Function | Trust (Uttar Pradesh) | Insurance (Jharkhand) |
---|---|---|
Provider contracting | Final approvals provided by the state health agency through district and state empanelment committees | Final approvals provided by the state health agency through district and state empanelment committees. These committees include a representative of the insurance company, among their members |
Claim processing | By implementation support agency, with verification and final decision on claims by the state health agency | By third-party administrators contracted by the insurance company, with random verification of a sample claims by the insurance company. The state health agency only audits rejected claims and a sample of approved claims |
Reimbursement of claims to providers | By the state health agency | By the insurance company. State health agency pays the premium to the insurance company |