To revolutionise claim settlement in the health insurance sector, the Union Health Ministry plans to launch the National Health Claim Exchange (NHCX) Portal within the next two to three months. NCHX portal is a digital platform, developed under the aegis of the National Health Authority (NHA), to simplify the process of filing health insurance claims, ensure faster processing, and improve interoperability between stakeholders, official sources told PTI on May 22, 2024.
Current System
Currently, insurance companies have separate portals, where health insurance claims are processed. Differences in the processes have made the claim settlement process cumbersome and time-consuming for both hospitals and patients.
The lack of standardisation across the insurance ecosystem when it comes to exchanging claims data and overreliance on manual or PDF data exchange methods makes the process time-consuming and costly. The processes differ across insurers, TPAs, and providers, leading to high processing costs and more inefficiencies, according to a PTI report.
NHA and the Insurance Regulatory and Development Authority of India (IRDAI) have been working together to launch the NHCX digital platform for over a year and IRDAI has issued a circular in June 2023 to insurers to join NHCX.
New System
As hospitals have different claim portals, and beneficiaries are asked different questions, NHCX with a single portal will streamline claim processing.
It will be a single-window interface for health insurance companies, hospitals, and insurance policyholders, leading to faster claim settlements. NHCX will work like a gateway for exchanging claims-related information between various stakeholders. It will use FHIR-compliant e-claim formats through a single gateway using standard APIs, leading to transparency, efficiency, and reduced operational costs.
The NHCX is launched as part of the Ayushman Bharat Digital Mission (ABDM), which aims to connect different digital health solutions spread across hospitals in the country. ABDM has several verticals including digitalizing all hospital processes, creating technology for digital consultations etc. Further, ABDM or National Digital Health Mission aims to digitalise medical records by creating Ayushman Bharat Health Accounts (ABHA) for patients. Ayushman Bharat Health Accounts (ABHA) accounts in India have touched 62.12 crore as of May 24, 2024.
NCHX is believed to be accessible across India from the launch date, and sources said it will initially provide a connection between stakeholders of already-linked 50 insurance companies and 250 hospitals, with more hospitals and insurers to join in future.
Many major players such as Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance, HDFC Ergo Insurance, ICICI Lombard General Insurance, The New India Assurance Company, Tata AIG General Insurance, and United India Insurance, have already finished integration with NHCX.
After IRDAI mandated that all insurance policies should be issued in electronic form from April 1, leading to insurance plans of one individual consolidated in his e-Insurance Account (eIA), NHCX is the next major reform in the insurance industry. IRDAI has earlier approved 'Bima Sugam' another revolution in the insurance sector to provide an online marketplace for insurance, to help policyholders compare premiums and features of all categories of insurance products. buy insurance products including life, health, motor and travel insurance.
