Govt to Launch NHCX within 2-3 Months to Streamline Health Insurance Processing

The NHA and IRDAI developed the NHCX to ensure interoperability and expedite the processing of health insurance claims.

The government is poised to launch the National Health Claim Exchange (NHCX) within the next two to three months, creating a single portal for the submission and processing of health insurance claims across hospitals nationwide, according to sources familiar with the matter.

Last year, the National Health Authority (NHA) and the Insurance Regulatory and Development Authority of India (IRDAI) joined forces to operationalize the NHCX.

In June 2023, IRDAI issued a circular advising all insurers and providers to onboard the NHCX.

The NHA and IRDAI developed the NHCX to ensure interoperability and expedite the processing of health insurance claims. This initiative is part of the broader Ayushman Bharat Digital Mission (ABDM).

To date, close to 50 insurance companies, around 250 major private hospitals, and other stakeholders have participated in workshops and meetings jointly conducted by NHA and IRDAI to ensure full integration of health insurance companies with the NHCX.

This initiative promises shorter wait times, quicker pre-authorization and discharge approvals from insurance companies, and potentially lower premium costs for consumers.

Platform Readiness & Launch Timeline

"The portal is ready and is likely to be launched in the next two to three months," said a senior central government official, requesting anonymity.

The NHCX will serve as a gateway for exchanging claims-related information among various stakeholders in the healthcare and health insurance ecosystem.

This integration is expected to enhance efficiency and transparency in the insurance industry, benefiting both policyholders and patients.

Several insurance companies, including Aditya Birla Health Insurance, Star Health and Allied Insurance, Bajaj Allianz Insurance Company, HDFC Ergo Insurance, ICICI Lombard General Insurance, The New India Assurance Company, Tata AIG General Insurance Company, Paramount TPA, and United India Insurance Company, have already completed NHCX integration on a pilot basis.

Current Challenges

The health insurance landscape is currently fragmented, with each insurance company operating its own portal. This fragmentation creates a cumbersome and time-consuming process for hospitals, patients, and other stakeholders involved in processing health insurance claims.

Presently, the process of exchanging claims lacks standardization, with most data exchanges occurring through PDF or manual methods. This lack of standardization results in varying processes among insurers, TPAs, and providers, leading to high costs for processing each claim.

For hospitals, the NHCX will mean a single-payer network, universal claims format, faster payments, improved patient experience, better visibility of claim statuses, and paperless operations.

For insurance companies, the move is expected to reduce overhead operational costs, enable new processes or rules for auto-adjudication, enhance fraud control and abuse prevention, reduce claim processing costs per claim, and improve the quality of data for the industry and regulators.

Despite these benefits, the NHCX is not a regulatory framework.

 "The nature of having this portal is not regulatory; rather, the government is working as a facilitator to make life easier for consumers and other stakeholders," said another senior official requesting anonymity.

The onboarding of hospitals and insurance providers will be a purely voluntary process.

By bringing various stakeholders together on a single platform, the NHCX aims to reduce inefficiencies, lower costs, and improve the overall experience for healthcare providers and patients.