NHCX, known as the National Health Claim Exchange, is a digital platform launched by the Ministry and the Insurance Regulatory Development Authority of India (Irdai). It aims to connect insurance companies, healthcare service providers, and government insurance scheme administrators. This platform will streamline the exchange of claims-related information among stakeholders in the healthcare and health insurance industry, including hospitals, TPAs, insurance companies, and intermediaries. At present, these stakeholders operate with different processes and standards for claims processing. The NHCX seeks to establish uniformity through a centralized portal and standardized data protocols.
“The purpose of NHCX is to ensure that information related to the customer’s health and insurance is easily shareable and comprehensible. This is significant because it translates to faster and more efficient health insurance claims experience for customers. NHCX will provide a robust digital infrastructure that will enable seamless claims processing, reduction in paperwork, interoperability, and data exchange which will lead to improved fraud detection and better transparency,” says Rupinderjit Singh, vice president - retail health, ACKO.
According to experts, the introduction of NHCX promises significant benefits for health insurance customers. At present, the claims process suffers from inefficiencies due to varied standards across different stakeholders. By integrating with NHCX, all stages of the claims process will be standardized. Experts claim this integration is expected to facilitate seamless interoperability in health claims processing, thereby improving efficiency and transparency in the insurance sector.
According to experts, Irdai’s emphasis on innovation, coupled with NHCX's streamlined processes, promises a variety of health insurance plans tailored to the customer’s specific needs. This offers them increased options, enabling them to select a plan that aligns with their requirements. Moreover, the digital transformations introduced by NHCX, in conjunction with efforts from NHA and IRDAI, will render more personalized health insurance experiences for customers. From claims processing to customized plans, technology will play a pivotal role in smoothing every aspect of their health insurance journey.
NHCX provides real-time updates on claim status. It reduces administrative tasks and, consequently, the overall cost per claim. Patients will benefit from lower costs due to these savings. When healthcare providers have access to comprehensive patient information, they can make more informed decisions and provide better care. The National Health Claims Exchange facilitates secure data sharing among authorized parties, enabling healthcare providers to view a patient's medical history, allergies, and other relevant information. This can improve diagnostic accuracy, personalized treatment plans, and overall better healthcare outcomes.
“This enhancement will directly benefit policyholders and patients, enabling them to access real-time information on eligibility checks, pre-authorization requests, claims approvals, and payment notifications. The implementation of this system is projected to drastically reduce processing times, potentially reducing a typical three--hour cashless approval process to just 15-20 minutes, thereby significantly boosting efficiency for hospitals and TPAs,” says Anuj Parekh, co-founder and CEO, Bharatsure, an insurtech company for group insurance distribution.
“Health insurance customers benefit directly from NHCX through faster cashless claims settlement, reduced processing time and documentation, and improved transparency. The platform allows them to access their medical records, check claim statuses, and communicate more effectively with healthcare providers and insurers,” adds Singh.
Things To Keep In Mind For The Policyholders: When considering NHCX, it is important to note that industry-wide integration efforts will be essential. “The exchange is scheduled to launch in the coming months, and initially, not all stakeholders may be fully integrated. However, as adoption increases gradually, this initiative is poised to alleviate major challenges in the health insurance journey, - the painful claims experience,” adds Parekh.
