Ayushman Bharat & state schemes
Hospital revenue integrity in Northeast India.
Wide catchment areas, long referral chains, and significant out-of-state patient movement into regional hubs.
Cities in Northeast India
Reading
How the scheme actually works here
PM-JAY alongside state schemes, with the defining feature being geography rather than policy: catchment areas are very large, referral chains are long, and patients frequently cross state lines to reach a regional hub.
The payer mix in Northeast India
Guwahati serves the entire Northeast. Imphal and Shillong serve wide hill catchments with long travel times.
Where hospitals here lose money
A patient from one state treated in another needs eligibility established across a boundary, and the referral evidence often travels slower than the patient.
Long travel and longer referral chains push admissions past notification windows that assume local patients.
Records originating in another state arrive incomplete or late.
Check this week
Measure time from admission to payer notification for out-of-state patients separately. If it differs materially from local patients, the window is being missed on geography, not on process.
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 Northeast India 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 Northeast India
Questions from Northeast India
Does Drapto work with Ayushman Bharat & state schemes in Northeast India?
Yes. Package rates are held per scheme, so a case can be checked for viability before admission rather than at billing. PM-JAY alongside state schemes, with the defining feature being geography rather than policy: catchment areas are very large, referral chains are long, and patients frequently cross state lines to reach a regional hub.
What do hospitals in Northeast India lose the most money to?
Out-of-state scheme eligibility. A patient from one state treated in another needs eligibility established across a boundary, and the referral evidence often travels slower than the patient.
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 Northeast India?
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 Northeast India 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 North EastA repudiated cashless claim in North East is generally heard by the Guwahati office, which broadly covers Assam; Meghalaya. 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.
See it on your own claims.
The payer mix is local. The mechanism is not — and it is the mechanism we show you.