Ayushman Bharat PM-JAY (Pradhan Mantri Jan Arogya Yojana) is the world's largest government-funded health insurance scheme, providing ₹5 lakh per family per year to over 12 crore families across India. For hospitals, PMJAY empanelment opens a massive, guaranteed revenue stream — but the registration process involves strict eligibility checks, 25+ documents, and a mandatory ABDM integration requirement introduced in 2024. This guide walks you through everything: eligibility, the exact steps to register on pmjay.gov.in, what documents you need, how claims are processed, and how to avoid the most common rejection pitfalls.

What is PMJAY and Why Should Your Hospital Enroll?

PM-JAY, the flagship scheme under Ayushman Bharat, was launched in September 2018 with a simple mandate: ensure that India's poorest families can access quality secondary and tertiary healthcare without financial catastrophe. The scheme covers over 1,949 medical and surgical packages ranging from routine deliveries to complex cardiac surgeries and organ transplants.

For hospitals, the business case for PMJAY empanelment is compelling:

Guaranteed volume: Over 12 crore families are PMJAY beneficiaries. In states like UP, Bihar, Rajasthan, and Odisha, a significant portion of a district's population is eligible — meaning a steady inflow of patients who can now afford hospital care.
Pre-defined package rates: While rates are fixed, they provide predictable revenue. Hospitals do not need to chase individual patients for payment.
Timely government reimbursement: Under the scheme rules, empanelled hospitals must receive payment within 15 days of claim approval at the State Health Agency (SHA) level.
NABH incentive bonus: NABH Entry Level accredited hospitals receive a 10% additional incentive on all PMJAY package rates, and full NABH accredited hospitals receive 15% extra — making accreditation financially rewarding.
Brand credibility: Being listed as a PMJAY-empanelled hospital builds significant trust in semi-urban and rural markets.

As of May 2026, over 28,000 hospitals across India are empanelled under PMJAY — both public and private. The government has set ambitious targets to expand this further, making now the right time to apply.

Eligibility Criteria for PMJAY Hospital Empanelment

Not every hospital qualifies for PMJAY. The National Health Authority (NHA) and State Health Agencies (SHAs) enforce clear eligibility norms. Here is what your hospital needs:

Bed Strength Requirements

General empanelment: Minimum 10 beds (including at least one Operation Theatre if surgical packages are to be offered)
Speciality-specific empanelment: Additional bed requirements for specific packages (e.g., ICU beds for critical care packages, NICU beds for neonatal packages)
Day-care facilities: Can apply for a limited package list without mandatory overnight beds if the procedures are classified as day-care procedures in the PMJAY package list

Infrastructure Requirements

Functioning emergency care unit (24x7 availability required for surgical package empanelment)
At least one qualified MBBS doctor available round-the-clock
Specialist availability matching the package categories applied for
Functional laboratory and radiology services (in-house or through tie-up)
Valid bio-medical waste management authorization
Fire safety NOC from the local fire department

Accreditation Requirements

Since 2023, NABH Entry Level accreditation has been strongly preferred, and in several states it has become a mandatory requirement for empanelment or for claiming the quality incentive. Check your state-specific SHA guidelines. You can read the full NABH accreditation process in our complete NABH guide.

ABDM Integration: Mandatory Since 2024

This is the most critical update for 2024-2026: ABDM (Ayushman Bharat Digital Mission) integration is now mandatory for PMJAY empanelment and for processing claims. Hospitals that are not ABDM-compliant face claim rejections and may be de-empanelled.

What ABDM integration requires:

HFR Registration: Your hospital must be registered on the Health Facility Registry (HFR) and have a valid HFR ID
ABHA ID linkage: Patients must be registered using their ABHA (Ayushman Bharat Health Account) ID at the time of admission
Digital health records: Clinical notes, discharge summaries, and lab reports should be linked to the patient's ABHA ID in a FHIR-compliant format
HMS integration: Your Hospital Management Software must be able to communicate with the ABDM sandbox/production APIs

Adrine HMS comes with built-in ABDM integration, handling HFR registration, ABHA linking, and digital health record sharing automatically. Read our detailed ABDM integration guide for technical details.

Step-by-Step PMJAY Hospital Empanelment Process

The empanelment process is managed on the Hospital Empanelment Module (HEM) at pmjay.gov.in. Here is the complete process:

Step 1: Self-Assessment and Pre-Qualification

Before applying, conduct an honest self-assessment:

Verify your hospital meets minimum bed and infrastructure requirements
Identify which package categories you wish to apply for
Confirm you have all required specialists on your payroll or on long-term contract
Check that your state's SHA has an open empanelment window (some states open empanelment only in specific months)

Step 2: HFR Registration (ABDM)

Register your hospital on the Health Facility Registry at facility.ndhm.gov.in. You will need your hospital's GST number, Clinical Establishment Act registration number, and basic infrastructure details. Upon completion, you receive an HFR ID — keep this handy for the PMJAY application.

Step 3: Create Account on HEM Portal

Visit pmjay.gov.in → Empanelment → Hospital Login. Create an account using your hospital's registered mobile number and email. You will receive an OTP for verification. Once logged in, select your state and district.

Step 4: Fill the Online Application Form

The HEM application form has multiple sections:

Hospital Profile: Name, address, type (private/trust/government), year of establishment, bed capacity breakdown (general ward, semi-private, private, ICU, NICU, PICU)
Infrastructure Details: OT count, equipment list, laboratory services, radiology services
Human Resources: List of all full-time doctors with their MCI/NMC registration numbers, specialists, nursing staff counts
Package Selection: Choose from the PMJAY package list — you can apply for multiple specialty packages (cardiology, oncology, orthopaedics, general surgery, etc.)
Accreditation Details: Enter NABH/NABL accreditation numbers if applicable
Banking Details: Bank account number and IFSC code for direct benefit transfer of claims
ABDM Details: Enter your HFR ID to link ABDM registration

Step 5: Upload Documents

Upload all required documents (detailed list in the next section). Each document must be a clear PDF or JPEG under 2MB. The portal allows you to save progress and upload documents in batches.

Step 6: Pay Empanelment Fee

Pay the non-refundable empanelment application fee online via the HEM portal (see fees section below).

Step 7: State Health Agency (SHA) Review

The SHA assigns a District Empanelment Committee (DEC) to verify your application. A designated official conducts a physical inspection of your hospital. The inspector verifies infrastructure, equipment, staff credentials, and record-keeping systems.

Step 8: Empanelment Agreement Signing

If approved, you receive a conditional empanelment letter. Sign the Memorandum of Agreement (MoA) with the SHA — this is a legally binding agreement specifying your obligations, package rates, and claim processing timelines.

Step 9: Activation and Go-Live

After MoA signing, your hospital appears on the official PMJAY hospital locator. Configure your HMS to start recording PMJAY admissions, linking patient ABHA IDs, and generating TMS (Transaction Management System) claims.

Documents Required for PMJAY Empanelment

Prepare the following 25+ documents before starting the online application:

Legal and Registration Documents

Certificate of Registration under the Clinical Establishment Act (CEA) or equivalent state act
Hospital registration certificate from state/municipal authority
GST registration certificate
PAN card of the hospital/trust/company
Memorandum and Articles of Association (for company/trust-registered hospitals)
Partnership deed (for partnership firms)
Fire NOC from local fire authority (should be current year)
Consent to Establish and Operate from State Pollution Control Board
Bio-medical waste management authorization from CPCB/SPCB

Infrastructure and Equipment Documents

Building plan/layout approved by local authority
List of medical equipment with purchase invoices or calibration certificates
OT inspection report or OT registration (if applicable)
Lift clearance certificate (for multi-story hospitals)
Generator/UPS availability certificate
List of beds with photographic evidence (ward-wise)

Human Resources Documents

List of all doctors with MCI/NMC/State Medical Council registration certificates
Appointment letters and ID proof for all resident/full-time doctors
Nursing Council registration for all nurses
Qualification certificates for technicians (lab, radiology, OT)
Staffing pattern chart signed by Medical Director

Financial Documents

Cancelled cheque of hospital bank account (for EFT payment)
Bank account statement (last 3 months)

Accreditation and Quality Documents

NABH/NABL accreditation certificate (if applicable)
NABH Entry Level certificate (if applicable — required for quality incentive)
Patient rights charter (displayed in hospital)
Quality and patient safety committee constitution letter

PMJAY Empanelment Fees Structure

The empanelment application fee is paid at the time of application and is non-refundable, even if the application is rejected. Fees vary by state and hospital size:

Up to 50 beds: ₹5,000 to ₹10,000 (varies by state)
51 to 100 beds: ₹10,000 to ₹20,000
101 to 200 beds: ₹20,000 to ₹30,000
201 to 500 beds: ₹30,000 to ₹50,000
500+ beds: ₹50,000 to ₹1,00,000

Empanelment is typically valid for 2 years, after which a renewal application with updated documents and inspection is required.

How the PMJAY Claim Process Works

Understanding the claim lifecycle is essential for cash-flow planning. Here is the end-to-end PMJAY claim process:

1. Patient Verification at Admission

When a patient presents an Ayushman Bharat card (physical or digital), your reception staff must verify beneficiary eligibility in real time through the PMJAY Beneficiary Identification System (BIS). The patient's ABHA ID should be linked at this stage. Adrine HMS integrates directly with BIS for instant verification.

2. Pre-Authorization Request

For most surgical and high-value packages, a pre-authorization is required before proceeding. Submit the pre-auth request through the Transaction Management System (TMS) with the patient's diagnosis, proposed procedure, estimated cost, and treating doctor details. SHA typically responds within 2-4 hours for urgent cases and 24-48 hours for elective procedures.

3. Treatment and Discharge Summary

Provide treatment as per the approved package. Maintain detailed clinical notes, investigation reports, and nursing charts. At discharge, generate a comprehensive discharge summary linked to the patient's ABHA ID in FHIR-compliant format (mandatory per ABDM guidelines).

4. Claim Submission

Submit the final claim through TMS within 5 days of patient discharge. The claim must include: final diagnosis (ICD-10 coded), procedure code from PMJAY package list, discharge summary, all investigation reports, itemized treatment summary, and surgeon/treating doctor details.

5. Claim Review and Approval

The SHA's claims processing team reviews the submission. Claims go through automated checks and then manual review. Common turnaround: 7-15 working days.

6. Payment

Once approved, payment is transferred via EFT directly to your hospital's registered bank account within 15 working days of approval. Under PMJAY rules, delayed payments beyond 30 days attract interest.

Common PMJAY Claim Rejection Reasons (and How to Avoid Them)

Claim rejection is the most painful problem for empanelled hospitals. Here are the top rejection reasons and how to prevent them:

Beneficiary not eligible: Always verify eligibility through BIS before admission. Never proceed on verbal confirmation alone.
Procedure not matching diagnosis: Ensure the ICD-10 code matches the PMJAY package code. Use HMS-based coding assistance to reduce mismatches.
Missing pre-authorization: Never start a surgical procedure without confirmed pre-auth, even in emergencies — for emergencies, submit the post-facto authorization within 24 hours with justification.
Incomplete documentation: Missing discharge summaries, unsigned consent forms, or absent investigation reports are the #1 reason for rejections. Use a discharge checklist.
Claim submitted after 5-day deadline: Automate claim submission through your HMS to never miss the window.
ABDM non-compliance: Claims from hospitals without HFR IDs or without ABHA linking are being rejected in 2026. Ensure full ABDM compliance before your first admission.
Upcoding: Never bill for a higher package than actually provided. SHA auditors conduct random records audits, and upcoding can lead to de-empanelment.

How Adrine HMS Helps with PMJAY Compliance

Managing PMJAY admissions manually is error-prone and operationally intensive. Adrine's Hospital Management Software is purpose-built for the Indian regulatory environment, with the following PMJAY-specific features:

ABDM integration out of the box: Automatic HFR ID linking, ABHA ID capture at registration, and FHIR-compliant digital health record generation — fully compliant with the 2024 ABDM mandate. Read more in our ABDM integration guide.
Beneficiary verification: Real-time BIS verification integrated into the OPD/IPD registration screen — staff see eligibility status in seconds without switching systems.
Pre-authorization workflow: Built-in TMS integration for submitting pre-auth requests and tracking approval status directly from the IPD admission screen.
Automated claim generation: Adrine automatically maps the patient's diagnosis and procedures to the correct PMJAY package codes, generates the claim file in the required XML/JSON format, and submits it to TMS — reducing claim rejection rates by up to 60%.
Claim rejection dashboard: Tracks all rejected claims with rejection reasons, enabling your billing team to respond and resubmit within the window.
NABH compliance module: Supports the documentation requirements for NABH accreditation, helping you qualify for the 10-15% PMJAY quality incentive through NABH Entry Level certification.

PMJAY State-Wise Variations: What You Need to Know

While NHA sets the national framework, each state has its own SHA that manages empanelment. Key variations to be aware of:

Package top-ups: States like Kerala, Tamil Nadu, and Maharashtra have supplemented PMJAY with state-specific top-up packages (e.g., Tamil Nadu's Chief Minister's Comprehensive Health Insurance Scheme). Empanelled hospitals may be able to claim both.
Empanelment windows: Some states (notably UP, Bihar) open empanelment in specific quarters only. Monitor your SHA website.
Physical inspection timelines: In urban areas, inspection happens within 30-45 days. In remote states, it may take 60-90 days — plan accordingly.
State-specific packages: In addition to national packages, SHAs may have state-specific packages at different rate structures. Review your state's package list carefully.

Frequently Asked Questions About PMJAY Empanelment

How long does PMJAY empanelment take?

Typically 45-90 days from application to activation, depending on your state and the completeness of your application. States with large backlogs (UP, Bihar) may take longer.

Can a single-specialty hospital apply for PMJAY?

Yes. A single-specialty hospital (e.g., an eye hospital or a maternity home) can apply for the relevant package categories only. You are not required to apply for all packages.

Is PMJAY empanelment compulsory for NABH accreditation?

No — PMJAY and NABH are independent programs. However, NABH accreditation significantly improves your PMJAY claim rates (10-15% incentive), so they are strongly complementary.

Can a hospital be de-empanelled?

Yes. SHAs de-emPanel hospitals for upcoding, fraud, persistent claim violations, ABDM non-compliance, or failure to maintain infrastructure standards. De-empanelment leads to blacklisting from the SHA database.

Action Plan: Getting Empanelled in 90 Days

Week 1-2: Conduct a self-assessment gap analysis. Identify missing documents, infrastructure gaps, and specialists needed.
Week 3-4: Register on HFR (ABDM). Begin NABH Entry Level application if not already accredited (see our NABH Entry Level guide).
Week 5-6: Compile all 25+ documents. Implement or upgrade HMS to an ABDM-compliant platform like Adrine.
Week 7: Submit online application on HEM portal and pay empanelment fee.
Week 8-10: Respond to SHA queries, prepare for physical inspection.
Week 11-12: Sign MoA, train staff on PMJAY workflow, configure TMS integration in HMS.
Week 13+: Go live, monitor claim acceptance rate, and optimize documentation.

PMJAY empanelment is one of the best investments a private hospital in India can make in 2026. With 12 crore+ families covered and the government actively pushing for more empanelled providers, the revenue opportunity is substantial — provided your documentation, ABDM compliance, and claim processes are in order. Explore how Adrine HMS can streamline your PMJAY journey from empanelment to claims.

Ayushman Bharat PMJAY Hospital Empanelment 2026: Complete Registration Guide