Ayushman Bharat set for AI overhaul: Faster claims, fraud detection and digital medical records

The Central government plans an artificial intelligence (AI)-led upgrade of Ayushman Bharat, focusing on automating insurance claims, improving fraud detection, and digitising 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).

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The government is looking at greater automation in insurance claims settlement through auto-adjudication, which could reduce processing timelines and operational costs. The National Anti-Fraud Unit (NAFU) is also expected to play an important role in strengthening fraud prevention, monitoring, and accountability under the scheme.

The AI push also extends to medical records. At a national review meeting last week, 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 they are linked to the Ayushman Bharat Health Account (ABHA).

The technology could reduce the documentation burden on doctors and help hospitals move towards digital clinical records.
The government is also looking to improve the integration of hospital information systems with the National Health Claims Exchange (NHCX), which is intended to facilitate the exchange of health insurance claims data. Greater digital integration across hospitals and technology providers is expected to improve the speed and accuracy of claims processing.

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Another area of focus is the use of AI models suited to Indian healthcare settings. The NHA highlighted the Benchmarking Open Data Platform for Health AI (BODH), 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.

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.

“Focus must shift from financing treatment to achieving better health outcomes,” Barnwal said, underlining the need to measure the success of the scheme in terms of healthcare outcomes rather than financial coverage alone.

The technology push comes as the government seeks to strengthen the implementation of AB PM-JAY and ABDM through better integration of digital systems, improved monitoring, and more efficient delivery of healthcare services.