The National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) are jointly operationalising the National Health Claim Exchange (NHCX), a digital platform aimed at streamlining health insurance claims.
These collaborative efforts represent a significant leap in digitalising health insurance processes, ensuring efficiency and transparency. Recent successes in workshops and integrations underscore the industry’s commitment to this transformative initiative.
Recognising the benefits, IRDAI previously advised all insurers and providers to adopt NHCX. The platform serves as a central gateway, facilitating the seamless exchange of information related to insurance claims among various stakeholders within the healthcare ecosystem, benefiting both policyholders and patients.
Benefits of NHCX
Here are the key benefits from this ground-breaking initiative:
- Digital Platform for Efficient Claims Processing: NHCX as a digital platform is designed to revolutionise the cumbersome process of health insurance claims, promising increased efficiency.
- Gateway for Seamless Information Exchange: NHCX is expected to acts as a gateway for sharing information about insurance claims among various entities in the healthcare sector, enhancing transparency and smoothing the claims process for policyholders and patients.
- Anticipated Reduction in Processing Time and Costs: NHCX aims to significantly reduce claims processing time from days to minutes, with an expected decrease in processing costs in hundreds to mere tens per claim.
- Fraud Prevention: NHCX to introduce a unique identification system, assigning IDs to patients, treating teams, and healthcare facilities, to prevent fraudulent claims and ensure transparency.
- May Facilitate OPD Coverage: Reduction in processing costs could make outpatient department (OPD) insurance viable, potentially leading to a rise in overall insurance penetration in the country.
- Single Gateway for Claims Processing: NHCX proposes a single gateway for hospitals to send claims directly to insurance companies, simplifying the entire claims processing workflow.
Key Developments
Workshop Success and Integrations
- A recent three-day workshop held in New Delhi from November 7th to 9th facilitated the onboarding of hospitals onto NHCX and aided insurance companies in complete integration.
- Over 150 professionals from 45 organisations participated, resulting in the successful addition of 10 hospitals to the NHCX provider registry.
- Eight insurance companies and Third-Party Administrators (TPAs) completed their integration with NHCX, bringing the total count to 12.
Incentivising Digital Transactions:
- To incentivise the transition toward digital health transactions, the NHA has introduced the Digital Health Incentive Scheme (DHIS) starting January 2023.
- Hospitals can receive financial incentives of Rs 500 per claim or 10% of the claim amount (whichever is lower) for every insurance claim transaction through NHCX.
Anticipated Full-Scale Launch:
- The collaborative efforts between NHA and IRDAI have generated considerable enthusiasm, and a full-scale launch of NHCX is anticipated in the near future.
For more information on the National Health Claims Exchange (NHCX), interested parties can visit https://sbxhcx.abdm.gov.in/.
