Ayushman Bharat plans AI claims and records upgrade

Central government is planning an AI upgrade to Ayushman Bharat, including automated insurance claims, fraud checks and digital medical records under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and Ayushman Bharat Digital Mission (ABDM).

Auto-adjudication of claims is being considered to cut processing time and operating costs. National Anti-Fraud Unit (NAFU) is expected to support fraud checks, monitoring and accountability. Government also wants better links between hospital systems and National Health Claims Exchange (NHCX) to improve claims-data exchange.

At a national review meeting last week, National Health Authority (NHA) demonstrated an AI voice scribe that turns doctor-patient conversations into structured records in multiple Indian languages. Doctors review and approve the records before they are linked to Ayushman Bharat Health Account (ABHA). States have been encouraged to use Benchmarking Open Data Platform for Health AI (BODH) to assess healthcare AI models using Indian datasets before adoption.