A total of 33 prominent companies providing health insurance in India have become members of the NHCX, which stands for National Health Claims Exchange. This centralized platform was created by the government to facilitate the exchange of information related to insurance claims.
The NHCX will facilitate the exchange of claims-related information among the stakeholders in the healthcare and health insurance ecosystem. Integration with NHCX will enable a smooth procedure of health claims processing, leading to improved efficiency and transparency in the insurance industry, ultimately benefiting policyholders and patients (1✔ ✔Trusted Source
National Health Claims Exchange
) (2✔ ✔Trusted Source
National Health Authority (NHA) organises Accelerator Workshops on ABDM Integration and NHCX Adoption in association with IRDAI
).
Approximately 514 million people in India were covered by health insurance schemes in 2021, representing 37% of the population. However, about 400 million individuals in India still lack access to health insurance! #healthinsurance #insuranceclaims #medindia’
The NHCX platform is a digital platform created by the National Health Authority (NHA) and the Union Ministry of Health and Family Welfare as a component of the Ayushman Bharat Digital Mission, providing a single-window for health claims exchange (1✔ ✔Trusted Source
National Health Claims Exchange
).
Challenges in Old Vs. Advantages of New System
Until now, this transaction has been conducted through multiple platforms, leading to an increase in processing time. Government sources have stated that the use of NHCX will not only expedite the insurance claims process, but it will also enhance transparency as the Insurance Regulatory Development Authority of India (IRDAI), the country’s top insurance regulatory body, will have real-time access to the status of claims settlement.
“Citizens will also be able to see the status of their insurance claim through the mobile,” said a top official of the National Health Authority (NHA), which has developed the centralised platform. He said that some companies have already started processing claims via the NHCX on a trial basis and an official launch of the platform along with all features will be done soon.
HDFC Ergo, a prominent company in the health insurance sector, has reported to have approved its initial claim using NHCX.
It has been reported that the NHCX, as it stands now, has no plans to regulate the industry. However, information gathered from the online platform could potentially be utilized in the future to create additional systems in order to prevent unethical practices like denying a claim without valid reasons.
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How NHCX Will Benefit Policy Holders
Currently, individuals seeking medical care at a hospital are required to submit their insurance information or a card issued by the Third Party Administrator (TPA-issued card). Subsequently, the hospital gains access to the claim processing platforms of the respective insurers and submits necessary documentation for pre-authorization or claim approval. Upon receiving the pre-authorization/claim form, the insurance company/TPA verifies and digitizes the form through their internal claims processing system. The claims are then reviewed by the appropriate team for settlement.
“Often, patients keep waiting throughout the day for this process to be completed leading to delay in discharge from hospital and additional room rent charges. With NHCX, they can monitor the progress of claim settlement. It is a major relief,” said a senior doctor.
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References:
- National Health Claims Exchange – (https://sbxhcx.abdm.gov.in/)
- National Health Authority (NHA) organises Accelerator Workshops on ABDM Integration and NHCX Adoption in association with IRDAI – (https://pib.gov.in/PressReleasePage.aspx?PRID=1976957)
Source-Medindia
