The National Health Claim Exchange is a digital health claims platform developed by the National Health Authority to ensure interoperability and faster processing of health insurance claims.
Reportedly, the National Health Claim Exchange (NHCX) is ready and is likely to be launched in the next two to three months. The claim exchange has been developed as part of Ayushman Bharat Digital Mission (ABDM).
The Insurance Regulatory and Development Authority of India (Irdai), through a circular in June 2023, had advised all insurers and providers to onboard the NHCX.
Several insurance companies such as Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance Company, and HDFC Ergo Insurance, ICICI Lombard General Insurance, The New India Assurance Company, Tata AIG General Insurance company, Paramount TPA, United India Insurance Company have completed NHCX integration.
Currently, insurance companies have separate portals, making it cumbersome and time-consuming for hospitals, patients, and other stakeholders to process health insurance claims.
What Will Change?
The current process of exchanging claims lacks standardisation across the ecosystem with most data exchange occurring through PDF/manual methods and the processes vary significantly among insurers, TPAs, and providers, leading to high cost of processing each claim.
Through NHCX, all insurance companies will be on a single platform. It will serve as a gateway for exchanging claims-related information among various stakeholders in the healthcare and health insurance ecosystem.
The integration with NHCX is expected to enable seamless interoperability of health claims processing, enhancing efficiency and transparency in the insurance industry, and benefitting policyholders and patients.
Meanwhile, industry players are expecting that the government-led platform is going to benefit the health insurance sector and its stakeholders including the policyholders.
Amitabh Jain, COO, Star Health Insurance, said that NHCX will benefit the health insurance sector. It is designed to drive efficiency, boost customer satisfaction, streamline data management and analytics, ensure regulatory compliance, minimise discrepancies, and facilitate scalability within the industry.”
“Star Health Insurance has fully integrated its systems with the NHCX. In tandem with the GI council, we are actively working towards onboarding all major hospitals onto the platform at the earliest. We believe that the NHCX will create a mutually beneficial scenario for customers, insurance companies, and hospitals alike,” Jain added.
Standardised Data Exchange
Dr. Bhabatosh Mishra, director of underwriting, products and claims, Niva Bupa Health Insurance, said that the platform will enable auto-adjudication of claims through the introduction of standard forms and standard information. It would be able to provide aggregated information for analysis of health and cost trends.
Mishra added that by providing convenience to hospitals and making it easier for them to manage different patient data, the platform will do away with the hospital’s need of having to log into multiple insurers and TPAs’ portals for addressing different patients’ claims.
Further, insurers will be able to auto-adjudicate claims easily as all hospitals will upload data in a standard format. This standardised data exchange protocol will be able to integrate with the health management information system and pull out relevant details to process claims.
Smoothening Process For Customer
Mishra highlighted that currently, many customers have multiple policies and if at the time of claim, the claim amount exceeds the limit of one policy, they have to manually approach their other insurer for reimbursement.
“With the health claim exchange, information related to all the policies held by the customer would be available and an automated claim request for the balance could be raised with the other insurer as well, thereby smoothening the process for the customer. This common portal will also make it easier to onboard newer hospitals on the insurer’s network,” Mishra said.
Seamless Process By Hospitals
Manish Dodeja, head-claims & underwriting, Care Health Insurance highlighted that currently hospitals either use portals of insurance companies or send cashless requests by email. This increases the processing time of them having to repeatedly move between each company’s portals as well as sending and tracking each case on different portals and emails.
“A centralised NHCX solution allows hospitals to raise cashless requests on a single platform and be able to track the case in real-time. It will help improve turnaround times and benefit the customer during admission and discharge,” Dodeja added.
The NHA and the Irdai last year joined hands to operationalise the NHCX.
The NHA and Irdai have been holding meetings and organising workshops with hospitals and insurance companies for full integration of 40-45 health insurance companies with NHCX.
