The National Health Authority and the Insurance Regularity and Development Authority’s (IRDAI) National Health Claim Exchange could be operational in the next 2-3 months, PTI reported on Wednesday, citing a senior official. When the exchange starts working, it is expected to ease the insurance settlement process as all insurers will be onboard a single platform.

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Currently, policyholders and other stakeholders, such as hospitals and third-party administrators (TPAs), have to visit the insurer’s respective web portals to make an insurance claim, which is time-consuming and cumbersome.

Need for an Insurance Claim Exchange

According to IRDAI’s June 8, 2023, circular, “The current health insurance claims settlement process is mostly manual, non-digital and as such, there is no proper data flow/administration, resulting in delays in claim processing. Further, the current system lacks standardisation across the ecosystem, with processes varying significantly amongst Insurers, TPAs, and healthcare providers. This not only leads to delays but also results in high processing costs.”

The exchange aims at providing claim-related information on a single platform. It will support interoperability in claim processing and facilitate the exchange of information among insurance companies, TPAs, policyholders, wellness providers, and other stakeholders.

In the current system, claim processing involves manual entries, and the data is exchanged among the stakeholders through PDF files. However, after the exchange’s launch, all stakeholders can access the data under one platform.

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The platform brings all insurers and stakeholders together on a single platform, enabling them to process claims quickly and effortlessly, as all can access and share the claim information. Many insurance companies, such as Aditya Birla Health Insurance, Bajaj Allianz Insurance Company, HDFC Ergo Insurance, Star Health and Allied Insurance, ICICI Lombard General Insurance, and Tata AIG General Insurance Company, are already onboard the platform.

The health claim portal, developed under the Ayushman Bharat Digital Mission (ABDM), will not allow claim interoperability but also help exchange data, like medical reports, claim forms, images, etc., among stakeholders, making the process faster and cost-efficient, ANI added.