What Is National Health Claim Exchange? How It Will Provide Faster Claim Processing – News18

The National Health Claim Exchange (NHCX) has been developed by the Insurance Regulatory and Development Authority of India (IRDAI) and the health ministry that aims to provide easy access and affordable health to patients. The NHCX digital platform will bring together health insurance companies, healthcare sector service providers and government insurance scheme administrators.

“The National Health Claim Exchange is going to be a game-changer. The IRDAI (Insurance Regulatory and Development Authority of India) has been collaborating with us. This product is completely ready and we should be able to launch it in 15-20 days,” National Health Authority’s chief executive officer Deepti Gaur Mukherjee had said at the Global Conference of Actuaries in Mumbai on February 14.

The portal is almost ready and is likely to be launched in the next two to three months, according to news agency ANI quoting official sources.

How Will NHCX Work?

At present, the health insurance claims settlement process in the country is mostly manual and time-consuming.

The NHCX as part of Ayushman Bharat Digital Mission aims to facilitate faster claim processing for policyholders and reduction in costs for insurance companies. It is meant to serve as a tech-enabled platform for exchanging claims-related information among insurance companies, claimants or beneficiaries and regulators.

“The insurance industry is poised to support the implementation of this system by facilitating streamlined interactions between hospitals and insurers, establishing a seamless, paperless, and secure contractual framework. Acting as a centralised hub for all health claims, the NHCX will significantly alleviate the administrative burden on hospitals,” said S Prakash, MD & CEO designate, Galaxy Health and Allied Insurance Company Limited, as quoted by The Hindu.

The IRDAI’s objective is to achieve ‘Insurance for All by 2047’.

For cashless claims, the processing time will be up to three hours from the receipt of discharge authorisation from the hospital. The IRDAI has set the insurance provider a deadline of July 31 to put systems and processes in place to ensure the smooth facilitation of the directive.

More than 30 insurance companies are already on board the NHCX platform while effort and awareness drives are going on to bring in the hospitals.

The National Health Authority had announced financial incentives under the Digital Health Incentive Scheme (DHIS) from January 2023 to encourage adoption of digital health transactions and digitisation of patient health records in the country. Under the DHIS, for every insurance claim transaction through NHCX, financial incentives of Rs 500 per claim or 10% of the claim amount, whichever is lower, would be given to hospitals, according to the health ministry.

What are the Incentives?

According to the health ministry, the NHCX will help in standardisation and interoperability of health claims and will bring in seamless exchange of data, documents and images between payer (insurance company/TPA/government scheme administrator) and provider (hospital/lab/poly clinic). Additionally, it will enable transparent and efficient claims processing and reduce related operational costs.

Industry experts also agree that the platform through centralised data could bring in a more standardised approach to healthcare pricing.

What are the Challenges?

There is a need to bridge the gap between the hospitals and insurance companies through digitization by necessitating upgrades to current IT systems and enhanced workforce training.

Health insurance contributes to about 29% of the total general insurance premium income in India.

Also, general and health insurance companies should use Ayushman Bharat-PMJAY (Pradhan Mantri Jan Aarogya Yojana) data available and practices it has developed to devise products for a section of population not covered by the scheme.