Ayushman Bharat Arogya Karnataka
Hospital revenue integrity in Karnataka.
The state scheme is integrated with PM-JAY, so a single empanelment covers both but with state-specific package rates for some procedures.
Cities in Karnataka
Reading
How the scheme actually works here
The state scheme is integrated with PM-JAY, so a single empanelment covers both — but state-specific package rates apply to some procedures. Hospitals often assume one rate card where two apply.
The payer mix in Karnataka
Bengaluru carries the highest concentration of corporate group cover in the country. Mysuru, Hubballi and Mangaluru run a more balanced scheme-and-private mix with strong referral inflow.
Where hospitals here lose money
Employer policies carry their own room caps, sub-limits and approval chains, and they differ between employers. Verifying at admission is the only point it helps.
Assuming PM-JAY rates where a state-specific rate applies produces short payment that looks like a deduction and is actually a billing error.
Mangaluru units drawing patients from across the border need referral and eligibility evidence a purely local desk is not set up to collect.
Check this week
For your top five corporate payers, list the room entitlement and any procedure sub-limits on one sheet. Most hospitals cannot produce this, and it is a ten-minute fix per payer.
What does not change at the state border
Room-rent proportionate deduction, pre-authorisation notification clocks, tariff drift against contract, and package-with-component billing work identically in Karnataka and everywhere else in India. They vary by contract, not by geography. What the state changes is the scheme layer sitting on top — which cases are viable, and what evidence the payer expects.
Worked through in detail: the nine ways an Indian payer reduces a claim, how scheme claims differ from private ones, and the ₹8,000 upgrade that costs ₹43,000.
Cities we cover in Karnataka
Questions from Karnataka
Does Drapto work with Ayushman Bharat Arogya Karnataka in Karnataka?
Yes. Package rates are held per scheme, so a case can be checked for viability before admission rather than at billing. The state scheme is integrated with PM-JAY, so a single empanelment covers both — but state-specific package rates apply to some procedures.
What do hospitals in Karnataka lose the most money to?
Corporate policy caps discovered late. Employer policies carry their own room caps, sub-limits and approval chains, and they differ between employers. Verifying at admission is the only point it helps.
Do the payer rules change between states?
The scheme layer does — package lists, empanelment and eligibility are state-specific. The mechanics underneath do not. Room-rent proportionate deduction, notification clocks and tariff drift work identically everywhere in India; they vary by contract, not by geography.
Is Drapto available across Karnataka?
Yes, anywhere in the state. Deployment is remote and takes one to five weeks depending on size, with your payer tariffs loaded before go-live rather than after.
What does the free audit involve?
Twenty claims you have already settled. We show what was disallowed, how much was predictable, and how much the payer never explained. About an hour of your team's time, and you keep the findings whatever you decide.
Read next
The scheme changes at the state border. The payer mechanics do not — room caps, notification clocks and tariff drift work the same way in Karnataka as everywhere else.
Every way an Indian payer reduces a claim →
Other states
Read next
What is not on this page. We do not publish hospital directories, rank hospitals, or list which facilities sit on any insurer’s or scheme’s panel. Empanelment is product-specific and changes constantly — a stale list published by a third party sends a family to a hospital believing they are covered when they are not.
Your Insurance Ombudsman
For repudiated claims in KarnatakaA repudiated cashless claim here is generally heard by the Bengaluru office, broadly covering Karnataka. Filing costs nothing and needs no lawyer, but there is a one-year clock from the insurer’s final reply.
Jurisdiction is defined by district in several states. Confirm yours against the Council for Insurance Ombudsmen’s list before filing.
The scheme you actually bill
Karnataka| State scheme | Ayushman Bharat Arogya Karnataka (AB-ArK) |
| Alongside | Ayushman Bharat PM-JAY, private insurers and TPAs |
| Why it matters here | Converged scheme. Referral from a public facility is required for many procedures. |
Tariffs are held per payer and per contract in Drapto, so a claim is never priced under the wrong one.
Verify before you rely on this. State schemes are renamed and revised with budgets and governments. Check the current position with the state health agency.
See it on your own claims.
The payer mix is local. The mechanism is not — and it is the mechanism we show you.