By Shalini Bhardwaj
New Delhi: The Union Health Ministry is setting up a National Health Claim Exchange (NHCX) platform to simplify the process of filing health insurance claims.
The National Health Exchange platform will work as a communication between the payer and the service provider.
“This platform is developed by the National Health Authority (NHA) to ensure faster processing of insurance claims and interoperability,” said official sources on Wednesday.
The Insurance Regulatory and Development Authority (IRDAI) also advised all insurers and service providers to onboard the NHCX. The portal is expected to be launched soon within two to three months.
“The National Health Claim Exchange portal is almost ready and likely to be launched in the next two to three months. This portal has been developed as part of Ayushman Bharat Digital Mission (ABDM),” said official sources.
The portal NHCX will be a single platform that will serve as a gateway for exchanging claims-related information between the payer and service providers.
“The NHCX would enable seamless interoperability of health claims processing, enhancing efficiency and transparency in the insurance industry and benefiting the policyholders and patients,” the source said further.
Approx. 40-45 health insurance companies and 200-250 hospitals all over the country will integrate with NHCX.
There are companies like Tata AIG General Insurance Company, Paramount TPA, Bajaj Allianz Insurance Company etc. have completed their integration with NHCX.
Currently, the health insurance claims settlement process in the country is mostly manual and time-consuming.
“Hospitals have different claim portals and on each portal, beneficiaries ask different questions that make it more complicated, but this is going to be a single portal. The claim processing will be fastened,” sources added.
The National Health Claims Exchange (NHCX) is a recommendation of the Joint Working Group of the Insurance Regulatory and Development Authority (IRDAI) and the National Health Authority (NHA).
NHCX aims at standardization and interoperability of health claims, and seamless exchange of data, documents and images between a payer (insurance company/TPA/Govt scheme administrator) and Provider (hospital/lab/polyclinic).
It also focuses on the data exchange with FHIR-compliant, e-claims format through a single gateway using standard protocols (APIs), enabling transparent and efficient claims processing, and reducing operational costs related to claims processing.
