The National Health Claim Exchange (NHCX), developed by the National Health Authority (NHA), aims to make the insurance claim settlement process more convenient for customers with faster resolution and other customer-centric upgrades. The platform began operating recently, with HDFC Ergo settling its first claim. In June 2023, the Insurance Regulatory and Development Authority of India (IRDAI) asked all insurers to join the exchange. As of November 14, 2023, 12 insurers had joined NHCX, and HDFC Ergo was the first one to do so.

What Is National Health Claim Exchange?

It is an integrated insurance platform for sharing of information for all stakeholders in the field, such as insurers, third party administrators (TPAs), hospitals, diagnostics labs, clinics, etc. NHA aims to standardize the settlement process via NHCX such as interoperability of health claims, exchange data, images, and documents between insurers, hospitals, labs, etc., exchange data with FHIR compliant e-claims, and make the process for transparent, efficient, and affordable.

How Can Stakeholders Benefit?

As NHCX aims to make information available in a single place, it will support interoperability and make data flow faster among stakeholders. In the present system, when a policyholder raises a health claim, it requires the submission of bills and insurance policy details, besides a lot of manual entries. According to IRDAI’s June 8, 2023, circular, “The current claim 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 system lacks standardisation across the ecosystem, with processes varying significantly amongst insurers, TPAs, and healthcare providers. It not only leads to delays but also results in high processing costs.”

With the NHCX platform, claim processing will be quicker and more efficient.

Also Read: Capital Gain Tax: Here’s How To Reduce Liability From Sale Of Property And Other Assets

• The platform will reduce beneficiaries’ waiting time by providing faster pre-authorisation and discharge approvals from insurance companies. It will also reduce the cost of insurance premiums, and pharmacy and OPD bills can be included for settlement through this platform, as per the NHA.
• For providers (hospitals, labs, pharmacies, clinics, etc), it will be useful as they will have a better patient experience. Their operational ease will increase with a paperless universal claims format, better claim visibility status, and a single-payer network instead of sending the claim to multiple insurers, so faster payments by insurers.
• The platform will help payers (insurance companies, TPAs, etc.) reduce operational costs per claim. Auto adjudication will help prevent fraud faster, and with paperless operations and better-quality data, it will improve overall efficiency.

This portal, developed under the Ayushman Bharat Digital Mission (ABDM), will radically change the healthcare ecosystem by making healthcare data like medical reports, health claim settlement forms, etc., available anytime for stakeholders. It will improve transparency, speed, and efficiency, benefiting the end user, policyholder and the patient.