National Health Claims Exchange (NHCX)
  • What Is NHCX?
  • Latest Health Insurance Development
  • Aim of NHCX
National Health Claims Exchange (NHCX)
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National Health Claims Exchange: The Latest Buzz

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

Deepti Gaur Mukherjee

(CEO, National Health Authority)

A delay of 10 to 12 hours in discharge despite being cleared by your doctors can be infuriating. Especially if your health insurer cannot settle your bills with the hospital! Similarly, there are multiple challenges faced by policyholders across the country during claim settlement.

According to a survey published by LocalSurvey in The Economic Times ‘43% of insurance holders face difficulties with claim settlement’. Furthermore, the survey revealed insurance companies reject claims by citing health conditions as pre-existing diseases(PEDs) or only provide partial claims.

Identifying these challenges, the National Health Claims Exchange (NHCX) was proposed as a joint recommendation of the Insurance Regulatory and Development Authority (IRDAI) and the National Health Authority (NHA). NHCX stands for National Health Claims Exchange, a platform designed by IRDAI and NHA (National Health Authority) that aims to facilitate a streamlined and transparent claim settlement process among insurance holders, healthcare providers, and insurance providers.

Let us further understand the aim and benefits of the National Health Claims Exchange.

Objective Of National Health Claims Exchange (NHCX)

The National Health Claims Exchange is a digital provider focusing on bringing together insurance providers, healthcare service providers, and government health insurance administrators under one roof.

The aim is to simplify health insurance claims for policyholders by:

  • Standardization & increased operational processes of health insurance claims.
  • Hassle-free exchange of data, documents, and others between the (TPA/Govt scheme administrator, etc.) and healthcare provider (hospital/lab, etc.)
  • Enabling transparent and quick claims processing.
  • Reduce the cost of operations related to claims settlement.

How Will It Make Your Life Easier?

Implementation of NHCX will simplify the claims process at multiple levels for:

Policyholders Healthcare Providers Insurance Providers
Waiting time will be reduced significantly A single-payer network Significant reduction in overhead operational costs
Quicker discharge and pre-authorization approvals A uniform claims format Will help control fraud and abuse towards both providers and policyholders
Reduced costs of health insurance premiums Enhanced experience in healthcare facilities for patients Reduced cost for claim processing with each new claim filed
Diverse claim settlements in the future including, OPD, pharmacy bills, etc. Transparency in the claim settlement process Better quality of data for industry and regulators

National Health Claims Exchange and Ayushman Bharat

The insurance industry is poised to support the implementation of this system by facilitating streamlined interactions between hospitals and insurers and establishing a seamless, paperless, and secure contractual framework. Acting as a centralized hub for all health claims, the NHCX will significantly alleviate the administrative burden on hospitals.

S Prakash

(MD & CEO designate, Galaxy Health Insurance and Allied Insurance Company Limited quoted by The Hindu)

It is interesting to note that National Health Claims Exchange is not a single entity. It is a part of the Ayushman Bharat Digital Mission. The initiative aims at enabling the quickest claim settlements for policyholders along with reducing costs for insurance companies.

NHCX is a tech-enabled platform designed to exchange claims-related information among insurance companies, beneficiaries, and healthcare providers to enable smooth claims settlement.

National Health Claims Exchange: The Future of Health Insurance

As per the current developments, only the Ayushman Bharat Scheme is under the National Health Claims Exchange. However, the General Insurance Council (GIC) plans to roll it out for all health insurance schemes including central and state schemes.

According to TOI, the NHCX platform is set to start with Fortis, Apollo Kolkata, Belle Vue, B M Birla, and Shushrut to come under NHCX. The National Health Claims Exchange is streamlined with the IRDAI mission of ‘Insurance For All by 2047’. The NHCX will support a streamlined, paperless, and digital process for safe interactions between insurance providers, hospitals, and policyholders.

National Health Claims Exchange (NHCX): FAQ's

1. What is NHCX?

NHCX stands for National Health Claims Exchange, a one-stop application designed by IRDAI and NHA (National Health Authority) that aims to facilitate a streamlined and transparent claim settlement process among insurance holders, healthcare providers, and insurance providers.

2. Will the National Health Claims Exchange reduce claims settlement time?

The National Health Claims Exchange (NHCX) aims to facilitate a streamlined and transparent claim settlement process among all health insurance entities, which will significantly reduce claim settlement time for both the policyholders and insurance companies.

3. How does the National Claims Exchange (NHCX) benefit patients?

As patients, you will benefit from the NHCX through reduced treatment costs, a quicker discharge process, improved transparency, and faster claim settlement.

4. Can you file claims for government schemes with the help of the National Health Claims Exchange?

Yes, you will be able to file claims for both private health plans and government schemes.

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Simran Kaur Vij

Written By: Simran Kaur Vij

Simran is an insurance expert with more than 3 years of experience in the industry. She may have all the answers to your insurance queries. With a background in Banking, she proactively helps her readers to stay on par with all the latest Insurance industry developments.