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1563041/2023/AYU.BHT(OPR)

Annexure-2

Ayushman CAPF Convergence Scheme

User Manual for BIS and TMS

1. Beneficiary Identification System (BIS) Process Flow

Ayushman CAPF card provided to beneficiaries by their respective forces/units are inactive and those may
be activated at empaneled hospital after e-KYC authentication. The existing PM-JAY BIS module is to be
used for authentication of CAPF beneficiaries. Activation of Ayushman CAPF card is one time activity only
for the beneficiary.

Following mechanism will be used for CAPF beneficiary verification.

• For a CAPF beneficiary to avail services, the beneficiary must present their Ayushman CAPF card/
Force ID at the empaneled EHCP.
• To confirm the identity, beneficiary must provide any valid government approved individual &
family ID to support authentication process.
• Once the card is approved in the system by the NHA authorized ISA at L1 approver level or the
respective force at L2 approver level, the beneficiary can avail cashless healthcare services at the
EHCP.
• No physical Card will be generated for Ayushman CAPF beneficiaries in the BIS on the
submission of eKYC by PMAM.

The process flow for CAPF beneficiary verification is depicted below.

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List of valid individual IDs and family IDs is given in below table.

Valid Govt. approved Individual IDs Valid Family IDs

i. Adoption Certificate ix. Freedom Fighter Photo i. Ration Card
ii. Any other MHA certified Card ii. Birth/ Adoption
ID x. Kissan Photo Passbook Certificate
iii. Birth Certificate xi. Marriage Certificate iii. Marriage Certificate
iv. Dependent ID Card issued by Government iv. Any other MHA certified
v. Disability ID Card/ xii. MNREGA Job Card ID
handicapped medical xiii. PAN Card v. Service Certificate
certificate issued by xiv. Passport vi. Dependent Card
respective State/ UT xv. Pensioner Photo Card
vi. Driving License xvi. Ration Card
vii. Employee ID Card xvii. Service Certificate
viii. Force ID xviii. Voter ID Card

Step by step process for Beneficiary Identification System (BIS)

Step 1: After logging in, PMAM to use “Search Beneficiary” (ref to point 1 in the below picture)
functionality available on the left menu for searching beneficiary in the system

1
2
4

3
5

Step 2: Select Scheme from the drop down (ref to point 2 in the above picture)

Step 3: Search using the Force ID or Ayushman CAPF ID (ref to point 3 in the above picture)

Step 4: If selected search parameter is Force ID, then in Sub-Scheme (ref to point 4 in the above picture)
beneficiary’s Force Type is to be selected from the dropdown list of 7 Force Types.
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Step 5: Enter Force ID (ref to point 5 in the above picture) and hit the ‘Search’ option. List of all
beneficiaries linked to that particular Force ID will appear on the screen (ref to below picture)

PMAM then click on “Collect KYC” option (ref to point 6 in the above picture) against the particular
beneficiary for whom eKYC is to be done.

Step 6: PMAM to select one mode of eKYC basis beneficiary’s consent - Aadhaar based or Non-Aadhaar
based (ref to point 7 in the below picture)

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Aadhaar-based authentication (Highly recommended)

a) PMAM takes verbal consent for Aadhaar e-KYC authentication

b) Select one of the Aadhaar ‘authentication type’ option from the dropdown
c) PMAM may undertake biometric authentication using any of the following options: -
➢ Fingerprint based (using Fingerprint Scanner)
➢ Iris scan based (using Iris Scanner)

Note: Aadhaar authentication is not synonymous to submitting copy of the Aadhaar card for uploading
on NHA’s IT platform.

Non Aadhar-based authentication (Not recommended)

a) Take verbal consent from beneficiary

b) Enter Mobile number and select relation type from the dropdown
c) Select Personal ID type from the dropdown, enter ID number.
d) Collect information from the beneficiary and fill the details prompted by system
e) Scan and upload documents (one of the valid documents from the list mentioned in table given
on page 2)

For Non-Aadhaar based authentication, ref to the below picture.

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Step 7: For ‘Family details’, select any Govt. ID from the drop-down list and enter ID number, upload
front and back photo of the family document and enter name of each family member mentioned in the
uploaded document and submit.

List of valid Government ID is given in table on page 2.

For Family details section, ref to the below picture.

Step 8: On submission, system would ask PMAM for confirmation.

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Step 9: Subsequently, beneficiary data is saved and forwarded for approval.

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2. Transaction Management System (TMS) Process Flow

At the EHCP, the beneficiary can avail cashless healthcare services on producing the active Ayushman
CAPF card. The process of patient registration, pre-authorization, submission of claim, claim processing
and electronic transfer of payment of approved claims to EHCP’s bank account is same as in AB PM-JAY
scheme.

The process flow in TMS portal for Ayushman CAPF scheme is depicted below.

Following are the key points regarding Ayushman scheme.

1 CAPF is a ‘state’ in the system and available in Portability mode only (not in Normal mode)
2 State specific PMJAY package would be applicable
3 Cashless healthcare services to CAPF beneficiaries would only be for IPD services in General Ward
4 MEDCO will use AB PM-JAY portal and login ID for registering CAPF patients
5 Pre-authorization and Claim processing would be done by ISA appointed by NHA
6 No referral would be required for availing services in PM-JAY private EHCPs

Step by step process for Transaction Management System (TMS) is shown below

Step 1: Log in into OneTMS portal (tms.pmjay.gov.in) and switch to Portability mode (ref to point 1 in
below picture)

Step 2: From the dropdown list, select “CAPF” as the “Patient State” (ref to point 2 in below picture)
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Step 3: Click on Registrations tab and then PM-JAY Registration

Step 4: Select ‘CAPF’ from Scheme dropdown

Step 5: Enter ID number

Step 6: System would automatically populate ID type field as per entered ID number

Step 7: On clicking ‘Retrieve’ button – all details of the beneficiary would be fetched.
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Beneficiary
Photo from
source
database

Step 8: Further steps are to be followed as in AB PM-JAY

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1563041/2023/AYU.BHT(OPR)
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1563041/2023/AYU.BHT(OPR)

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Government of lndia
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Dr. Vipul Aggarwal, trs
Deputy Chief Executive Officer
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National Health Authority

s-1201sI 22 / 2020- N HA( H NW&QA)-Pa rt(2)

Dated: 13th Agril202Z
To,
Chief Executive Officer (CEO)
State Health Agency

Subject: Extending healthcare services to Ayushman CAPF beneficiaries under AB PM-JAY ecosystem

Madam/Sir,

National Health Authority (NHA) has entered into an MoU with Ministry of Home Affairs (MHA)
to provide cashless healthcare services to serving personnel and their dependents of CAPF. The scheme
is called Ayushman CAPF and is being implemented for the personnel Assam Rifles (AR), Border Security
Force (BSF), Central lndustrial Security Force (CISF), Central Reserve Police Force (CRPF), lndo-Tibetan
Border Police (ITBP), National Security Guard (NSG) and Sashastra Seema Bal (SSB).

2. The pilot for Ayushman CAPF was launched in Guwahati in January 2A2t. Scheme was
subsequently expanded to pan lndia in hospitals empaneled with CGHS and onboarded on NHA's lT
platform for convergence project. lt has been decided that from 20th April 2022, Ayushman CAPF scheme
will be rolled out in private hospitals empaneled with SHA/NHA under AB PM-JAY. Ayushman CAPF
beneficiaries willing to avail cashless healthcare services in these hospitals as per defined AB PM-JAY
health benefit packages (HBPs) can do the same.

3. The empaneled hospitals will be submitting the request for pre-authorization and claim
processing on NHA's lT platform. Across the States/UTs beneficiaries will be availing services under the
portability mode. TMS and BIS platforms will be used for recording the transactions and beneficiary
identification respectively. EHCPs will be paid as per applicable state specific AB PM-JAY rates. Claim
processing and payment will be done by NHA. For the roll out, NHA will provide requisite training and
handholding of private EHCPs under AB PM-JAY.

4. State health agencies (5HAs) are requested to kindly communicate to empaneled hospitals about
the launch of the scheme. Further, EHCPs should be asked to start providing cashless services to CAPF
beneficiaries from the launch date.

Yours Sincerely

Copy to:
L Joint Secretary, MHA (P-ll)
2 Director, MHA (P&C)
3 PPS to CEO, NHA
4 PPS to AddI. CEO, NHA
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