PMJAY claim rejected: file on CGRMS, escalate, then use RTI

Reviewed on: 2026-08-27.

cgrms.nha.gov.in is the Centralized Grievance Redressal Management System, CGRMS, run by the National Health Authority for Ayushman Bharat PM-JAY, and it was verified live and reachable while this guide was written. The NHA's own website navigation lists it as the “Grievance Portal”. The NHA's grievance-redressal guideline gives its original address as cgrms.pmjay.gov.in - the same system, also live; if one address ever fails you, try the other.

The portal states its own scope plainly, and these four lines come straight from its screens: a grievance “can be lodged by any stakeholder for AB PM-JAY and Convergence schemes”; you can “track real time status of grievance based on Unique Grievance Number (UGN)”; registered grievances “are closely monitored and redressed by the Nodal Grievance Officers/Committees”; and feedback can be given on redressal. A February 2025 statement of the Ministry of Health and Family Welfare in Parliament confirms the same system from the government side: grievances can be filed through the “web-based portal Centralized Grievance Redressal Management System (CGRMS), Central & State call centers (14,555), email, letter to SHAs etc”.

One number to carry before anything else: 14555, the toll-free PM-JAY helpline. It is printed on the NHA website, in the CGRMS portal itself, and in both the Parliament reply and the ministry's press releases quoted in this guide.

The portal works on an OTP, so keep the mobile phone handy before you start. The flow below is the one the portal actually presents, field by field.

1. Register the grievance. Choose who you are filing as - the portal calls this the applicant type - and confirm the scheme: it asks whether you are raising the grievance under PM-JAY, and otherwise lets you pick the scheme. You then enter your Scheme ID or Ayushman Card ID.
2. Pick the grievance type and sub-type. The portal asks for a Grievance Type and a Grievance Sub Type - the nature of the grievance. “Denied Treatment” and “Claim Adjudication” are among the sub-types it offers, and there is a dedicated sub-type for “Correction in Ayushman Card”. If your fight is about a claim, have the Claim ID and the claim submission date ready.
3. Identify the hospital. You enter the hospital name or ID, its type, and the state and district of both the beneficiary and the hospital. The portal also asks whether the patient is currently in hospital - answer this truthfully, because an in-hospital grievance moves on a faster clock.
4. Describe and upload. Write the grievance description. You can attach supporting documents in PDF, JPEG or PNG up to 10 MB each, and the portal also accepts audio and video evidence - MP3, MP4, MOV, AVI, MPEG, MPG or AMR - within the same 10 MB limit. Attach the denial slip, the bills if you were forced to pay, and the prescription.
5. Declare and verify. Tick the declaration that the facts stated are true to the best of your knowledge, and enter the OTP sent to your mobile number.
6. Save the UGN. The portal generates a Unique Grievance Number - the screen calls it your UGN for future reference. Write it down exactly. This one number is your handle for tracking, appeals and any RTI later.

If you cannot use the portal, the guideline allows the same grievance by other routes: the call centre at 14555 (call-centre executives register the details in CGRMS themselves and forward them to the district nodal officer), a letter, telephone call, e-mail or fax to the State Health Agency or the NHA, or directly to the District Grievance Nodal Officer, who must enter offline grievances into the portal.

Go back to cgrms.nha.gov.in, choose Track Status, and enter the UGN - the portal allows a fresh lookup only after a short wait between attempts. The status moves through a fixed vocabulary: Pending, Queried (an officer has asked for something), Received/Forwarded, Escalated, Resolved, Closed. Beyond the first reply you also see Appealed and Re-Opened, and you can Withdraw a grievance yourself. If the status sits still, the escalation path below tells you which committee now owns it - and the portal's own dashboards count auto-escalated grievances, so movement upward is part of the design, not a favour.

Give feedback when the case closes: the portal has a feedback step, and your answer is part of the record the committees review.

Hospitals rarely say “claim rejected” in those words at the desk. What they say - and what the portal categories map to - usually falls into one of these:

1. “Not in the package.” The ministry describes around 2,000 medical procedures covered as packages with fixed rates. If the procedure genuinely is not on the list, it is not covered; but a hospital calling a covered procedure uncovered to demand cash is the classic violation. The recorded rejection reason, which an RTI extracts, settles which one it was. If the problem is a cash demand at the counter rather than a claim rejection, see the guide to cashless denial and hospital complaints.
2. “Your card is invalid” or “you are not eligible.” This is a database problem - name mismatch, a flagged record, or a wrong entry - not a medical decision. The portal's “Correction in Ayushman Card” sub-type exists exactly for this. Eligibility itself can be checked at beneficiary.nha.gov.in, the NHA “Am I Eligible” portal.
3. “The insurance company rejected the claim.” In insurance-mode states the claim passes through an insurer or TPA, and rejections land in the “Claim Adjudication” category. The matrix routes these to the State Grievance Nodal Officer.
4. “Cover exhausted.” In insurance-mode states the guideline itself recognises disputes where the amount demanded exceeds the package rate because the cover is insufficient or exhausted - a legitimate category, but one where the hospital must still follow the process, not quietly bill the patient.
5. “We are not empanelled for this.” Empanelment is specific and recorded. An RTI can get the hospital's empanelment status and validity from the State Health Agency - and since February 2025 the NHA's Hospital Engagement Module 2.0 verifies private hospitals physically and reviews them periodically.

One rejection reason you can firmly cross off: pre-existing disease. The ministry's own release on the Vay Vandana expansion states the scheme “covers all pre-existing diseases from first day itself without any waiting period”. No hospital can lawfully refuse a covered package because the illness existed before enrolment.

The escalation is not an informal appeal to whoever will listen. The NHA's Grievance Redressal Guidelines define the ladder, and the February 2025 Parliament reply confirms a three-tier system - District, State and National - with a dedicated nodal officer and Grievance Redressal Committee at each tier.

Who chairs these committees is fixed by the guideline: the District Grievance Redressal Committee is chaired by the Head of the District - the District Magistrate, District Collector or Deputy Commissioner; the State Grievance Redressal Committee is chaired by the CEO of the State Health Agency or State Nodal Agency; and the National Grievance Redressal Committee is chaired by the Deputy CEO of the NHA. The district and state committees meet every month. Every state has one State Health Agency implementing PM-JAY; its office and nodal officers are the address your written escalations go to.

And the system has teeth against hospitals, not just patients: the Parliament reply records that State Health Authorities can act against errant hospitals by de-empanelling them, levying penalties, suspending them, issuing warning letters, and lodging FIRs.

1. 14555 - the toll-free national PM-JAY helpline, verbatim on the NHA site, inside the CGRMS portal, and in the ministry's releases. States also run their own call centres; grievances phoned in are registered in CGRMS by the call-centre executives.
2. 1800110770 - a missed-call line the ministry gives specifically for information on the Vay Vandana senior-citizen card.
3. CPGRAMS at pgportal.gov.in - the central government grievance portal, a useful parallel route with its own appeal step, which reaches the right ministry department.
4. Letter, e-mail or fax to the State Health Agency or the NHA - the guideline's offline route; always take or keep proof of dispatch.
5. The hospital help desk. Every empanelled hospital must mandatorily run a help desk - the Arogya Mitra Sahayta Kendra, staffed by the Pradhan Mantri Arogya Mitra - to help beneficiaries complete formalities, verify identity, choose packages and obtain authorisations. It is the first place to demand the denial in writing.

Ayushman Bharat PM-JAY, launched on 23 September 2018 at Ranchi, gives eligible families cashless and paperless cover of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation at empanelled hospitals. It is the world's largest government-funded healthcare programme. Since 29 October 2024, every senior citizen aged 70 and above also gets Rs 5 lakh a year through the Ayushman Vay Vandana card, irrespective of socio-economic status - a top-up for families already covered, and senior citizens already covered by CGHS, ECHS or similar schemes choose one scheme or the other.

There is no PMJAY Act. PM-JAY is a centrally sponsored scheme run on guidelines issued by the National Health Authority, which is an attached office of the Ministry of Health and Family Welfare. The grievance timelines and committees described above come from those binding guidelines, not from statute.

What is enforceable at the hospital counter is the empanelment itself: under the terms and conditions of empanelment, hospitals are mandated to provide scheme services to eligible beneficiaries. Demanding money for a covered package breaches those terms, and that is precisely what the grievance system and the SHA's penalty powers exist for.

Because the NHA and the State Health Agencies are public authorities, the Right to Information Act 2005 applies to them. An RTI under Section 6(1) can demand the recorded reason for a rejection, the hospital's empanelment status, and the action taken on your grievance number - the written record that verbal assurances never give you. See the full RTI Act 2005, and the deeper RTI guide for an Ayushman Bharat claim denial.

1. Ask for the denial in writing at the help desk. Note the date, time and the staff name. A verbal “not covered” is what the hospital hopes you will accept; the written slip is what the committee and the PIO will act on.
2. Call 14555 from the hospital itself. Give the hospital name, your card number and the exact refusal. The call centre registers the grievance in CGRMS; note the complaint or UGN reference.
3. Lodge on CGRMS the same day. Follow the form flow above, choose the sub-type that matches your case, and answer the still-in-hospital question honestly - that answer puts a 48-hour clock on the district nodal officer.
4. Do not pay quietly if you can avoid it. A covered package is meant to be cashless. If you are forced to pay, keep every bill, receipt and discharge summary - they are both the grievance evidence and the refund claim.
5. Watch the clock, then escalate. In-hospital and 48 hours pass, or after discharge 15 days pass: the case should move to the District Committee. Use the UGN to track, and quote it in every escalation. Appeal windows at each rung are 30 days.
6. File an RTI for the paper trail. The sample letter below asks for the recorded rejection reason, the hospital's empanelment status, the package position, and the action on your grievance. This is the step that most often unsticks a stalled claim.
7. Use CPGRAMS in parallel if you prefer - pgportal.gov.in, the central portal with its own appeal option.

• Ayushman Bharat or Vay Vandana card number and a copy of the card
• Beneficiary ID and a photo ID such as Aadhaar
• Name, address and hospital ID of the empanelled hospital
• The written denial slip, or a dated note of the verbal refusal with the staff name
• All bills and payment receipts if you were made to pay
• Doctor's notes, admission papers, the treatment or package name, and for claim disputes the Claim ID and claim submission date
• The UGN or the 14555 complaint number
• Documents and any audio or video evidence, each within 10 MB, ready to upload

• Waiting for the hospital to change its mind. The 48-hour clock runs from registration while the patient is in hospital. Register on CGRMS or through 14555 the same day.
• Losing the UGN. Without the Unique Grievance Number you cannot track, appeal, or anchor an RTI. Save it the moment the portal issues it.
• Accepting a verbal not covered. Make the desk write it, or write it yourself with date, time and name.
• Paying cash silently. For a covered package that is exactly what the system penalises hospitals for - but only if your bills and grievance exist.
• Believing the pre-existing disease excuse. The ministry's release is explicit: all pre-existing diseases are covered from day one, no waiting period.
• Skipping RTI. The recorded reason for rejection sits in a file the SHA holds. Section 6(1) puts it in your hands for Rs 10.

To,
The Central Public Information Officer,
State Health Agency / National Health Authority,
[full office address]

Subject: Request for information under the RTI Act 2005 - PM-JAY
claim rejection and grievance number [UGN]

Sir/Madam,

Under Section 6(1) of the Right to Information Act 2005, I request
the following information regarding my Ayushman Bharat PM-JAY case.

My card number: ____________
Hospital name and address: ____________
Date of admission / denial: ____________
Grievance number (UGN): ____________

1. The recorded reason for rejecting cashless treatment or the claim
   in my case, with copies of the relevant file notings.
2. Whether the above hospital is currently empanelled under PM-JAY,
   with the date and validity period of its empanelment.
3. Whether the procedure or package in my case is covered under
   PM-JAY, with the package code and rate.
4. The action taken on my grievance number (UGN) registered on CGRMS,
   its current status, and the officer responsible.
5. Whether any penalty, warning or action has been taken against the
   hospital for refusing cashless treatment to beneficiaries.

If any part is held by another authority, please transfer it under
Section 6(3) and inform me. I request the reply within the time fixed
under Section 7(1). I am eligible for a fee waiver if I am below the
poverty line and enclose proof; otherwise I enclose the Rs 10
application fee.

If the reply is not received in time, I reserve my right of first
appeal under Section 19(1).

Place:
Date:
Signature:
Name and full address:

If the office gives no reply or an evasive one, move a first appeal - build it with the First Appeal Builder. To draft a fresh RTI fast, try the AI RTI Drafter, or the AI RTI Drafter tool. If typing is hard, use the AwaazRTI voice tool.

cgrms.nha.gov.in - the Centralized Grievance Redressal Management System of the National Health Authority, verified live at the time of writing and linked as the Grievance Portal from the NHA website. The older address in the NHA guideline, cgrms.pmjay.gov.in, is the same system and also works. Any other site asking money to lodge an Ayushman grievance is not the official portal.

Open the CGRMS portal, choose Track Status, and enter your Unique Grievance Number, the UGN the portal issued when you filed. The status shows as Pending, Queried, Received/Forwarded, Escalated, Resolved or Closed, and changes to Appealed or Re-Opened after an appeal. The portal enforces a short wait between lookups, so note the UGN down rather than retrying in a loop.

14555, toll free. It appears on the NHA website, inside the CGRMS portal, and in the Ministry of Health statements to Parliament. State call centres also take PM-JAY grievances and register them in CGRMS. For the Vay Vandana senior-citizen card specifically, the ministry also gives a missed-call line, 1800110770.

Only if the procedure genuinely is outside the package list - the ministry describes around 2,000 covered procedures at fixed package rates. Ask the help desk to state the rejection in writing with the package lookup, lodge a Denied Treatment grievance on CGRMS while the patient is admitted, and if needed use RTI to get the recorded reason and the package position. A covered procedure refused for cash is exactly what the grievance committees and the State Health Agency's penalty powers handle.

Not for a covered package. Under the terms of empanelment, hospitals are mandated to provide scheme services to eligible beneficiaries, and PM-JAY is cashless and paperless at the point of care. Demand in writing, call 14555, lodge on CGRMS, keep every bill - refunds of forced payments are pursued through the same grievance record.

While the patient is in hospital: the District Grievance Nodal Officer is to resolve it within 48 hours, failing which it goes to the District Committee. For grievances raised at or after discharge: the DGNO has 15 days, the District Committee 30 days after that. Appeals at each level are within 30 days, and each committee - District, State, then National - has 30 days to decide, with the National committee's decision final.

No. PM-JAY is a centrally sponsored scheme run by the National Health Authority on government guidelines, not an Act of Parliament. The timelines and committees come from the NHA Grievance Redressal Guidelines. The Act you can quote against the NHA or a State Health Agency is the RTI Act 2005, because both are public authorities.

Yes. Since 29 October 2024, every senior citizen aged 70 and above gets Rs 5 lakh a year through the Ayushman Vay Vandana card, irrespective of socio-economic status - an additional top-up for families already covered. Senior citizens already covered by CGHS, ECHS or similar schemes choose one scheme or the other. Register at an empanelled hospital, on the Ayushman app, or at beneficiary.nha.gov.in.

No. The Ministry of Health and Family Welfare states the cover applies to all pre-existing diseases from the first day, without any waiting period. If a hospital cites your medical history as the reason, that is not a scheme ground - record it and grievance it.

The recorded reason for the rejection, the hospital's empanelment record, the package status and the action on your UGN all sit in files the State Health Agency or NHA hold. An RTI under Section 6(1) gets you certified answers for Rs 10 within 30 days - the written record that turns your word against the hospital into a document a committee must deal with.

Keep every bill and receipt, and say so in the grievance: demanding money for a covered package is a recognised grievance category both before and after discharge. Track the case by UGN, and if the reply claims the package was uncovered, use RTI to get the package position in writing - that answer is the basis for demanding the refund.

On the NHA beneficiary portal at beneficiary.nha.gov.in - the Am I Eligible service - or through the Ayushman app, or at any empanelled hospital's help desk. For the Vay Vandana card the ministry also gives the 14555 helpline and the 1800110770 missed-call line.

You still hold two general legal routes: a consumer complaint for deficiency of service against the hospital, and a writ petition to the High Court under Article 226 against an authority that fails to act. Both are last resorts after the grievance ladder and your RTI record - and both are stronger with the UGN trail and the RTI replies attached.

• National Health Authority, Grievance Portal (CGRMS) - https://cgrms.nha.gov.in
• NHA website (About, Am I Eligible, helpline 14555) - https://nha.gov.in
• NHA beneficiary portal (Am I Eligible, Vay Vandana self-registration) - https://beneficiary.nha.gov.in
• NHA Guidelines for Grievance Redressal (committees, DGNO/SGNO/NGNO, 48-hour and 30-day matrix, lodging channels, UGN) - https://cdnbbsr.s3waas.gov.in/s3169779d3852b32ce8b1a1724dbf5217d/uploads/2022/05/2022051099.pdf
• NHA Guidelines for Ayushman Mitra (mandatory hospital help desk) - https://cdnbbsr.s3waas.gov.in/s3169779d3852b32ce8b1a1724dbf5217d/uploads/2022/05/2022051064.pdf
• PIB, MoHFW, 4 February 2025 - three-tier grievance system, CGRMS and 14,555 call centres, action against errant hospitals - https://www.pib.gov.in/PressReleasePage.aspx?PRID=2099547&reg=3&lang=1
• PIB, MoHFW, 9 December 2024 - Vay Vandana launch 29 October 2024, Rs 5 lakh for all senior citizens 70+, pre-existing diseases covered from day one, 14555 and 1800110770 - https://www.pib.gov.in/PressReleasePage.aspx?PRID=2082288&reg=3&lang=1
• PIB, MoHFW, 22 September 2018 - PM-JAY launch at Ranchi, Rs 5 lakh per family per year, cashless and paperless - https://www.pib.gov.in/Pressreleaseshare.aspx?PRID=1546948
• CPGRAMS central grievance portal - https://pgportal.gov.in
• Right to Information Act 2005 - https://righttoinformation.wiki/act

• RTI Act 2005 full text and sections
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