NEW DELHI: Soon, all health insurance claims will be processed by hospitals and insurance companies through a single window – the National Health Claims Exchange (NHCX). Health ministry sources told TOI the NHCX, developed by the National Health Authority (NHA), is ready and under trial at present. “NHCX will have a standardised format to be followed by insurance companies to process claims,” said a source.
Currently, most insurance companies offering health coverage have their own platforms and processes to approve claims.
Patients who visit a hospital for treatment provide their insurance policy details or a card issued by the third-party administrator (TPA) or insurance company. The hospital then accesses the claim processing portal of the company and uploads the required documents for pre-authorisation or claim approval. On receipt of the pre-authorisation/claim form, the insurance company/TPA authenticates and digitises the form using its internal claims processing portal. The claim is then adjudicated by the relevant team. These data exchanges often involve PDF/manual paperwork which adds to the processing time and increases the risk of errors.
Officials in the health ministry said NHCX is the result of a collaborative effort between the NHA, the apex body responsible for implementing the Ayushman Bharat PM Jan Aarogya Yojana, and the Insurance Regulatory and Development Authority (IRDAI). “IRDAI will continue to regulate the insurance industry. We are not going to get into that. The health ministry’s motive behind developing NHCX is only to act as a facilitator for faster and more transparent processing of health insurance claims,” said a senior official.
He added that at present, because the process is so complicated, patients are often forced to wait for long hours to get approval. There have also been complaints about denial of claim on allegedly unjust grounds, said an official.
He also said records generated on NHCX may be used in future to devise systems to be added to the platform to reduce such instances.
Ayushman Bharat Digital Mission is a key health initiative by govt which aims to provide digital health IDs (ABHA ID) for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required. Health ministry sources said NHCX will extensively use ABHA IDs to access patient information for clearing insurance claims.
Currently, most insurance companies offering health coverage have their own platforms and processes to approve claims.
Patients who visit a hospital for treatment provide their insurance policy details or a card issued by the third-party administrator (TPA) or insurance company. The hospital then accesses the claim processing portal of the company and uploads the required documents for pre-authorisation or claim approval. On receipt of the pre-authorisation/claim form, the insurance company/TPA authenticates and digitises the form using its internal claims processing portal. The claim is then adjudicated by the relevant team. These data exchanges often involve PDF/manual paperwork which adds to the processing time and increases the risk of errors.
Officials in the health ministry said NHCX is the result of a collaborative effort between the NHA, the apex body responsible for implementing the Ayushman Bharat PM Jan Aarogya Yojana, and the Insurance Regulatory and Development Authority (IRDAI). “IRDAI will continue to regulate the insurance industry. We are not going to get into that. The health ministry’s motive behind developing NHCX is only to act as a facilitator for faster and more transparent processing of health insurance claims,” said a senior official.
He added that at present, because the process is so complicated, patients are often forced to wait for long hours to get approval. There have also been complaints about denial of claim on allegedly unjust grounds, said an official.
He also said records generated on NHCX may be used in future to devise systems to be added to the platform to reduce such instances.
Ayushman Bharat Digital Mission is a key health initiative by govt which aims to provide digital health IDs (ABHA ID) for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required. Health ministry sources said NHCX will extensively use ABHA IDs to access patient information for clearing insurance claims.
