designed to force approval.
- Claim documents: within 24 hours of discharge. Late submission carries a penalty of 0.1 per cent per day beyond seven days from discharge. This one runs against you.
- Payment: 15 calendar days for in-state claims, 30 for portability claims. Transfers are meant to be made weekly, electronically.
- Delay penalty: 1 per cent of the claimed amount per week beyond those windows.
Note which document that last one sits in. The 1 per cent weekly penalty is in the NHA's Guidelines on Claim Settlement, not in the Claims Adjudication Manual. If you are writing to a state agency, cite the right one.
It has been enforced
On 23 July 2026 the Himachal Pradesh High Court ordered the state to release pending bills within three weeks, with 1 per cent weekly interest on amounts delayed beyond 15 days. The hospital in question was owed ₹25.22 crore under PM-JAY and a further ₹11.03 crore under the state scheme. The court held that the state could not withhold approved bills on the ground that a vigilance inquiry was pending.
That is a useful precedent, and the underlying problem is not confined to one state. Private hospitals in Jammu and Kashmir reported roughly ₹275 crore outstanding in April 2026; by late August they described eight months of arrears with only 10 to 15 per cent released. Haryana's association put its figure at ₹500 crore in 2025.
What this means for your hospital
Decide deliberately how much of your revenue you want in scheme volume, and then manage it as a receivable rather than as revenue. Three things follow.
Document the delay from day one. An ageing report by claim, with submission dates and the 15-day mark flagged, is the difference between a grievance you can escalate and a complaint you cannot evidence.
Fix the submission discipline first, because the 0.1 per cent daily penalty for late filing is the one deduction that is entirely your own doing.
And check your state's tariff notification for the accreditation premium before you assume it. If your state pays it, the 15 per cent on full NABH changes the arithmetic on accreditation considerably. If it doesn't, accredit for the other reasons.
Sources
- NHA, Guidelines on Hospital Empanelment and De-empanelment, Version 3.0 — bed minimums, the essential criteria, de-empanelment and appeal routes
- NHA, Health Benefit Package 2.2 User Guidelines — the accreditation, teaching, aspirational-district and metro premiums and the compounding worked example
- NHA, Guidelines on Claim Settlement — 15 and 30 day payment windows and the 1 per cent weekly delay penalty
- NHA, Claims Adjudication Manual 2.0 — six-working-hour pre-authorisation turnaround and the adjudication workflow
- Verdictum, 23 July 2026 — Himachal Pradesh High Court, 2026:HHC:29794, release of pending bills with 1 per cent weekly interest
- IANS, 23 March 2026 — Lok Sabha reply, 36,229 empanelled hospitals as on 28 February 2026
- Greater Kashmir, 21 August 2026 — eight months of arrears in Jammu and Kashmir, 10 to 15 per cent released
Scheme revenue that arrives eight months late is not revenue.
We rebuild the claims process, document the delay properly, and put the escalation route in your team's hands rather than ours.
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