MJPJAY / Ayushman Bharat
Hospital revenue integrity in Maharashtra.
Mahatma Jyotirao Phule Jan Arogya Yojana runs alongside PM-JAY, with its own package list and empanelment. Hospitals commonly carry both, and the package rate for the same procedure can differ between them.
Cities in Maharashtra
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How the scheme actually works here
MJPJAY and PM-JAY run in parallel in Maharashtra, and most empanelled hospitals carry both. The practical consequence is that the same procedure can attract two different package rates depending on which scheme the beneficiary falls under, and the front desk has to establish which one applies before admission rather than at billing.
The payer mix in Maharashtra
Maharashtra has the widest payer spread of any Indian state. Mumbai and Pune carry dense corporate group cover and high private-pay share; Nagpur and Aurangabad draw scheme volume from a large rural catchment. A group operating across the state is effectively running two different businesses.
Where hospitals here lose money
A case admitted under the wrong scheme is re-worked at billing or written off. Establish eligibility before admission, not after.
High sums insured mean high room entitlements, which makes upgrades feel affordable. The proportionate deduction does not care.
A Mumbai unit and a Nagpur unit on different versions of the same payer contract is the most common finding in a Maharashtra group.
Check this week
Pull one month of scheme admissions and count how many were re-classified after admission. If it is more than a handful, the problem is at the desk, not in billing.
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 Maharashtra 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 Maharashtra
Mumbai · Pune · Nagpur · Nashik · Chhatrapati Sambhajinagar
Questions from Maharashtra
Does Drapto work with MJPJAY / Ayushman Bharat in Maharashtra?
Yes. Package rates are held per scheme, so a case can be checked for viability before admission rather than at billing. MJPJAY and PM-JAY run in parallel in Maharashtra, and most empanelled hospitals carry both.
What do hospitals in Maharashtra lose the most money to?
Dual-scheme confusion. A case admitted under the wrong scheme is re-worked at billing or written off. Establish eligibility before admission, not after.
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 Maharashtra?
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 Maharashtra as everywhere else.
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 MaharashtraA repudiated cashless claim here is generally heard by the Mumbai or Pune offices, broadly covering Goa; Mumbai Metropolitan Region. 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
Maharashtra| State scheme | Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) |
| Alongside | Ayushman Bharat PM-JAY, private insurers and TPAs |
| Why it matters here | Runs converged with PM-JAY. Package rates and the empanelment route are state-defined. |
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.