Government Plans AI-Led Upgrade of Ayushman Bharat for Claims Processing & Digital Health Records

The proposed interventions include greater use of automated claims processing, AI-enabled clinical documentation, and data analytics to strengthen implementation of the AB PM-JAY and ABDM.

The Central government has announced plans to integrate AI to automate Ayushman Bharat health insurance claims.

Reportedly, plans are underway to implement AI in fraud detection along with digitisation of medical records to make healthcare delivery more efficient.

The proposed interventions include greater use of automated claims processing, AI-enabled clinical documentation, and data analytics to strengthen implementation of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and the Ayushman Bharat Digital Mission (ABDM).

“Every rupee spent on healthcare must lead to better care for our people. Technology, data and artificial intelligence can strengthen implementation, improve efficiency and support more informed decision-making,” said Dr Sunil Kumar Barnwal, Chief Executive Officer of the National Health Authority (NHA).

Under the proposed changes, the government is looking to expand automation in health insurance claims settlement through auto-adjudication.

The approach could reduce claim processing timelines and associated operational costs. The National Anti-Fraud Unit (NAFU) is also expected to strengthen fraud prevention, monitoring, and accountability under AB PM-JAY.

Further, the AI push also extends to medical records. At a recent national review meeting, the NHA demonstrated an AI-enabled voice scribe that converts doctor-patient conversations into structured clinical records in multiple Indian languages. Doctors review and approve these records before linking them to the Ayushman Bharat Health Account (ABHA).

The voice-scribe technology is intended to reduce the documentation burden on doctors and support the transition towards digital clinical records.

The NHA also highlighted the Benchmarking Open Data Platform for Health AI (BODH), which has been developed to evaluate and benchmark healthcare AI models using Indian datasets. States have been encouraged to use the platform to assess the performance and suitability of AI solutions before adopting them in healthcare settings.

Meanwhile, the government is also examining ways to improve the integration of hospital information systems with the National Health Claims Exchange (NHCX), which facilitates the exchange of health insurance claims data.

Greater digital integration between hospitals and technology providers is expected to support more efficient and accurate claims processing.

The Health Analytics and Artificial Intelligence Unit also presented findings on data quality. States have committed to establishing dedicated analytics and AI teams to strengthen data-driven planning and decision-making.

Emphasising the need to assess healthcare programmes through their impact on patients, Barnwal said, “Focus must shift from financing treatment to achieving better health outcomes.”

The proposed AI interventions form part of the government's broader efforts to strengthen AB PM-JAY and ABDM through digital integration, automated processes, improved monitoring and data-driven healthcare delivery.

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