National Health Claims Exchange: The Latest Buzz
The National Health Claims 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, policyholders across the country face multiple challenges 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 that 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 is a platform designed by IRDAI and NHA that aims to facilitate a streamlined and transparent claim settlement process among policyholders, healthcare providers, and insurance providers.
Let us further understand the objectives and benefits of the National Health Claims Exchange.
Objective of National Health Claims Exchange (NHCX)
The National Health Claims Exchange is a digital platform focused 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 and increased operational efficiency of health insurance claims.
- Hassle-free exchange of data, documents, and other information between TPAs/government scheme administrators and healthcare providers (hospitals/labs, etc.).
- Enabling transparent and quick claims processing.
- Reduced cost of operations related to claims settlement.
How Will It Make Your Life Easier?
The 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 targeting 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 the 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 the 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 while also 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 claim settlement.
National Health Claims Exchange: The Future of Health Insurance
As per current developments, only the Ayushman Bharat Scheme is currently 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 begin with Fortis, Apollo Kolkata, Belle Vue, B.M. Birla, and Shushrut hospitals coming 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.
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