In a significant administrative push, the state of Uttar Pradesh has managed to drastically reduce the backlog of pending claims under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) within a year. The number of unsettled claims, which stood at a staggering over 10 lakh in January 2025, was brought down to approximately 3 lakh by December 2025. This achievement follows a series of targeted interventions by the Yogi Adityanath government to streamline the verification and payment pipeline for the flagship health insurance scheme.
Government Directives Drive Efficiency
The turnaround was initiated after the state government issued clear directives to concerned agencies. The primary focus was on ensuring timely payments to empanelled hospitals and systematically removing obstacles that were slowing down the verification process. This was deemed critical to ensure that the treatment of beneficiaries across the state was not disrupted due to pending claims. Officials highlighted that the intent was to create a smoother ecosystem for both healthcare providers and patients.
Reforms and Financial Disbursement
The financial scale of this operational cleanup is substantial. In the period between January and December 2025, the state disbursed a massive ₹4,649 crore to hospitals empanelled under the scheme against the cleared claims. Archana Verma, the CEO of the State Agency for Comprehensive Health and Integrated Services (SACHiS), stated that continuous reforms were implemented to make the claim settlement process faster and more transparent for all hospitals, whether government-run or private.
"On average, more than 2 lakh claims are received every month," Verma noted. "Despite this high volume, we have been regularly resolving not only the new incoming claims but also chipping away at the old pendency."
Strengthening the Audit and Processing Framework
A key component of this success story was the strengthening of the medical audit system, which is crucial for claim verification. Puja Yadav, Additional CEO of SACHiS, explained that the number of medical auditors was increased significantly—from just 40 to 130. Simultaneously, to handle the processing load, the number of claim processing desks was raised from 100 to 125.
These measures ensured that payments to hospitals were consistently made within the stipulated 30-day turnaround time. The progress was closely monitored through regular review meetings focused on tracking pending cases and ensuring accountability at every step of the chain. This multi-pronged approach of augmenting manpower, simplifying procedures, and enforcing strict timelines proved effective in tackling the backlog head-on.
